Male contraceptive pill

In the past 50 years, there have been few changes in male contraception compared to the range of options available to women.

There are only three types of contraception currently available for men. They are:

• withdrawal - where the penis is removed from the vagina before ejaculation of semen
• condoms - a barrier form of contraception that stops sperm reaching and fertilising an egg
• vasectomy - a minor surgical procedure that stops sperm being ejaculated from the penis during sex (it is usually permanent) 

Ongoing research

There are many ongoing research projects into different methods of male contraception.

Researchers are optimistic that a safe, effective and reversible method of male contraception will eventually become a reality, although this is still several years away. 

Types of research

There are two main areas of research into male contraception:

• hormonal contraception - where synthetic (man-made) hormones are used to temporarily stop the development of healthy sperm
• non-hormonal methods - where other techniques are used to prevent healthy sperm from entering a woman’s vagina

These are explained further below.

Hormonal contraception

In fertile men, new sperm cells are constantly created in the testicles. This process is triggered by the hormone testosterone.

The goal of hormonal contraception research is to find a way of temporarily blocking the effects of testosterone so testicles stop producing healthy sperm cells. However, this needs to be achieved without lowering testosterone levels to such an extent that it triggers side effects, such as a loss of sexual desire.

Synthetic testosterone and other steroid combinations

One way of doing this is by giving men a synthetic version of testosterone, together with a hormone called progestogen. Progestogens are synthetic versions of a female sex hormone often found in female hormonal contraceptives, such as the progestogen-only pill.

This approach stops the testes producing testosterone which, in most cases, prevents normal sperm production. However, at the same time it keeps the amount of testosterone in the blood normal, preventing side effects. 

This is a very effective approach, but some men still carry on producing enough sperm to cause a pregnancy. The reason why this happens is unknown, but it may be that some men carry on producing enough testosterone to continue to stimulate some sperm production.

Research is now focusing on different combinations of synthetic testosterone and progestogens. Several trials in different countries are looking at the effectiveness and long-term safety of hormonal contraceptives for men, including some phase III trials. Phase III trials are the last clinical trials carried out before a medicine is given a marketing licence.

An important disadvantage of using synthetic testosterone is that sperm production is suppressed at different rates in men of different ethnic origins.

These differences may be due to genetic, dietary or environmental factors but exact reasons are unknown. Understanding the reasons may lead to new ways of providing an effective form of contraception for all men of diverse ethnic backgrounds.

Non-hormonal contraception

Many of the non-hormonal methods of contraception currently being studied involve the vas deferens. The vas deferens is the tube that sperm pass through on their way to the penis. This tube is cut during a vasectomy.

RISUG and the IVD   

One promising avenue of research is a technique called Reversible Inhibition of Sperm Under Guidance (RISUG). During this technique, a non-toxic synthetic chemical is injected into the vas deferens. The chemical reacts and blocks the vas deferens. It also kills sperm when they come into contact with it. The chemical is effective almost immediately after it is injected.

The chemical stays in place until a man decides that he wants to have children. It can then be washed out using another injection which dissolves it and flushes it out of the vas deferens.

A variation of this technique is the intra-vas device (IVD). It involves injecting a 'plug' into the vas deferens which can be removed later. The IVD filters out the sperm as it passes through the vas deferens. 

Initial results of RISUG and IVD are promising, but further research is needed to assess the long-term effectiveness and safety of both techniques.

Epididymis

Other research is focusing on the epididymis. This is a long, coiled tube behind the testicles that allows sperm to mature normally, which is essential for normal fertilty.

Attempts have been made to interfere with the way the epididymis works and the way sperm matures inside the epididymis. However, so far neither approach has been successful.