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Gottert A, Mathur S, Gnofam M, Sailer J, Pulerwitz J, Haddad LB. Men's Willingness to Use and Preferences for Novel Male Contraceptive Methods in Malawi. Stud Fam Plann 2024; 55:215-227. [PMID: 39118313 DOI: 10.1111/sifp.12275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Evidence is needed in low- and middle-income countries regarding men's willingness to use new male contraceptive methods in development, preferences regarding method attributes, and what shapes willingness/preferences. We analyzed data from cross-sectional surveys with 611 men in Malawi, concerning willingness to use each of four types of new male methods. Mean age was 24.5 years; half (50 percent) were married/cohabiting. Over half (51 percent) of men expressed willingness to use at least one new male method, including a topical contraceptive gel (33 percent), injection (32 percent), pill (29 percent), and implant (14 percent). Many male product attributes were considered important (with 59-67 percent endorsement), including ease of use, comfort of use, side effects, partner approval, type of method, frequency of facility visits, and cost. A prevalent reported reason for willingness was to "share responsibility for family planning with my partner" (44 percent). In multivariate regression analyses, willingness was inversely associated with inequitable gender attitudes (p < 0.001) and was not associated with married/cohabiting status, using condoms, or perceived risk for HIV. These findings add to growing evidence that a majority of men express willingness to use new male contraceptive methods like a topical gel, injectable, or pill. Reflection around gender roles is likely critical within future education about male contraceptive methods.
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Meriggiola MC, Goulis DG. Contraceptive counseling: Shared decision on contraceptive choices. Andrology 2024. [PMID: 38973317 DOI: 10.1111/andr.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/19/2024] [Accepted: 06/22/2024] [Indexed: 07/09/2024]
Abstract
The promising results achieved in male hormonal contraceptive trials over the last decades suggest that new male contraceptives could hit the market soon. In shared decision-making counseling, couples and their healthcare provider collaborate to make decisions about contraception choices. This model of contraceptive counseling could aid men in taking responsibility for contraception and women in trusting their partners in family planning. The shared decision-making process in contraceptive counseling requires partners to provide input on their preferences, values, and desires, while healthcare professionals share medical knowledge and evidence-based information.It has been proven that this method leads to higher adherence and satisfaction. To ensure that contraceptive counseling is inclusive, fair, and supportive of different reproductive experiences and needs, it is crucial to incorporate the Reproductive Justice Framework into counseling.
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Affiliation(s)
- Maria Cristina Meriggiola
- Dipartimento Ospedale della Donna e del Bambino, Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Dimitrios G Goulis
- First Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Huyghe E, Ducrot Q, Costa N. Vasectomy: An increasingly common procedure in France. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102640. [PMID: 38697266 DOI: 10.1016/j.fjurol.2024.102640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/26/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVES To analyze the evolutionary trends concerning vasectomy over the last 8 years in order to better understand the situation and identify measures to be implemented to develop this activity. METHODS The number of vasectomy procedures performed between 2015 and 2022 was extracted from the Open CCAM file compiled from the national database of the Programme de médicalisation du système d'informations français (PMSI). RESULTS Over the period 2015-2022, the number of vasectomy procedures increased from 3743 in 2015 to 29,890 in 2022. This increase was observed in all French metropolitan and overseas regions. The number of minimally invasive vasectomies (notably without scalpel) rose sharply, from 313 to 7760. Almost all vasectomies were performed during outpatient hospitalization (0 nights), with fewer than 300 acts reported/year in outpatient care. CONCLUSION In France, vasectomy is becoming an increasingly frequent contraceptive method. This analysis is in line with recent surveys carried out in France, and tends to prove that more and more couples of childbearing age are in favour of sharing the contraceptive burden. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Eric Huyghe
- Department of Reproductive Medicine, Paule-de-Viguier Hospital, Toulouse University Hospital, Toulouse, France; Department of Urology, Andrology and Renal Transplantation, Rangueil Hospital, Toulouse University Hospital, Toulouse, France; UMR DEFE Inserm 1203 University of Toulouse 3, Toulouse, France.
| | - Quentin Ducrot
- Department of Reproductive Medicine, Paule-de-Viguier Hospital, Toulouse University Hospital, Toulouse, France
| | - Nadège Costa
- Medico-Economic Evaluation Unit, Hôtel-Dieu, Toulouse University Hospital, Toulouse, France
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4
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Lee KH, Hwang JY. Ca 2+ homeostasis and male fertility: a target for a new male contraceptive system. Anim Cells Syst (Seoul) 2024; 28:171-183. [PMID: 38686363 PMCID: PMC11057403 DOI: 10.1080/19768354.2024.2345647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024] Open
Abstract
Ca2+ is a key secondary messenger that determines sperm motility patterns. Mammalian sperm undergo capacitation, a process to acquire fertilizing ability, in the female reproductive tract. Capacitated sperm change their flagellar waveform to develop hyperactivated motility, which is crucial for successful sperm navigation to the eggs and fertilization. The sperm-specific channel, CATSPER, and an ATPase transporter, PMCA4, serve as major paths for Ca2+ influx and efflux, respectively, in sperm. The ionic paths coordinate Ca2+ homeostasis in the sperm, and their loss-of-function impairs sperm motility, to cause male infertility. In this review, we summarize the physiological significance of these two Ca2+ gates and suggest their potential applications in novel male contraceptives.
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Affiliation(s)
- Kyung-Ha Lee
- Department of Molecular Biology, Pusan National University, Busan, South Korea
- Institute of Systems Biology, Pusan National University, Busan, South Korea
| | - Jae Yeon Hwang
- Department of Molecular Biology, Pusan National University, Busan, South Korea
- Institute of Systems Biology, Pusan National University, Busan, South Korea
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5
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Nickels L, Yan W. Nonhormonal Male Contraceptive Development-Strategies for Progress. Pharmacol Rev 2023; 76:37-48. [PMID: 38101934 PMCID: PMC10759220 DOI: 10.1124/pharmrev.122.000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
Despite the widely demonstrated public health benefits of contraception, limited contraceptive options are available for men, placing both the contraceptive burden and opportunity solely on women. This review outlines the need for an increased focus on male contraceptive development and highlights several related topics, including the perspectives of women and men on male contraceptives, historical challenges, and reasons behind the persistent delays in male contraceptive development. It also discusses the importance of serendipitous observations in drug discovery and the limitations of depleting sperm or spermatogenic cells as a contraceptive approach. It further provides an overview of ongoing research and development on novel methods, with a goal to offer insights into the multifaceted aspects of nonhormonal male contraceptive development, addressing its implications for the health of men and women. SIGNIFICANCE STATEMENT: Despite well over half a century of effort in developing male contraceptives, there are no approved male contraceptive drugs on the market. This review aims to present strategies for progress in nonhormonal male contraception based on lessons learned from history, with the hope of expediting development and bringing a male contraceptive drug closer to reality.
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Affiliation(s)
- Logan Nickels
- Male Contraceptive Initiative, Durham, North Carolina (L.N.); The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California (W.Y.); and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (W.Y.)
| | - Wei Yan
- Male Contraceptive Initiative, Durham, North Carolina (L.N.); The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California (W.Y.); and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (W.Y.)
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6
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Giacometti A, Huyghe E, Ferretti L, Moreau D. [Acceptability of innovative male contraceptive methods among major of age heterosexual adult men in France in 2021]. Prog Urol 2023; 33:993-1001. [PMID: 37806909 DOI: 10.1016/j.purol.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION New methods of male contraception are being studied: male hormonal contraception, reversible occlusion of the vas deferens and thermal contraception. This study aimed to evaluate the acceptability of these methods among men. MATERIAL AND METHODS We carried out an opinion survey from July to November 2021, through an anonymous questionnaire distributed in France on the internet. The subjects were adult, heterosexual men. RESULTS Of the 1545 connections to the questionnaire, we analyzed the 905 complete questionnaires. Seventy three percent of men say they are in favor of adopting an innovative male contraceptive method as their primary contraception: 64% in favor of reversible occlusion of the vas deferens, 22% in favor of male hormonal contraception and 13% in favor of thermal contraception. CONCLUSION Despite its limitations, this study shows that a significant part of the male population is interested in innovative methods of contraception that concern them. This should encourage continued research in this area. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- A Giacometti
- Département de médecine générale, université de Bordeaux, Bordeaux, France.
| | - E Huyghe
- Département d'urologie, andrologie et transplantation rénale, CHU de Toulouse, Toulouse, France
| | - L Ferretti
- Service d'urologie, MSPB Bagatelle, Talence, France; Service d'urologie, CHU de Bordeaux, Bordeaux, France
| | - D Moreau
- Ingénieur statisticien en épidémiologie, Rennes, France
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Wang C, Meriggiola MC, Amory JK, Barratt CLR, Behre HM, Bremner WJ, Ferlin A, Honig S, Kopa Z, Lo K, Nieschlag E, Page ST, Sandlow J, Sitruk-Ware R, Swerdloff RS, Wu FCW, Goulis DG. Practice and development of male contraception: European Academy of Andrology and American Society of Andrology guidelines. Andrology 2023. [PMID: 37727884 DOI: 10.1111/andr.13525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUNDS Despite a wide spectrum of contraceptive methods for women, the unintended pregnancy rate remains high (45% in the US), with 50% resulting in abortion. Currently, 20% of global contraceptive use is male-directed, with a wide variation among countries due to limited availability and lack of efficacy. Worldwide studies indicate that >50% of men would opt to use a reversible method, and 90% of women would rely on their partner to use a contraceptive. Additional reasons for novel male contraceptive methods to be available include the increased life expectancy, sharing the reproductive risks among partners, social issues, the lack of pharma industry involvement and the lack of opinion makers advocating for male contraception. AIM The present guidelines aim to review the status regarding male contraception, the current state of the art to support the clinical practice, recommend minimal requirements for new male contraceptive development and provide and grade updated, evidence-based recommendations from the European Society of Andrology (EAA) and the American Society of Andrology (ASA). METHODS An expert panel of academicians appointed by the EAA and the ASA generated a consensus guideline according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. RESULTS Sixty evidence-based and graded recommendations were produced on couple-centered communication, behaviors, barrier methods, semen analysis and contraceptive efficacy, physical agents, surgical methods, actions before initiating male contraception, hormonal methods, non-hormonal methods, vaccines, and social and ethical considerations. CONCLUSION As gender roles transform and gender equity is established in relationships, the male contribution to family planning must be facilitated. Efficient and safe male-directed methods must be evaluated and introduced into clinical practice, preferably reversible, either hormonal or non-hormonal. From a future perspective, identifying new hormonal combinations, suitable testicular targets, and emerging vas occlusion methods will produce novel molecules and products for male contraception.
