The Future of contraception

Happy without children

Elizabeth Ponomareva, XX2 century

Of all the available types of conception prevention known to people today, perhaps only one can be called pleasant and satisfactory – this is the way when contraception is not done by you. And since, as a result, about half of the people who have sex without the purpose of procreation are not too happy with the side effects, this area is undoubtedly still waiting for discoveries and innovations.

Unfortunately, a number of factors are slowing down progress in this area. The development of contraceptives is expensive and risky. Some ideas originated decades ago, but have not yet entered the market, for example, for ethical reasons. For example, it is quite difficult to develop irreversible contraceptives in Brazil, where the Catholic Church actively opposes such innovations. At the same time, the public, especially in developed countries, wants the new products to be both "natural", safe and almost 100% effective. So it is not surprising that the enthusiasm of organizations that could sponsor research is low.

According to the UN, the majority (64% in 2015) of women of reproductive age who are married or in a civil union are protected in one way or another.

The UN divides the existing methods of contraception into modern and traditional. The first organization includes: male and female sterilization, oral contraceptives, intrauterine devices (IUDs), female and male condoms, injections, implants, vaginal barrier method and postcoital contraception. Traditional methods of contraception are: temporary abstinence, interrupted sexual intercourse, lactation amenorrhea, douching and various folk methods.

Contraceptive pills of the "classic type" have been used since the early 1960s, are intended for women and involve daily intake. They include estrogen and progesterone (or their synthetic analogues). These hormones prevent ovulation and increase the release of cervical mucus, which fills the cervical canal and partially prevents the penetration of sperm into the uterus. Among the possible side effects of contraceptives of this kind is the risk of developing blood clots in patients prone to this.

Most of those who protect themselves use modern methods of protection (90%). The most common methods of contraception in the world are female sterilization and IUD, in 2015, 19% and 14% of women resorted to them, respectively. Short-term methods are less common: 9% of women chose pills, 8% relied on male condoms, and 5% used injections.

The choice of methods of protection varies greatly from country to country. Thus, short-term and reversible methods such as pills, injections and condoms are more popular in Africa and Europe, while long-term or irreversible methods such as sterilization, implants and IUDs are more common in Asia and North America.

According to UN estimates, in the future, the proportion of those who protect themselves will only grow, especially in Oceania and Central Africa. At the same time, the choice of women will gradually shift in favor of long-term or irreversible methods.

As for the creation of new methods of contraception, the following trends are noticeable here.

Firstly, we are expecting an expansion of protection formats, starting with a switch sewn into the scrotum, ending with a spray that you will need to spray on your hand, plus various creams, plasters, gels, various implants and so on. Now, for example, biodegradable implants are being developed that do not need to be surgically removed.

Secondly, there should be more options for protection that men can use. It is assumed that one of the incentives to give men more personal control in this matter was the trials of celebrities who suddenly turned out to be fathers for themselves, despite condoms or other protective measures. Another is the gradual equalization of the balance of family responsibility between men and women. If men take on more responsibilities for the upbringing of children, it is reasonable that they want to have more control over the process of their conception.

Thirdly, of course, researchers and manufacturers will try to improve the performance of existing tools. Thus, in relation to female oral contraceptives, it is assumed to reduce the doses of estrogen and improve the quality of progesterone. Or you can hope to replace estrogen and progesterone with selective hormone modulators that will only affect specific glands and will not cause side effects such as thrombosis. Moreover, there may be drugs that will not only protect against conception, but also – at the same time – protect against diseases (STDs, breast cancer) and even improve health. For example, research is underway on 7α-methyl-nandrolone to create male oral contraceptives that are likely to have a beneficial effect on men's health.

No later than in 2018, two interesting developments await us.

Vasalgel

Non-profit organization The Parsemus Foundation is developing a safe and, importantly, reversible vasectomy replacement. During the operation (under local anesthesia, half an hour), a polymer called Vasalgel is injected into the vas deferens. The polymer is a viscous semi-permeable gel that simply clogs the duct and does not pass spermatozoa through it, making conception impossible. If a man wants to become fertile again, it is enough to wash the ducts with dimethyl sulfoxide or sodium bicarbonate. So far, Vasalgel has been tested only on rabbits and baboons. In the fall, the company struggled to get the desired density from the polymer, and there is a possibility that in 2017 they will already call for volunteers for testing.

I must say that the idea is not new at all. It is based on a procedure that has been tested on 250 volunteers in India for 10 years. During this time, only 1 unplanned pregnancy occurred. The RISUG (Reversible Sperm Containment under Guidance) procedure was developed at the Indian Institute of Technology in Kharagpur by Dr. Sujoy K. Gua.

The method has many advantages: it is durable (up to 10 years), relatively inexpensive (it will definitely pay off more than once in 10 years) and, apparently, is quite safe. However, Professor Gua has been fighting for the introduction of his invention for 37 years. We hope that the Americans will be more lucky.

The principle of operation of the Vasalgel male contraceptive.

