A View from Elaine Lissner
Will We Ever Get a Better Male Contraceptive?
Many forces have slowed the development of better contraceptives for men.
It seems as if every few months the press heralds a scientific breakthrough that could lead to a new male contraceptive—in five to 10 years. But then the years go by and the promised contraceptive never appears. Why? What’s the holdup?
Maybe one problem is that people have been using the wrong tool for the job. Chemists in the 1950s changed society forever when they figured out how to shut off female ovulation with synthetic hormones. So you’d think we’d just have to repeat the trick with men, right?
Not quite. Many a researcher has lamented that it’s harder to stop millions of sperm than it is to stop one egg—a complaint that sounds intuitively logical. But it goes beyond that. Men are not women, and men’s anatomy is not women’s anatomy. So it doesn’t make sense to use the same tools—hormones—that we used for women.
In men, all the sperm swim through one tiny tube, the vas deferens. So rather than shut them off at the source, we should disrupt their transit.
Some of the most intriguing methods in this direction make use of muscular action to clamp down on the vas deferens. My own group is working on something called Vasalgel, a polymer gel that blocks or filters out sperm in the vas deferens tube. A plant-derived compound in advanced trials in Indonesia interferes with sperm’s ability to penetrate the egg. These are the elegant approaches we need to be advancing, not hammering the entire body with hormones.
So why haven’t we yet finished the job?
For starters, clinical trials are a multimillion-dollar process. If you’re a researcher developing one of these methods, where do you turn? Big pharma is not interested—the liability in treating healthy young people for years is high, and if you’re already the company selling contraceptives to those men’s partners, the payoff is low. Nonprofits try to do the development work but are hampered by shoestring budgets and a lack of business savvy. Major foundations such as the Bill & Melinda Gates Foundation are stepping up to fill the gap for female contraceptive development but have determined that men in their target areas—ultra-poor regions such as Bihar, India, and sub-Saharan Africa—are not ready for male contraception.
Maybe the best option is something called social venture enterprise—turning to social investors who would like to get their money back if it goes well but who are also committed to seeing an affordable product reach the market.
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We have a waiting list of more than 38,000 men and women hoping for news of clinical trials for Vasalgel. There’s clearly a market for a male contraceptive. Now we just have to get them one.
Elaine Lissner is the founder of Parsemus Foundation, which aims to advance low-cost evidence-based medicines.