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Affiliation(s)
- Christina Wang
- Division of Endocrinology, Department of Medicine and Clinical and Translational Science Institute, The Lundquist Insitute and Harbor-UCLA Medical Center, Torrance, California, USA
| | - Maria Cristina Meriggiola
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - John K Amory
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Christopher L R Barratt
- Division of Systems and Cellular Medicine, Medical School, Ninewells Hospital, University of Dundee, Dundee, Scotland
| | - Hermann M Behre
- Center for Reproductive Medicine and Andrology, University Medicine Halle, Halle, Germany
| | - William J Bremner
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Alberto Ferlin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Stanton Honig
- Division of Reproductive and Sexual Medicine, Department of Urology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Zsolt Kopa
- Department of Urology, Andrology Centre, Semmelweis University, Budapest, Hungary
| | - Kirk Lo
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Eberhard Nieschlag
- Center of Reproductive Medicine and Andrology, University Hospital, Münster, Germany
| | - Stephanie T Page
- Division of Metabolism, Endocrinology and Nutrition, UW Medicine Diabetes Institute, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jay Sandlow
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Regine Sitruk-Ware
- Center for Biomedical Research, Population Council, New York, New York, USA
| | - Ronald S Swerdloff
- Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor-UCLA Medical Center, Torrance, California, USA
| | - Frederick C W Wu
- Division of Endocrinology, Diabetes and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Dimitrios G Goulis
- First Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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8
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Gómez-Torres P, Lucha-López AC, Martínez-Pérez GZ, Sheridan T, Vera Cruz G. Acceptability and Determinants of using Male Hormonal Contraceptives: A Systematic Review from a Gender Perspective. PSYCHOLOGY & SEXUALITY 2023. [DOI: 10.1080/19419899.2023.2191606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Piedad Gómez-Torres
- Department of Physiatrics and Nursing, University of Zaragoza, Zaragoza, Spain
- Research Group Sector III Heathcare (GIIS081), Institute of Research of Aragón, Zaragoza, Spain
| | - Ana C. Lucha-López
- Department of Physiatrics and Nursing, University of Zaragoza, Zaragoza, Spain
- Research Group Sector III Heathcare (GIIS081), Institute of Research of Aragón, Zaragoza, Spain
- Unidad de Investigación en Fisioterapia (UIF), University of Zaragoza, Zaragoza, Spain
| | | | - Taylor Sheridan
- Barcelona Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | - Germano Vera Cruz
- Department of Psychology, University of Picardie Jules Verne, Amiens, France
- Centre de Recherche en Psychologie: Cognition, Psychisme et Organisations UR 7273 CRP-CPO, University of Picardie Jules Verne, Amiens, France
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9
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Luque GM, Schiavi-Ehrenhaus LJ, Jabloñski M, Balestrini PA, Novero AG, Torres NI, Osycka-Salut CE, Darszon A, Krapf D, Buffone MG. High-throughput screening method for discovering CatSper inhibitors using membrane depolarization caused by external calcium chelation and fluorescent cell barcoding. Front Cell Dev Biol 2023; 11:1010306. [PMID: 36743410 PMCID: PMC9892719 DOI: 10.3389/fcell.2023.1010306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023] Open
Abstract
The exclusive expression of CatSper in sperm and its critical role in sperm function makes this channel an attractive target for contraception. The strategy of blocking CatSper as a male, non-hormonal contraceptive has not been fully explored due to the lack of robust screening methods to discover novel and specific inhibitors. The reason for this lack of appropriate methodology is the structural and functional complexity of this channel. We have developed a high-throughput method to screen drugs with the capacity to block CatSper in mammalian sperm. The assay is based on removing external free divalent cations by chelation, inducing CatSper to efficiently conduct monovalent cations. Since Na+ is highly concentrated in the extracellular milieu, a sudden influx depolarizes the cell. Using CatSper1 KO sperm we demonstrated that this depolarization depends on CatSper function. A membrane potential (Em) assay was combined with fluorescent cell barcoding (FCB), enabling higher throughput flow cytometry based on unique fluorescent signatures of different sperm samples. These differentially labeled samples incubated in distinct experimental conditions can be combined into one tube for simultaneous acquisition. In this way, acquisition times are highly reduced, which is essential to perform larger screening experiments for drug discovery using live cells. Altogether, a simple strategy for assessing CatSper was validated, and this assay was used to develop a high-throughput drug screening for new CatSper blockers.
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Affiliation(s)
- Guillermina M. Luque
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina,*Correspondence: Guillermina M. Luque, ; Mariano G. Buffone,
| | | | - Martina Jabloñski
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Paula A. Balestrini
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Analia G. Novero
- Instituto de Biología Molecular y Celular de Rosario (CONICET-UNR), Rosario, Santa Fe, Argentina
| | - Nicolás I. Torres
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Claudia E. Osycka-Salut
- Instituto de Investigaciones Biotecnológicas, Universidad Nacional de San Martín (UNSAM-CONICET), Buenos Aires, Argentina
| | | | - Dario Krapf
- Instituto de Biología Molecular y Celular de Rosario (CONICET-UNR), Rosario, Santa Fe, Argentina
| | - Mariano G. Buffone
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina,*Correspondence: Guillermina M. Luque, ; Mariano G. Buffone,
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10
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Service CA, Puri D, Hsieh TC, Patel DP. Emerging concepts in male contraception: a narrative review of novel, hormonal and non-hormonal options. Ther Adv Reprod Health 2023; 17:26334941221138323. [PMID: 36909934 PMCID: PMC9996746 DOI: 10.1177/26334941221138323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/20/2022] [Indexed: 03/14/2023] Open
Abstract
Access to reliable contraception is a pillar of modern society. The burden of unintended pregnancy has fallen disproportionately on the mother throughout human history; however, recent legal developments surrounding abortion have sparked a renewed interest in male factor contraceptives beyond surgical sterilization and condoms. Modern efforts to develop reversible male birth control date back nearly a century and initially focused on altering the hypothalamic-pituitary-testes axis. These hormonal contraceptives faced multiple barriers, including systemic side effects, challenging dosing regimens, unfavorable routes of delivery, and the public stigma surrounding steroid use. Novel hormonal agents are seeking to overcome these barriers by limiting the side effects and simplifying use. Non-hormonal contraceptives are agents that target various stages of spermatogenesis; such as inhibitors of retinoic acid, Sertoli cell-germ cell interactions, sperm ion channels, and other small molecular targets. The identification of reproductive tract-specific genes associated with male infertility has led to more targeted drug development, made possible by advances in CRISPR and proteolysis targeting chimeras (PROTACs). Despite multiple human trials, no male birth control agents have garnered regulatory approval in the United States or abroad. This narrative review examines current and emerging male contraceptives, including hormonal and non-hormonal agents.
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Affiliation(s)
- C. Austin Service
- Department of Urology, University of California
San Diego, San Diego, CA, USA
| | - Dhruv Puri
- Department of Urology, University of California
San Diego, San Diego, CA, USA
| | - Tung-Chin Hsieh
- Department of Urology, University of California
San Diego, San Diego, CA, USA
| | - Darshan P. Patel
- Department of Urology, University of California
San Diego, 9333 Genesee Avenue, Suite 320, La Jolla, CA 92121, USA
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Sheridan T, Gómez-Torres P, Vera Cruz G, Martínez-Pérez GZ. A global grounded theory exploration of investigators' perspectives on male hormonal contraceptive development and acceptability. Glob Public Health 2022; 17:3760-3772. [PMID: 35901059 DOI: 10.1080/17441692.2022.2102201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
While best practices have been proposed on how to engage men in family planning (FP), the limited options of male hormonal contraceptives (MHC) are a barrier to reaching men as clients of FP programs. The lack of alternative MHC is preventing the global health community from providing holistic reproductive healthcare. A qualitative grounded theory study was conducted in 2020 to explore MHC experts' perceptions around the development and theoretical acceptability of MHCs. Individual in-depth interviews were conducted with 15 key informants. The informants cited evidence that there is a demand for MHC. The inability to access this data by the pharmaceutical industry was acknowledged. Many informants expressed concern of the possibility for MHC to increase male power in a predominantly patriarchal world. To most informants, at least for the initial introduction of MHC, fertility sharing is something that will largely happen among couples alone rather than individually. There is proven demand among women and men for MHC, however industries may still be reluctant to invest. Effort is needed by the sexual and reproductive health and rights community to include male engagement in FP and to advocate for the development and use of MHC as a tool for women's empowerment.