SLV Switch

Another interesting replacement for vasectomy is being developed in Germany. The patient also has surgery on the vas deferens, but in this case valves are implanted in them. Tiny SLV switches made of anti-allergenic (and even vegan) material are attached to the valves. If you want to reproduce, you turn it on, if you want to keep your genes to yourself, you turn it off. The buttons are felt through the scrotum. There is even foolproof protection: you can turn on the switch only by pressing two buttons on it at the same time. So far, the only man who uses this device (since 2009) is its inventor, Clemens Bimek, and he's doing great.

In fact, of course, not everything is so simple. Flipping switches in the scrotum every day is a bad idea. After the canal is closed, the seed remains in it, and it will take another three months (or 30 ejaculations), as well as a visit to the doctor to make sure that conception will no longer take place. In addition, there are suspicions that the valves may damage the ducts. Finally, the idea of such a body modification can be frightening for a number of consumers.

Be that as it may, Bimek plans to enter the market in 2018, and now you can sign up for volunteers on their website.

In the slightly more distant future (let's take 10 years), we can hope for the emergence of a new generation of oral contraceptives.

Anti - gestagens

One of the promising areas of development is associated with the use of progesterone antagonists (the hormone responsible for conception and pregnancy). A number of such substances have already been discovered, and among them is mifepristone, synthesized in 1982, which in some countries is used for medical abortions.

Mifepristone can interrupt not only pregnancy, but also the ovulation process. However, due to its abortifacient properties, research and market entry are complicated by ethical considerations. But it has an undeniable advantage – it can be useful to women who are contraindicated estrogen, the usual component of oral contraceptives (this happens, for example, with high blood pressure or overweight).

One of the options for using mifepristone in the future is to create a pill that will need to be taken only once a month, during the luteinization phase (the period of maturation of the corpus luteum in the ovary). A pilot study in Sweden showed that out of 21 women who took the drug, only one became pregnant during 152 cycles. Of course, it would be more convenient not to bother with pills every day, but the main problem is immediately obvious – how to calculate the right day. By the way, there are already mobile applications that determine the various stages of the menstrual cycle, but they require users to measure their basal temperature daily. However, who knows, perhaps with the development of wearable fitness devices, there will also be some bracelets that will be able to tell a woman when her period starts.

Another option for taking mifepristone is to use it in case of delayed menstruation. Again, a woman will need to closely monitor her cycle, and within 10 days from the date of the expected start of menstruation, she will be able to take a pill and cause menstruation. Since in the case of pregnancy, the result will be an early abortion, ethical questions arise here again. And again there is a problem with the timing, because the cycle of some women fluctuates.

Men's Pill

The idea of hormonal contraception for men arose at the same time when female hormonal contraception arose, that is, more than 50 years ago. But it develops slowly. In particular, due to the various side effects detected from time to time. So in October of this year, another promising experiment was interrupted. During the experiment, 320 men were injected with a new hormonal drug. The composition of the drug includes a special group of progesterones that block sperm production, and testosterone.

The tests lasted a year and were 96% effective. But the participants experienced side effects such as depression, mood swings, muscle pain, acne and increased libido.

It is interesting here that the use of female hormonal contraceptives is also known to cause a variety of side effects, about the same plan. Nevertheless, this did not stop either scientists, the state, or the women themselves. The question arises – are women too submissive or are men not strong enough in spirit? Another issue that will undoubtedly arise is the issue of trust. Will women trust contraception to their partners and believe that they will not miss the day of reception and will not keep silent about their mistake?

Anyway, 75% of the volunteers said that they are satisfied with the contraceptive and would like to continue using it after the drug is available. What is encouraging is that the development of male contraceptives is supported by a number of serious organizations, starting with WHO and ending with the Melissa and Bill Gates Foundation.

Contraceptive vaccines

Another interesting direction is vaccination against conception, no matter how strange it may sound. This technique is already being applied to mammalian animals to control their populations. The essence of the procedure is to apply a vaccine that causes an immune response that makes the animal temporarily infertile. The substances contained in the vaccine, one way or another, interrupt the process of production, functioning or development of gametes.

The advantages of the method, of course, are that there is no need for surgery, it does not depend on the goodwill of the partner, does not require daily repetition and does not relate to hormonal methods. In addition, this method is suitable, in principle, for everyone who has germ cells at all.

But it also has its drawbacks, because of which implementation is still far away. For example, experiments on mice have shown that the effectiveness depends very much on the immunity of the animal. In addition, we do not yet know very well how the immunity of the mucous membranes works, which means that the results are partly unpredictable. Finally, vaccines have their side effects. For example, one of the experiments on monkeys showed that there is a risk of ovarian inflammation, as well as premature menopause.

There are other developments under intricate names like "Clean sheets pill" (Clean sheets pill, also known as "Dry Orgasm Pill", Dry orgasm pill; for men) or, for example, "Career pill" (Career pill; for women) or without such names (in the case when the information is not it reached the yellow press), and let's hope that they will not stop.

Portal "Eternal youth" http://vechnayamolodost.ru  13.01.2017