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Young and childless men are increasingly choosing to get sterilized.
That is the finding of a recent academic study showing the proportion of Canadian vasectomy patients without children has nearly tripled since the pandemic.
But men may soon have contraception options that are safer, less invasive and more easily reversible than vasectomies. New forms of male contraception are in early clinical trials in Canada, and the results are promising.
“Men are … stuck with these two pretty poor options: condoms … or vasectomy,” said Darlene Walley, CEO of NEXT Life Sciences, one of the biotech companies developing male contraceptives.
“We don’t anticipate any [side effects], and nor have we found any,” she said, referring to the two products her company is in the process of trialling.
Dr. Premal Patel, a urologic surgeon and co-founder of Men’s Health Clinic Manitoba, says new forms of male contraception would be a welcome addition.
“I think having a reversible option is always advantageous,” said Patel, noting it will make it easier for men to change their mind about having children.
Vasectomy reversal
The burden of birth control has historically fallen most on women, but men have also long had two contraception choices: condoms, which require consistent use, or vasectomy, a surgical procedure.
“Vasectomy is not without problems,” said Patel. “One to five per cent of men experience post-vasectomy pain syndrome, and it can be pretty debilitating.”
There are other downsides too.
“Vasectomy reversal can actually be pretty successful if it’s done … [within] 10 years,” Patel said. “But it’s a long procedure — it takes two to three hours … under an operating microscope … and it’s costly.
“And it may not work.”
Patel says some men who have had vasectomies later reconsider their decision not to have children, but often find the prospect of undergoing a vasectomy reversal too daunting.
This makes the emerging forms of male contraception a potential game changer.
“[I]f they took pills and gels, maybe they’re more inclined to change their mind,” he said.
Male birth control
Male contraceptives have historically proven difficult to develop, in part due to biology.
Unlike female contraception, which prevents the release of a single egg each month, the male reproductive system produces sperm continuously, at “about 100 million sperm per day,” says Bernard Robaire, a reproductive biologist at McGill University.
“Even if you find a method that’s 98 per cent effective in suppressing sperm production or motility, it may still not significantly affect fertility.”
The male contraceptive products now in clinical trials include hormonal and non-hormonal pills, gels and long-acting implants.
Hormonal methods suppress sperm production by altering the body’s testosterone signals, effectively “tricking” the brain into reducing the signals that tell the testes to produce sperm. These products commonly take the form of topical gels, applied to each shoulder once daily.
Non-hormonal approaches, which include pills, long-acting gels or injectables, interfere directly with sperm development or function.
“Sperm leave the testes looking like sperm, but they can’t swim, and they can’t fertilize an egg,” Robaire said. “The idea is to inhibit the swimming ability of the sperm.”
Implant methods include non-hormonal, long-acting gels that are injected to block sperm.
“[They] inject a gel inside the tube that feeds the testes — the vas deferens, the one that’s cut when you do a vasectomy — and that would block that tube,” said Robaire.
But unlike vasectomies, this method would be easily reversed.
“[Y]ou’d be able to inject something else that would dissolve the gel,” he said.
Plan A
Most of these male contraception products remain in the early stages of clinical trials.
However, Patel expects it could still take several years before male contraceptives are available in Canada.
“It looks like they’re still in phase two trials,” he said. “So they’re probably still a few years away.”
Walley, of NEXT Life Sciences, says doctors have expressed enthusiasm for the company’s two products: a long-acting injectable gel called Plan A and a pill for short-term use.
“Plan A — doctors really love it because they feel it’s something … men can set and forget,” she said. “Our pill form is for the men who want something that they could do on-demand.”
Researchers and clinicians say the potential market is large.
“I’ve given many interviews over the years — the number of emails and calls I get [afterwards] with people who want to volunteer for the trials, it’s always high,” said Robaire.
Walley similarly says recruiting participants for clinical trials has been a breeze.
“We have doctors coming to us on a regular basis … that are very, very interested,” she said.
Some sources wonder whether enthusiasm among consumers will be equally high.
“Vasectomy is such a well-known procedure,” said Patel. “Often people just kind of say, ‘OK, it’s time for me to get the snip.’”
Product uptake may depend on ease of use, he adds.
“The gel one sounds more doable,” said Patel. “[Compared to] patients remembering to take pills.”
Patel expects many couples would welcome a reversible method that allows men to share more responsibility for birth control. “Women have obviously been taking contraceptives for so long,” he said.
“So I think it’s valuable for men to have that option as well.”
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