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Affiliation(s)
- Taylor Sheridan
- The Barcelona Institute for Global Health Foundation (ISGlobal), Barcelona, Spain
| | - Piedad Gómez-Torres
- Department of Physiatrics and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Germano Vera Cruz
- Department of Psychology, UR 7273 CRP-CPO, University of Picardie Jules Verne, Amiens, France
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Abstract
Rates of unplanned pregnancies are high globally, burdening women and families. Efforts to develop male contraceptive agents have been thwarted by unacceptable failure rates, side effects and a dearth of pharmaceutical industry involvement. Hormonal male contraception consists of exogenous androgens which exert negative feedback on the hypothalamic-pituitary-gonadal axis and suppress gonadotropin production. This in turn suppresses testicular testosterone production and sperm maturation. Addition of a progestin suppresses spermatogenesis more effectively in men. Contraceptive efficacy studies in couples have shown male hormonal methods are effective and reversible, but also may come with side effects related to sexual desire, acne and serum cholesterol and inconvenient methods of dosing and delivery. Recently, novel androgens as potential contraceptive agents are being evaluated in early clinical trials and look to overcome these drawbacks. Here we summarize landmark studies of prototype male hormonal contraceptives, showcasing recent advances and future prospects in this important area of public health.
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Affiliation(s)
- Arthi Thirumalai
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA.
| | - Stephanie T Page
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA.
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13
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Male contraceptive development: A medicinal chemistry perspective. Eur J Med Chem 2022; 243:114709. [DOI: 10.1016/j.ejmech.2022.114709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/20/2022] [Accepted: 08/21/2022] [Indexed: 11/21/2022]
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14
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Tcherdukian J, Mieusset R, Netter A, Lechevallier E, Bretelle F, Perrin J. Knowledge, professional attitudes, and training among health professionals regarding male contraceptive methods. EUR J CONTRACEP REPR 2022; 27:397-402. [PMID: 35899860 DOI: 10.1080/13625187.2022.2093851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Health professionals are at the forefront of information and acceptability regarding contraceptive methods, however only one study evaluated their knowledge of male contraception (MC) including hormonal MC (HMC) and thermal MC (TMC). Our objective was to evaluate the knowledge, professional attitudes, and training of French practitioners regarding the management of couple contraception by male contraception (MC). STUDY DESIGN We designed a descriptive, cross-sectional, multicentre study in 2,396 French practitioners belonging to national or regional institutions involved in contraception. We solicited practitioners by e-mail to complete an anonymous questionnaire; we analysed their knowledge, professional attitudes, and training regarding the management of couple contraception by MC. RESULTS The overall participation rate was 18% (427/2,396). Condoms, withdrawal, and vasectomy were known by 98%, 89%, and 76% of the population, respectively. Hormonal MC and Thermal (TMC) were known by 10% and 24% of the population, respectively. Fifty-five percent of the population never or infrequently offered MC during a couple's contraceptive request consultation. Only 14% of the population had ever participated in training on MC; 96% wanted to be better trained on MC, and 87% expressed a willingness to participate in training on the subject. CONCLUSIONS Health professionals involved in contraception have unsatisfactory knowledge about MC methods based on spermatogenesis inhibition and are eager to have more information about them. To advance the acceptability and dissemination of MC methods, it seems imperative to enhance research in the field and to provide health professionals with an adapted training programme.
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Affiliation(s)
- Jessica Tcherdukian
- University Department of General Medicine, Faculty of Medicine of Marseille, Aix-Marseille University, Marseille, France
| | - Roger Mieusset
- Développement Embryonnaire, Fertilité et Environnement (DEFE) INSERM Montpellier-Toulouse, Toulouse cedex 9, France.,Andrology-Reproductive Medicine, Paule de Viguier Hospital, Toulouse, France
| | - Antoine Netter
- Department of Gynaecology and Obstetrics, Gynépole, AP-HM La Conception University Hospital, Marseille cedex 5, France
| | - Eric Lechevallier
- Urology Department, AP-HM La Conception University Hospital, Marseille cedex 5, France
| | - Florence Bretelle
- Department of Gynaecology and Obstetrics, Gynépole, AP-HM La Conception University Hospital, Marseille cedex 5, France.,IRD, AP-HM, MEPHI, IHU Méditerranée Infection, Aix Marseille Univ, Marseille, France
| | - Jeanne Perrin
- AMP-CECOS Clinical-Biological Centre, AP-HM La Conception University Hospital, Marseille cedex 5, France.,Aix Marseille Univ, CNRS, IRD, IMBE, Avignon University, Marseille, France
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Page ST, Blithe D, Wang C. Hormonal Male Contraception: Getting to Market. Front Endocrinol (Lausanne) 2022; 13:891589. [PMID: 35721718 PMCID: PMC9203677 DOI: 10.3389/fendo.2022.891589] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022] Open
Abstract
Rates of unplanned pregnancies are high and stagnant globally, burdening women, families and the environment. Local limitations placed upon contraceptive access and abortion services exacerbate global disparities for women. Despite survey data suggesting men and their partners are eager for expanded male contraceptive options, efforts to develop such agents have been stymied by a paucity of monetary investment. Modern male hormonal contraception, like female hormonal methods, relies upon exogenous progestins to suppress the hypothalamic-pituitary-gonadal axis, in turn suppressing testicular testosterone production and sperm maturation. Addition of an androgen augments gonadotropin suppression, more effectively suppressing spermatogenesis in men, and provides androgenic support for male physiology. Previous contraceptive efficacy studies in couples have shown that hormonal male methods are effective and reversible. Recent efforts have been directed at addressing potential user and regulatory concerns by utilizing novel steroids and varied routes of hormone delivery. Provision of effective contraceptive options for men and women is an urgent public health need. Recognizing and addressing the gaps in our contraceptive options and engaging men in family planning will help reduce rates of unplanned pregnancies in the coming decades.
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Affiliation(s)
- Stephanie T. Page
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, United States
| | - Diana Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Christina Wang
- Clinical and Translational Science Institute at the Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
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16
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Christin-Maitre S. [Worldwide contraception]. Med Sci (Paris) 2022; 38:457-463. [PMID: 35608469 DOI: 10.1051/medsci/2022058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The latest statistics concerning contraceptive use in the world have been published in 2019 by the United Nations. Among the 1.9 billion of women of reproductive age (15-49 years), 1.1 billion have a need for family planning. Among them, 190 millions are not using any contraception, although they wanted to avoid a pregnancy. There is a significant discrepancy among continents concerning the percentage of contraceptive use and the distribution of the different types of contraception. Female sterilization is the most widespread method of contraception since it represents 24% of all contraception methods used. Male condoms is used by 21% of couples. Thus, progress is still needed to disseminate effective, well tolerated and potentially reversible methods of contraception. Education of females, couples, medical and paramedical staff is one of the priority targets to improve contraception throughout the world.
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Affiliation(s)
- Sophie Christin-Maitre
- Service d'endocrinologie, diabétologie et médecine de la reproduction, Hôpital Saint-Antoine, 75012 Paris, France - Sorbonne Université, Inserm UMR-S 933, Maladies génétiques d'expression pédiatrique, Hôpital Trousseau, 26 avenue Arnold Netter, 75571 Paris Cedex 12, France
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17
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Ramos-Ortiz J, King H, DeMaria AL. Hormonal Male Contraception: Formative Research to Develop and Test Communication Messaging. Am J Mens Health 2022; 16:15579883221094702. [PMID: 35748372 PMCID: PMC9240595 DOI: 10.1177/15579883221094702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Male-controlled contraception is limited, yet a promising hormonal male
contraceptive (HMC) development in may increase options for men to share in the
work of pregnancy prevention. This study examined college-aged (18–26 years)
men’s and women’s perceptions of influential marketing strategy for an
experimental novel HMC method, a transdermal gel. Six focus groups
(n = 29) were conducted to glean insights for ad prototype
creation. Ad prototypes were designed and then tested in semi-structured
interviews (n = 20) to understand whether the messages were
adequately representing the attributes intended while also allowing participants
to contribute insights on improving appeal. A constant comparative approach was
used for data contextualization and theme identification. Results provided a
foundation for the creation of HMC message prototypes, aimed at increasing
knowledge and uptake of a novel family planning method for men. Representation
of a relatable character, or drawing on authentic experiences, aligned best with
participant values. Focus groups illuminated salient concepts for HMC marketing,
including humor, destigmatization, information, and credibility. Interview
message testing yielded an understanding of elements participants responded most
strongly to, including (1) ad sentiment and (2) trustworthiness. Findings
provide a basis for understanding the placement of a potential marketing
campaign to effectively frame HMC uptake as easy to use, safe, and popular while
building on peer norms and group acceptability among a college-aged demographic.
Healthcare providers and other practitioners can utilize these findings while
engaging in family planning conversations, interventions, and message
development.
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Affiliation(s)
- Jaziel Ramos-Ortiz
- Division of Consumer Science, Purdue University, West Lafayette, IN, USA
| | - Hannah King
- Department of Public Health, Purdue University, West Lafayette, IN, USA
| | - Andrea L DeMaria
- Department of Public Health, Purdue University, West Lafayette, IN, USA
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18
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ChoGlueck C. Still no pill for men? Double standards & demarcating values in biomedical research. STUDIES IN HISTORY AND PHILOSOPHY OF SCIENCE 2022; 91:66-76. [PMID: 34879317 DOI: 10.1016/j.shpsa.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 06/13/2023]
Abstract
Double standards are widespread throughout biomedicine, especially in research on reproductive health. One of the clearest cases of double standards involves the feminine gendering of reproductive responsibility for contraception and the continued lack of highly effective, reversible methods for cisgender men. While the biomedical establishment accepts diversity and inclusion as important social values for clinical trials, their continued use of inequitable standards undermines their ability to challenge unfair social hierarchies by developing male contraception. Thus, the gender/sex bias present in contraceptive research raises the "New Demarcation Problem": If we accept that values can and will play important roles in science, how can we nevertheless distinguish positive influences of values from more corrosive bias? I argue that biomedical researchers ought to aim their clinical trials at equity and utilize methodologies that actually achieve that aim. More specifically, I contend that we can avoid the problem of double standards by gender/sex in contraceptive research by utilizing more equitable standards. My demarcation strategy captures dynamic interplay between values and their effects, with direct policy implications for institutions conducting, funding, and evaluating clinical trials. For male contraceptive trials, this involves shifting risk assessment from an individual model to a shared model for sexual partners.
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Affiliation(s)
- Christopher ChoGlueck
- Department of Communication, Liberal Arts, and Social Sciences (CLASS), New Mexico Institute of Mining and Technology (New Mexico Tech), 215 Finch Hall, 801 Leroy Place, Socorro, 87801, New Mexico, USA.
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19
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Richard C, Pourchasse M, Freton L, Esvan M, Ravel C, Peyronnet B, Mathieu R, Chhor S. Male contraception: What do women think? Prog Urol 2021; 32:276-283. [PMID: 34924309 DOI: 10.1016/j.purol.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/29/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Women currently bear the most responsibility in contraception, with a wide choice of methods, while only a few existing male contraceptives are available. However, it has been shown that men are willing to get involved in birth control and to control their own fertility. Our research was focused on female population and a survey was carried out to explore women's perceptions of male contraception. METHODS An observational quantitative cross-sectional study using a self-administered-questionnaire was carried out between November 2019 and February 2020. All women aged from 16-years-old to menopause completing the questionnaire were included. Descriptive statistical analyses were conducted, qualitative variables were expressed as counts and frequency. RESULTS In total, 379 interpretable completed questionnaires were included. Among the women, 69.7% were in favour of letting men deal with contraception, without referring to a specific method. After having been made aware of the medical information concerning existing male contraceptives and those in development, the proportion of women in favour dropped to 46.7%. The most acceptable method for a majority of women was the male pill, which is still being developed. The majority (78.4%) of the women in our survey felt insufficiently informed about male contraception. DISCUSSION In our study, women seemed to want to share contraceptive responsibility with men, but the lack of information and of acceptable contraception methods available remained an obstacle. Although larger-scale studies are needed to confirm these results, the development of a wider range of male contraception methods seems to be what both men and women have long been expecting.
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Affiliation(s)
- C Richard
- Department of Urology, University of Rennes, Rennes, France.
| | - M Pourchasse
- Department of General Medicine, University of Rennes, Rennes, France
| | - L Freton
- Department of Urology, University of Rennes, Rennes, France
| | - M Esvan
- Clinical Investigation Department, University of Rennes, Rennes, France
| | - C Ravel
- CECOS, University of Rennes, Rennes, France
| | - B Peyronnet
- Department of Urology, University of Rennes, Rennes, France
| | - R Mathieu
- Department of Urology, University of Rennes, Rennes, France
| | - S Chhor
- Department of General Medicine, University of Rennes, Rennes, France; Clinical Investigation Department, University of Rennes, Rennes, France
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20
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Shunnarah A, Tumlinson R, Calderón AI. Natural Products with Potential for Nonhormonal Male Contraception. JOURNAL OF NATURAL PRODUCTS 2021; 84:2762-2774. [PMID: 34633803 DOI: 10.1021/acs.jnatprod.1c00565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Despite increased access to contraception over the last 60 years, unplanned pregnancies continue to contribute to economic disparities and overpopulation. Additionally, the burden of family planning falls primarily on women, as a reliable pharmaceutical male contraceptive has yet to be developed. The objective of this literature-based systematic review was to identify compounds for future study from natural sources with potential nonhormonal male contraceptive activity. After the exclusion of extracts and compounds with known hormonal mechanisms, 26 unique compounds were identified from natural species. The plant source, compound class, structure, target, mechanism of action, safety/toxicity profile, and in vitro, in vivo, and human studies for each compound were evaluated and discussed. β-Caryophyllene, embelin, oleanolic acid, triptonide, and N-butyldeoxynojirimycin (NB-DNJ) were selected as the five most promising compounds for future study using prespecified criteria such as number of studies, efficacy and safety profile, reversibility, and previous use in humans for any indication. In order to move forward with development of a male contraceptive from a natural source, additional studies are needed to determine the predicted safety and efficacy for in vivo and human clinical trials.
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Affiliation(s)
- Alana Shunnarah
- Department of Drug Discovery and Development, Auburn University Harrison School of Pharmacy, 2316 Walker Building, Auburn, Alabama 36849, United States
| | - Robin Tumlinson
- Department of Drug Discovery and Development, Auburn University Harrison School of Pharmacy, 2316 Walker Building, Auburn, Alabama 36849, United States
| | - Angela I Calderón
- Department of Drug Discovery and Development, Auburn University Harrison School of Pharmacy, 2316 Walker Building, Auburn, Alabama 36849, United States
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21
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Hook C, Hardee K, Shand T, Jordan S, Greene ME. A long way to go: engagement of men and boys in country family planning commitments and implementation plans. Gates Open Res 2021; 5:85. [PMID: 34136752 PMCID: PMC8187813 DOI: 10.12688/gatesopenres.13230.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background: To reach global goals related to women and girls’ access to modern family planning (FP) and gender equality, evidence shows that it is critical to understand and account for the role of men and boys as users of reproductive health services, as partners for millions of women & girls around the world, and as advocates in their communities. Under the Family Planning 2020 (FP2020) partnership, countries were encouraged to develop costed implementation plans and action plans in an effort to provide 120 million additional women and girls with contraception. As FP2020 becomes FP2030, reviewing these previously-developed strategies helps understand the extent to which countries considered the engagement of men as an important aspect of their family planning portfolios. Methods: We conducted textual analysis on commitments and implementation plans related to achieving FP2020 commitments in six countries in Africa and one in Asia to determine the extent to which male engagement was incorporated into country or subnational family planning goals, with particular focus on FP policy, program, and financial commitments. Results: Some of the documents analyzed included robust plans for including male engagement in their efforts to expand access to FP. The strongest aspects of male engagement programming were those that sought to engage men as advocates for women’s access to and use of FP services, and improve their knowledge and attitudes related to contraception and reproduction. The weakest aspects were engaging men as users of services and, vitally, tackling underlying gender norms which hamper men’s and women’s health-seeking behaviors and attitudes. Conclusions: Developing FP programs that target men and boys as people deserving of reproductive health services, as partners with women in building their families, and as social activists in their communities, will complement and strengthen existing FP programs as well as promote broader goals related to gender equality.
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Affiliation(s)
| | - Karen Hardee
- What Works Association, Washington, DC, 20036, USA
| | - Tim Shand
- ShandClarke Consulting Ltd, London, UK
| | - Sandra Jordan
- Public Health Consultant, Washington, DC, 20036, USA
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22
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Nguyen BT, Brown AL, Jones F, Jones L, Withers M, Ciesielski KM, Franks JM, Wang C. "I'm not going to be a guinea pig:" Medical mistrust as a barrier to male contraception for Black American men in Los Angeles, CA. Contraception 2021; 104:361-366. [PMID: 34118271 PMCID: PMC8857976 DOI: 10.1016/j.contraception.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Racial disparities in unintended pregnancy and contraceptive use in the United States are not mediated by access to family planning services alone. Rather, a history of medical mistrust underlies Black Americans' adoption of new medical technologies, inclusive of contraception. Efforts to develop hormonal male contraceptives need to incorporate Black Americans' experiences and perspectives so that new contraceptives enable their reproductive goals and promote gender equity. STUDY DESIGN Working with our community-based partner, Healthy African American Families in Los Angeles, California, we conducted six 60-minute focus group discussions with 39 Black men over age 18, in ongoing heterosexual relationships, to explore attitudes towards and willingness to use hormonal male contraceptives. RESULTS Just over one-third (35%) of respondents reported willingness to use or rely on hormonal male contraceptives. The majority held negative attitudes about hormonal male contraceptives, citing concerns about side effects and safety. Several respondents expressed mistrust of the medical community and medical research, noting that hormonal male contraceptives could be used against Black communities; several expressed unwillingness to trial hormonal male contraceptives without years of testing. However, all groups described scenarios where they would use them despite stated concerns. CONCLUSIONS Black men's hypothetical willingness to use hormonal male contraceptives is limited by medical mistrust, which may be overcome by their concerns about the unreliability of current options or the contraceptive behaviors of female partners. Nevertheless, addressing Black Americans' history of medical mistreatment and exploitation will be essential for hormonal male contraceptives to positively contribute to Black men's reproductive options and agency. IMPLICATIONS While the development of reversible, hormonal male contraception intends to fulfill unmet global needs for contraception, the utility of these hormonal male contraceptive methods among Black men living on low incomes in Los Angeles, California cannot be fully realized until developers address and overcome historical and ongoing medical mistrust.
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Affiliation(s)
- Brian T Nguyen
- Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles CA.
| | | | - Felica Jones
- Healthy African American Families Phase II, Los Angeles, CA
| | - Loretta Jones
- Healthy African American Families Phase II, Los Angeles, CA
| | - Mellissa Withers
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles CA
| | - Katharine M Ciesielski
- Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles CA
| | - Jennifer M Franks
- Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles CA; Department of Obstetrics & Gynecology, Kern Medical Center, Bakersfield, CA
| | - Christina Wang
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA
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23
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Hook C, Hardee K, Shand T, Jordan S, Greene ME. A long way to go: engagement of men and boys in country family planning commitments and implementation plans. Gates Open Res 2021; 5:85. [PMID: 34136752 DOI: 10.12688/gatesopenres.13230.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Evidence shows that, to reach global goals related to women and girls' access to modern family planning (FP) and gender equality, it is critical to understand and account for the role of men and boys as users of reproductive health services, as partners for millions of women & girls around the world, and as advocates in their communities. Under the Family Planning 2020 (FP2020) partnership, countries were encouraged to develop costed implementation plans and action plans in an effort to provide 120 million additional women and girls with contraception. As FP2020 becomes FP2030, reviewing these previously-developed strategies helps understand the extent to which countries considered the engagement of men as an important aspect of their family planning portfolios. Methods: We conducted textual analysis on commitments and implementation plans related to achieving FP2020 commitments in seven countries in Africa and one in Asia to determine the extent to which male engagement was incorporated into country or subnational family planning goals, with particular focus on FP policy, program, and financial commitments. Results: Some of the documents analyzed included robust plans for including male engagement in their efforts to expand access to FP. The strongest aspects of male engagement programming were those that sought to engage men as advocates for women's access to and use of FP services, and improve men's knowledge and attitudes related to contraception and reproduction. The weakest aspects were engaging men as users of services and, vitally, tackling underlying gender norms which hamper men's and women's health-seeking behaviors and attitudes. Conclusions: Developing FP programs that target men and boys as people deserving of reproductive health services, as partners with women in building their families, and as social activists in their communities, will complement and strengthen existing FP programs as well as promote broader goals related to gender equality.
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Affiliation(s)
| | - Karen Hardee
- What Works Association, Washington, DC, 20036, USA
| | - Tim Shand
- ShandClarke Consulting Ltd, London, UK
| | - Sandra Jordan
- Public Health Consultant, Washington, DC, 20036, USA
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24
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Long JE, Lee MS, Blithe DL. Update on Novel Hormonal and Nonhormonal Male Contraceptive Development. J Clin Endocrinol Metab 2021; 106:e2381-e2392. [PMID: 33481994 PMCID: PMC8344836 DOI: 10.1210/clinem/dgab034] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The advent of new methods of male contraception would increase contraceptive options for men and women and advance male contraceptive agency. Pharmaceutical R&D for male contraception has been dormant since the 1990s. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) has supported a contraceptive development program since 1969 and supports most ongoing hormonal male contraceptive development. Nonhormonal methods are in earlier stages of development. CONTENT Several hormonal male contraceptive agents have entered clinical trials. Novel single agent products being evaluated include dimethandrolone undecanoate, 11β-methyl-nortestosterone dodecylcarbonate, and 7α-methyl-19-nortestosterone. A contraceptive efficacy trial of Nestorone®/testosterone gel is underway. Potential nonhormonal methods are at preclinical stages of development. Many nonhormonal male contraceptive targets that affect sperm production, sperm function, or sperm transport have been identified. SUMMARY NICHD supports development of reversible male contraceptive agents. Other organizations such as the World Health Organization, the Population Council, and the Male Contraception Initiative are pursuing male contraceptive development, but industry involvement remains limited.
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Affiliation(s)
- Jill E Long
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- Correspondence: Dr. Jill Long, 6710B Rockledge Drive, Room 3243, Bethesda, MD 20892, USA.
| | - Min S Lee
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Diana L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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25
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Thirumalai A, Amory JK. Emerging approaches to male contraception. Fertil Steril 2021; 115:1369-1376. [PMID: 33931201 DOI: 10.1016/j.fertnstert.2021.03.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/29/2021] [Indexed: 01/12/2023]
Abstract
Despite significant interests in contraception by men, effective methods of male contraception are limited to vasectomy and condoms. Recently, there have been several promising advances in male contraceptive research. This review will update readers on recent research in both hormonal and nonhormonal approaches to male contraception. Hormonal approaches to male contraception have been stymied by adverse effects, formulations requiring injections or implants, a 5% to10% nonresponse rate, as well as poor understanding of user acceptability. In the last several years, research has focused on novel, orally bioavailable androgens such as dimethandrolone undecanoate and 11β-methyl-19-nor-testosterone. Additionally, combinations of a topical testosterone gel combined with a gel containing segesterone acetate, a potent progestin, have shown promise in clinical trials recently. Simultaneously, significant preclinical progress has been made in several approaches to nonhormonal male contraceptives, including compounds that inhibit sperm motility such as eppin, compounds that inhibit retinoic acid binding or biosynthesis, and reversible approaches to obstruction of the vas deferens. It is imperative for these areas of research to continue making strides so that there is a gamut of contraceptive options for couples to choose from. Some of these approaches will hopefully reach clinical utility soon, greatly improving contraceptive choice for couples.
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Affiliation(s)
- Arthi Thirumalai
- Center for Research in Reproduction and Contraception, Department of Medicine, University of Washington, Seattle, Washington
| | - John K Amory
- Center for Research in Reproduction and Contraception, Department of Medicine, University of Washington, Seattle, Washington.
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26
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Sax MR, Hurley EG, Rossi RA, Thakore S, Hasija A, Sroga-Rios J. Young Adult Males' Perspectives of Male Hormonal Contraception. South Med J 2021; 114:73-76. [PMID: 33537786 DOI: 10.14423/smj.0000000000001204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the willingness of young adult males to use male hormonal contraception and to determine the most desirable formulation. METHODS An institutional review board-approved survey measuring the willingness to use MHC was dispersed to two distinct populations: University of Cincinnati postgraduate programs and Cincinnati Health Department clinics. Questions on the survey allowed for the collection of demographic characteristics, as well as the preferred method of MHC, and concerns regarding potential adverse effects. This survey was directed at young adult males; therefore, only male participants who were 18 to 35 years old were included for analysis. Results were reported as frequencies in each group and χ2 analyses were performed to compare groups, with a P < 0.05 considered significant. RESULTS Of 162 total survey participants, 45% would use MHC, whereas 30.9% were unsure and 23.5% would not use MHC. Overall, the University of Cincinnati survey population was more likely to be interested in using MHC than the Cincinnati Health Department population (P < 0.05). In both populations, most were interested in using the injectable form. Cited concerns deterring participants from using MHC were different between these two populations, with University of Cincinnati participants more frequently expressing concerns about possible failure of the contraceptive method, whereas Cincinnati Health Department participants had concerns about potential adverse effects (P < 0.001). CONCLUSIONS There is significant interest among young adult males in using various forms of MHC, especially in injectable form. Differences in views of MHC were seen in two distinct male populations. Specifically, males who achieved a higher level of education, were employed, or in a relationship were found to more frequently be willing to use MHC. With further research and funding, MHC may serve as a significant way to decrease unintended pregnancies in the future.
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Affiliation(s)
- Megan R Sax
- From the Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio and the Ohio State University Fisher College of Business, Columbus, Ohio
| | - Emily G Hurley
- From the Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio and the Ohio State University Fisher College of Business, Columbus, Ohio
| | - Rocco A Rossi
- From the Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio and the Ohio State University Fisher College of Business, Columbus, Ohio
| | - Suruchi Thakore
- From the Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio and the Ohio State University Fisher College of Business, Columbus, Ohio
| | - Abhinav Hasija
- From the Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio and the Ohio State University Fisher College of Business, Columbus, Ohio
| | - Julie Sroga-Rios
- From the Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio and the Ohio State University Fisher College of Business, Columbus, Ohio
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27
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Schwandt H, Boulware A, Corey J, Herrera A, Hudler E, Imbabazi C, King I, Linus J, Manzi I, Merritt M, Mezier L, Miller A, Morris H, Musemakweli D, Musekura U, Mutuyimana D, Ntakarutimana C, Patel N, Scanteianu A, Shemeza BE, Stapleton M, Sterling-Donaldson G, Umutoni C, Uwera L, Zeiler M, Feinberg S. An examination of the barriers to and benefits from collaborative couple contraceptive use in Rwanda. Reprod Health 2021; 18:82. [PMID: 33874969 PMCID: PMC8054403 DOI: 10.1186/s12978-021-01135-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 04/02/2021] [Indexed: 11/20/2022] Open
Abstract
Background Supportive male involvement is strongly correlated with contraceptive use. In Rwanda, where the contraceptive prevalence rate among married women increased from 17 to 52% from 2005 to 2010, and stagnated at 53% in 2015, understanding the role of male partners in collaborative couple contraceptive use can help inform programs designed to further increase the use of contraception in Rwanda. Methods This study utilized qualitative methods in 2018, specifically 32 in-depth interviewers with mostly current users of modern contraceptive methods and eight focus group discussions with family planning providers—both family planning nurses and community health workers (CHWs). Respondents were from Musanze and Nyamasheke Districts, the districts with the highest and lowest modern contraceptive use, respectively, to explore the role of couple collaboration in family planning use in Rwanda. Data were analyzed using the thematic content approach in Atlas.ti (8). Results Findings demonstrate that some men are opposed to use of male methods of contraception, and some are opposed to any contraceptive use, which can lead to covert use. Women and providers prefer collaborative couple contraceptive use—as a result, providers advocate for and encourage male partner participation in contraceptive use. Women are most often burdened with seeking out information, initiating discussions, and sharing information discovered about contraceptive use with partners. Decision-making about contraceptive use, once discussed, can be collaborative and motivated by financial considerations. When couple contraceptive use is collaborative, benefits range from marital harmony to husband’s support of sustained use through reminders about appointments, joint counseling, and support in managing side effects. Conclusion Family planning providers at the community and clinic levels encourage collaborative contraceptive use among couples and some Rwandan couples communicate well about family planning use. Despite the positives, women are expected to source family planning information, share that information with their male partners, seek out family planning services, and use family planning. If more Rwandan male partners accepted use, used male methods of contraception, and participated even more in the work it takes to use family planning, the potential for sustained, and even enhanced, contraceptive use in Rwanda could be realized.
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Affiliation(s)
- Hilary Schwandt
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA.
| | - Angel Boulware
- Spelman College, 350 Spelman Ln SW, Atlanta, GA, 30314, USA
| | - Julia Corey
- Wheaton College, 26 E Main St, Norton, MA, 02766, USA
| | - Ana Herrera
- Northwest Vista Community College, 3535 N Ellison Dr., San Antonio, TX, 78251, USA
| | - Ethan Hudler
- Whatcom Community College, 237 W Kellogg Rd, Bellingham, WA, 98226, USA
| | | | - Ilia King
- Xavier University, 1 Drexel Dr., New Orleans, LA, 70125, USA
| | | | | | - Madelyn Merritt
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA
| | - Lyn Mezier
- SUNY Oswego, 7060 NY-104, Oswego, NY, 13126, USA
| | - Abigail Miller
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA
| | - Haley Morris
- Western Oregon University, 345 Monmouth Ave N, Monmouth, OR, 97361, USA
| | | | - Uwase Musekura
- Eastern Oregon University, One University Blvd, La Grande, OR, 97850, USA
| | | | | | - Nirali Patel
- Arcadia University, 450 S Easton Rd, Glenside, PA, 19038, USA
| | | | | | - Madi Stapleton
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA
| | | | | | | | - Madeleine Zeiler
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA
| | - Seth Feinberg
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA
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[Vasectomy : Current information]. Urologe A 2021; 60:523-532. [PMID: 33738559 DOI: 10.1007/s00120-021-01494-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Abstract
Vasectomy is considered to be the simplest, most effective and cheapest method of fertility control in men, with a significantly lower risk of morbidity and mortality compared to tubal ligation in women. Patient informed consent is particularly important and should include potential irreversibility, surgical options, anesthesia, possible complications as well as postoperative behavior and the need for re-evaluation. There are different access routes available with conventional and no-scalpel vasectomy as well as different techniques for closing the ends of the vas deferens. To confirm sterility the European Association of Urology (EAU) recommends that an ejaculate analysis should be performed 3 months after the procedure and after approximately 20 ejaculations. Complications are relatively rare, although particularly vasectomy failure due to recanalization has to be considered. Approximately 3-6% of vasectomized men strive for a refertilization, which with experienced surgeons is successful in about 90% of cases.
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Latack KR, Yuen F, Wang C, Nguyen BT. Online community queries on hormonal male contraception: An analysis of the Reddit "Ask Me Anything" experience. Contraception 2021; 104:159-164. [PMID: 33617839 DOI: 10.1016/j.contraception.2021.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Reddit is one of the most popular websites in the United States because of its user-driven aggregation and community-based curation of online content. We describe the use and impact of Reddit's Ask Me Anything platform, for public engagement and education about developments in hormonal male contraception (HMC). METHODS We analyzed the content from and user engagement with 2 Reddit Ask Me Anything events that answered user queries about HMC in June 2018 and March 2019. Clinical trial investigators provided real-time responses throughout the events. We examined the 25 most popular posts from each event, analyzing content for salient themes via an inductive approach. To quantify event impact, we examined Google Trends data and subsequent traffic to the investigator website. RESULTS Over 18,000 registered Reddit users interacted with each of the 2 Ask Me Anything events, with each generating over 1600 comments. The most popular posts of each Ask Me Anything event expressed interest in off-target effects associated with the use of HMCs. Additional themes included queries about previous and ongoing clinical trials, HMC physiology, and market analyses and projections of public willingness to use HMCs. The events coincided with a spike in both Google searches for "male birth control" and first-time visits to the study's website where users could express interest in participating in clinical trials. CONCLUSION Reddit Ask Me Anything events conducted by HMC investigators revealed wide public interest in HMCs. The events prompted further searches for more information on male contraception, while driving traffic to the investigator website for trial recruitment purposes. IMPLICATIONS Reddit Ask Me Anything events are a popular, cost-free online platform for publicly responding to a range of HMC-related queries, while providing investigators with insight into stakeholder priorities and preoccupations.
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Affiliation(s)
- Kyle R Latack
- University of Southern California, Department of Obstetrics and Gynecology, Section of Family Planning, Los Angeles, CA, United States
| | - Fiona Yuen
- Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Christina Wang
- Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Brian T Nguyen
- University of Southern California, Department of Obstetrics and Gynecology, Section of Family Planning, Los Angeles, CA, United States.
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Shrader CH, Peters Jefferson K, Kanamori M, Rochat R, Siegler A. "I'd Rather Use a Refuse Bag:" A Qualitative Exploration of a South African Community's Perceptions of Government-Provided Condoms and Participant-Preferred Solutions. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:615-627. [PMID: 32367483 PMCID: PMC7609579 DOI: 10.1007/s10508-020-01701-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 05/26/2023]
Abstract
Despite South Africa experiencing one of the largest HIV epidemics in the world, condom use has decreased since 2008. However, condoms are the only low-cost HIV prevention technology widely available in South Africa. This study aims to explore a South African community's perceptions of condoms, recent condom use decrease, and suggestions for increasing condom use. In 2014, we conducted seven focus groups (n = 40 men) and 20 in-depth interviews (n = 9 men, n = 11 women) with participants aged ≥ 18 years recruited from four urban settlement health clinics in Cape Town, South Africa. Data were collected, coded, and analysed using a general inductive approach. Participants perceived government-provided condoms negatively, with themes including "disgust" for condom physical properties, concerns with social status associated with free condoms, and performance concerns. There was an intersection of themes surrounding masculinity, condom use, and sexual pleasure. Solutions to increase condom use included improving the quality and variety of free condoms and rebranding free condoms. Participants suggested that condoms are distributed with novel attributes (e.g., more colors, smells/flavors, sizes, and in-demand brands) and that government programs should consider offering all brands of condoms at no or low cost. This study suggests a substantial rethinking of condom branding for government-provided condoms. Our findings suggest that condom dissemination and promotion programs should proactively address public concerns regarding condoms. Existing societal and structural norms such as hegemonic masculinity must also be addressed using gender-transformative interventions. We also strongly suggest the creation of a Male Condom Acceptability Scale to understand condom users' needs.
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Affiliation(s)
- Cho-Hee Shrader
- Division of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Ste 1006, Miami, FL, 33132, USA.
| | | | - Mariano Kanamori
- Division of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Ste 1006, Miami, FL, 33132, USA
| | - Roger Rochat
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aaron Siegler
- Department of Epidemiology and Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Cartwright AF, Lawton A, Brunie A, Callahan RL. What About Methods for Men? A Qualitative Analysis of Attitudes Toward Male Contraception in Burkina Faso and Uganda. INTERNATIONAL PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 46:153-162. [PMID: 32985988 DOI: 10.1363/46e9720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT Male contraceptive options are limited; however, product development efforts tend to focus on female methods. Research on attitudes toward methods for men-particularly in regions of low contraceptive prevalence, such as Sub-Saharan Africa-could inform the development of new male methods. METHODS Qualitative data were taken from focus group discussions with 80 men aged 23-67 and 398 women aged 15-50 conducted in Burkina Faso and Uganda in 2016. Transcripts were analyzed thematically to explore support among men and women for male contraceptive methods, and to extract suggestions about ideal method characteristics. RESULTS Male and female participants in both countries expressed support for new male contraceptive options; more positive attitudes were expressed in Uganda than in Burkina Faso. Participants of both sexes recognized that male methods could reduce the family planning burden on women and offer men greater control over their fertility; however, some had concerns about side effects and thought that men would not use contraceptives. Relationship characteristics, such as polygamous unions, were cited as possible challenges. In both countries, various delivery methods (e.g., creams or jellies, injections and implants) and durations (from short-acting to permanent) were proposed. CONCLUSIONS The acceptability of new male methods among most participants in the two countries indicates a potential demand for male contraceptives. Options should include a variety of method characteristics to maximize choice, engage men, and support men and women's contraceptive needs.
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Affiliation(s)
| | - Anna Lawton
- Research associate, Behavioral, Epidemiological & Clinical Sciences Department, FHI 360, Durham, NC, USA
| | - Aurélie Brunie
- Health scientist, Health Services Research Department, FHI 360, Washington, DC
| | - Rebecca L Callahan
- Associate director, Product Development &Introduction Department-all at FHI 360, Durham, NC, USA
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Mathiew M, Dennis BM, Bennetts F, Su NNE, Nguyen N, Botteon A, Baell JB, Ventura S. Synthesis of 2-phenyl-5,6,7,8-tetrahydroquinoxaline derivatives and screening for P2X1-purinoceptor antagonist activity in isolated preparations of rat vas deferens, for translation into a male contraceptive†. Biol Reprod 2020; 103:323-332. [PMID: 32648904 PMCID: PMC7526726 DOI: 10.1093/biolre/ioaa117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/14/2020] [Indexed: 11/21/2022] Open
Abstract
Sympathetically mediated contractions of smooth muscle cells in the vasa deferentia are mediated by neuronally released adenosine 5′-triphosphate (ATP) and noradrenaline, which stimulate P2X1-purinoceptors and α1A-adrenoceptors, respectively. This process is crucial for sperm transport, as demonstrated in knockout mouse studies where simultaneous genetic deletion of P2X1-purinoceptors and α1A-adrenoceptors resulted in male infertility. We hypothesize that dual pharmacological antagonism of these two receptors could inhibit sperm transport sufficiently to provide a novel nonhormonal method of male contraception. To generate a suitable P2X1-purinoceptor antagonist, substituents were introduced on the phenyl moiety of 2-phenyl-5,6,7,8-tetrahydroquinoxaline to create a series of analogues that were tested for P2X1-purinoceptor antagonism in isolated preparations of rat vas deferens. Novel compounds were initially screened for their ability to attenuate contractile responses to electrical field stimulation (EFS: 60 V, 0.5 ms, 0.2 Hz). The addition of polar substituents to the meta, but not ortho, position markedly increased the inhibition of contractions, as did the addition of both polar and aliphatic substituents to the para position. Di-substituted compounds were also synthesized and tested, resulting in a compound 31 (2-hydroxy, 4-fluoro), which exhibited the greatest potency, with an IC50 of 14 μM (95% confidence limits: 12–16 μM). Additionally, compound 31 noncompetitively antagonized contractions mediated by exogenously administered αß-methylene ATP (10 nM–30 μM) but had no inhibitory effect on contractions mediated by exogenously administered noradrenaline (30 nM–100 μM) or acetylcholine (30 nM–100 μM). These results have contributed to a structure–activity relationship profile for the P2X1-purinoceptor that will inform future designs of more potent antagonists.
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Affiliation(s)
- Mitch Mathiew
- Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria. Australia
| | - Belinda M Dennis
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria. Australia
| | - Felix Bennetts
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria. Australia
| | - N N Eunice Su
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria. Australia
| | - Nghi Nguyen
- Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria. Australia
| | - Antony Botteon
- Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria. Australia
| | - Jonathan B Baell
- Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria. Australia
| | - Sabatino Ventura
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria. Australia
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Park S, Shimada K, Fujihara Y, Xu Z, Shimada K, Larasati T, Pratiwi P, Matzuk RM, Devlin DJ, Yu Z, Garcia TX, Matzuk MM, Ikawa M. CRISPR/Cas9-mediated genome-edited mice reveal 10 testis-enriched genes are dispensable for male fecundity. Biol Reprod 2020; 103:195-204. [PMID: 32561905 PMCID: PMC7401030 DOI: 10.1093/biolre/ioaa084] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 11/29/2022] Open
Abstract
As the world population continues to increase to unsustainable levels, the importance of birth control and the development of new contraceptives are emerging. To date, male contraceptive options have been lagging behind those available to women, and those few options available are not satisfactory to everyone. To solve this problem, we have been searching for new candidate target proteins for non-hormonal contraceptives. Testis-specific proteins are appealing targets for male contraceptives because they are more likely to be involved in male reproduction and their targeting by small molecules is predicted to have no on-target harmful effects on other organs. Using in silico analysis, we identified Erich2, Glt6d1, Prss58, Slfnl1, Sppl2c, Stpg3, Tex33, and Tex36 as testis-abundant genes in both mouse and human. The genes, 4930402F06Rik and 4930568D16Rik, are testis-abundant paralogs of Glt6d1 that we also discovered in mice but not in human, and were also included in our studies to eliminate the potential compensation. We generated knockout (KO) mouse lines of all listed genes using the CRISPR/Cas9 system. Analysis of all of the individual KO mouse lines as well as Glt6d1/4930402F06Rik/4930568D16Rik TKO mouse lines revealed that they are male fertile with no observable defects in reproductive organs, suggesting that these 10 genes are not required for male fertility nor play redundant roles in the case of the 3 Glt6D1 paralogs. Further studies are needed to uncover protein function(s), but in vivo functional screening using the CRISPR/Cas9 system is a fast and accurate way to find genes essential for male fertility, which may apply to studies of genes expressed elsewhere. In this study, although we could not find any potential protein targets for non-hormonal male contraceptives, our findings help to streamline efforts to find and focus on only the essential genes.
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Affiliation(s)
- Soojin Park
- Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Experimental Genome Research, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Keisuke Shimada
- Department of Experimental Genome Research, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Yoshitaka Fujihara
- Department of Experimental Genome Research, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
- Department of Bioscience and Genetics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Zoulan Xu
- Department of Experimental Genome Research, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
- Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan
| | - Kentaro Shimada
- Department of Experimental Genome Research, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
- Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan
| | - Tamara Larasati
- Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Experimental Genome Research, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Putri Pratiwi
- Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Ryan M Matzuk
- Center for Drug Discovery, Baylor College of Medicine, Houston, TX, USA
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Darius J Devlin
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Interdepartmental Program in Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Zhifeng Yu
- Center for Drug Discovery, Baylor College of Medicine, Houston, TX, USA
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Thomas X Garcia
- Center for Drug Discovery, Baylor College of Medicine, Houston, TX, USA
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Department of Biology and Biotechnology, University of Houston-Clear Lake, Houston, TX, USA
| | - Martin M Matzuk
- Center for Drug Discovery, Baylor College of Medicine, Houston, TX, USA
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Masahito Ikawa
- Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Experimental Genome Research, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
- Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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Salicioni AM, Gervasi MG, Sosnik J, Tourzani DA, Nayyab S, Caraballo DA, Visconti PE. Testis-specific serine kinase protein family in male fertility and as targets for non-hormonal male contraception†. Biol Reprod 2020; 103:264-274. [PMID: 32337545 PMCID: PMC7401350 DOI: 10.1093/biolre/ioaa064] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 11/14/2022] Open
Abstract
Male contraception is a very active area of research. Several hormonal agents have entered clinical trials, while potential non-hormonal targets have been brought to light more recently and are at earlier stages of development. The general strategy is to target genes along the molecular pathways of sperm production, maturation, or function, and it is predicted that these novel approaches will hopefully lead to more selective male contraceptive compounds with a decreased side effect burden. Protein kinases are known to play a major role in signaling events associated with sperm differentiation and function. In this review, we focus our analysis on the testis-specific serine kinase (TSSK) protein family. We have previously shown that members of the family of TSSKs are postmeiotically expressed in male germ cells and in mature mammalian sperm. The restricted postmeiotic expression of TSSKs as well as the importance of phosphorylation in signaling processes strongly suggests that TSSKs have an important role in germ cell differentiation and/or sperm function. This prediction has been supported by the reported sterile phenotype of the Tssk6 knockout (KO) mice and of the double Tssk1 and Tssk2 KO mice and by the male subfertile phenotype observed in a Tssk4 KO mouse model.
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Affiliation(s)
- Ana M Salicioni
- Department of Veterinary and Animal Sciences, University of Massachusetts-Amherst, Integrated Sciences Building 427S, 661 North Pleasant Street, Amherst MA 01003, USA
- Molecular and Cellular Biology Graduate Program, University of Massachusetts, Amherst, MA, USA
| | - María G Gervasi
- Department of Veterinary and Animal Sciences, University of Massachusetts-Amherst, Integrated Sciences Building 427S, 661 North Pleasant Street, Amherst MA 01003, USA
| | - Julian Sosnik
- Department of Biology, University of Massachusetts, Boston, MA, USA
| | - Darya A Tourzani
- Department of Veterinary and Animal Sciences, University of Massachusetts-Amherst, Integrated Sciences Building 427S, 661 North Pleasant Street, Amherst MA 01003, USA
- Biotechnology Training Program, University of Massachusetts, Amherst, MA, USA
| | - Saman Nayyab
- Department of Veterinary and Animal Sciences, University of Massachusetts-Amherst, Integrated Sciences Building 427S, 661 North Pleasant Street, Amherst MA 01003, USA
- Molecular and Cellular Biology Graduate Program, University of Massachusetts, Amherst, MA, USA
| | - Diego A Caraballo
- IFIBYNE-CONICET, Department of Physiology, Molecular and Cellular Biology, University of Buenos Aires, Buenos Aires, Argentina
| | - Pablo E Visconti
- Department of Veterinary and Animal Sciences, University of Massachusetts-Amherst, Integrated Sciences Building 427S, 661 North Pleasant Street, Amherst MA 01003, USA
- Molecular and Cellular Biology Graduate Program, University of Massachusetts, Amherst, MA, USA
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Yuen F, Nguyen BT, Swerdloff RS, Wang C. Continuing the search for a hormonal male contraceptive. Best Pract Res Clin Obstet Gynaecol 2020; 66:83-94. [PMID: 32197832 PMCID: PMC7375909 DOI: 10.1016/j.bpobgyn.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/28/2020] [Accepted: 02/09/2020] [Indexed: 11/28/2022]
Abstract
This chapter discusses the mechanisms of action of hormonal male contraception, which suppresses the hypothalamic-pituitary-testis axis. When the intratesticular concentration of testosterone is subsequently suppressed to adequately low concentrations, spermatogenesis is arrested. Androgens are a necessary hormonal male contraceptive component because they not only suppress the hypothalamic-pituitary-testis axis, but also provide the male hormone necessary to maintain peripheral androgen functions. Past studies using testosterone alone and testosterone combined with progestins demonstrated contraceptive efficacy in the female partner at rates similar to combined hormonal female methods. Newer hormonal male contraceptive formulations and the alternative routes of administration are discussed, along with potential barriers, challenges, and opportunities for hormonal male contraceptive development. Novel methods that are safe, effective, reversible, user-friendly, and coitus-independent are intrinsic to equitably meet the various needs and limitations of an increasingly diverse population.
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Affiliation(s)
- Fiona Yuen
- Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90509, USA.
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90007, USA.
| | - Ronald S Swerdloff
- Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90509, USA
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90509, USA.
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Abstract
The economic and public health burdens of unplanned pregnancies are evident globally. Since the introduction of the condom >300 years ago, assumptions about male willingness to participate in contraception, as well as concerns about failure rates and side effects, have stagnated the development of additional reversible male contraceptives. However, changing attitudes and recent research advances have generated renewed interest in developing reversible male contraceptives. To achieve effective and reversible suppression of spermatogenesis, male hormonal contraception relies on suppression of testicular testosterone and sperm production using an androgen-progestin combination. While these may be associated with side effects—changes in libido, weight, hematocrit, and cholesterol—recently, novel androgens and progestins have shown promise for a “male pill” with reduced side effects. Here we summarize landmark studies in male contraceptive development, showcase the most recent advances, and look into the future of this field, which has the potential to greatly impact global public health.
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Affiliation(s)
- Arthi Thirumalai
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington 98195, USA
| | - Stephanie T. Page
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington 98195, USA
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Long JE, Lee MS, Blithe DL. Male Contraceptive Development: Update on Novel Hormonal and Nonhormonal Methods. Clin Chem 2019; 65:153-160. [PMID: 30602479 DOI: 10.1373/clinchem.2018.295089] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/20/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Development of new methods of male contraception would address an unmet need for men to control their fertility and could increase contraceptive options for women. Pharmaceutical research and development for male contraception was active in the 1990s but has been virtually abandoned. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) has supported a contraceptive development program since 1969 and supports the majority of hormonal male contraceptive development. Nonhormonal methods are also in development but are at earlier stages. CONTENT Several hormonal male contraceptive agents have entered clinical trials. Single-agent products being evaluated include dimethandrolone undecanoate, 11β-methyl-nortestosterone dodecyl carbonate, and 7α-methyl-19-nortestosterone. A contraceptive efficacy trial of Nestorone® gel and testosterone gel in a single application will begin in 2018. Potential nonhormonal methods are at preclinical stages of development. Many nonhormonal male contraceptive targets that affect either sperm production or sperm function have been identified. Targeted pathways include the retinoic acid pathway, bromodomain and extraterminal proteins, and pathways for Sertoli cell-germ cell adhesion or sperm motility. Druggable targets include CatSper, the sperm Na+/K+-exchanger, TSSK, HIPK4, EPPIN, and ADAMs family proteins. Development of a procedure to reversibly block the vas deferens (initially developed in India in the 1980s) is undergoing early stage research in the US under the trade name Vasalgel™. SUMMARY NICHD has supported the development of reversible male contraceptive agents. Other organizations such as the World Health Organization and the Population Council are pursuing male contraceptive development, but industry involvement remains dormant.
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Affiliation(s)
- Jill E Long
- Contraceptive Development Program; Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
| | - Min S Lee
- Contraceptive Development Program; Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Diana L Blithe
- Contraceptive Development Program; Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
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Reynolds-Wright JJ, Anderson R. Male contraception: where are we going and where have we been? BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:bmjsrh-2019-200395. [PMID: 31537614 PMCID: PMC6892591 DOI: 10.1136/bmjsrh-2019-200395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/13/2019] [Accepted: 08/30/2019] [Indexed: 05/22/2023]
Abstract
Progress in developing new reversible male contraception has been slow. While the hormonal approach has been clearly shown to be capable of providing effective and reversible contraception, there remains no product available. Currently, trials of a self-administered gel combination of testosterone and the progestogen Nestorone® are under way, complementing the largely injectable methods previously investigated. Novel long-acting steroids with both androgenic and progestogenic activity are also in early clinical trials. The non-hormonal approach offers potential advantages, with potential sites of action on spermatogenesis, and sperm maturation in the epididymis or at the vas, but remains in preclinical testing. Surveys indicate the willingness of men, and their partners, to use a new male method, but they continue to lack that opportunity.
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Affiliation(s)
- John Joseph Reynolds-Wright
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Richard Anderson
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Moroole MA, Materechera SA, Mbeng WO, Aremu AO. Medicinal plants used for contraception in South Africa: A review. JOURNAL OF ETHNOPHARMACOLOGY 2019; 235:19-27. [PMID: 30731180 DOI: 10.1016/j.jep.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 05/25/2023]
Abstract
UNLABELLED ETHNOPHARMACOLOGICAL RELEVANCE: The indigenous people of South Africa, such as the Khoisan, Zulu, and Ndebele, have used medicinal plants for contraception. One of the reasons for using contraception among indigenous communities is for child spacing. AIM OF THE STUDY The study aims to review medicinal plants used for contraception in South Africa as potential sources for the discovery and development of safe male and female hormonal contraceptives. MATERIALS AND METHODS A literature search was conducted on medicinal plants used for contraception in South Africa by referencing textbooks and scientific databases such as Google Scholar, Science Direct, PubMed, North-West University Institutional Repository, National ETD Portal, government policies and documents on contraception, theses and dissertations, and other web sources such as records from SANBI and PROTA. RESULTS A minimum of 25 medicinal plants were identified as being used for contraception in South Africa, and these plants included local and exotic plants. Medicinal plants with contraceptive activity are Bulbine latifolia, Pouzolzia mixta, Salsola tuberculatiformis, Securidaca longipedunculata, and Typha capensis. In vivo and in vitro studies showed a decrease in mount, intromission and ejaculatory frequencies, inhibition of implantation, contraceptive effect, displaced glucocorticoids, and prolonged diestrus or had negative effects on vitality, motility, and sperm production. CONCLUSIONS Some of the plants used for contraception in South Africa are toxic to both animals and humans. Research is needed focusing on medicinal plants used by men for contraception and by women for postcoital contraception in South Africa. Traditional healers must be included when drafting contraception policies and interventions. Medicinal plants such as B. latifolia and P. mixta demonstrated that medicinal plants used for contraception in South Africa are potential sources for the discovery and development of safe male and female hormonal contraceptives.
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Affiliation(s)
- M A Moroole
- Indigenous Knowledge Systems (IKS) Centre, Faculty of Natural and Agricultural Sciences, North West University, Private Mail Bag X2046, Mmabatho 2790, North West Province, South Africa.
| | - S A Materechera
- Indigenous Knowledge Systems (IKS) Centre, Faculty of Natural and Agricultural Sciences, North West University, Private Mail Bag X2046, Mmabatho 2790, North West Province, South Africa.
| | - W Otang Mbeng
- School of Biology and Environmental Sciences, Faculty of Natural Sciences and Agriculture, University of Mpumalanga, Mbombela Campus, P/bag X11283, Nelspruit 1200, Mpumalanga, South Africa.
| | - A O Aremu
- Indigenous Knowledge Systems (IKS) Centre, Faculty of Natural and Agricultural Sciences, North West University, Private Mail Bag X2046, Mmabatho 2790, North West Province, South Africa.
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Research update and opportunity of non-hormonal male contraception: Histone demethylase KDM5B-based targeting. Pharmacol Res 2019; 141:1-20. [DOI: 10.1016/j.phrs.2018.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 11/29/2018] [Accepted: 12/09/2018] [Indexed: 12/28/2022]
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Wu S, Yuen F, Swerdloff RS, Pak Y, Thirumalai A, Liu PY, Amory JK, Bai F, Hull L, Blithe DL, Anawalt BD, Parman T, Kim K, Lee MS, Bremner WJ, Page ST, Wang C. Safety and Pharmacokinetics of Single-Dose Novel Oral Androgen 11β-Methyl-19-Nortestosterone-17β-Dodecylcarbonate in Men. J Clin Endocrinol Metab 2019; 104:629-638. [PMID: 30252057 PMCID: PMC6334268 DOI: 10.1210/jc.2018-01528] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/19/2018] [Indexed: 01/09/2023]
Abstract
Context 11β-Methyl-19-nortestosterone-17β-dodecylcarbonate (11β-MNTDC) is an orally bioavailable prodrug of 11β-methyl-19-nortestosterone (11β-MNT) with androgenic and progestational activity. Objectives (i) Quantify 11β-MNT binding to androgen and progesterone receptors. (ii) Evaluate safety, tolerability, and serum gonadotropin and testosterone suppression by 11β-MNTDC in men. Design and Setting (i) In vitro receptor binding and transactivation studies and (ii) randomized, double-blind, placebo-controlled single-dose, dose-escalating phase I study at two academic medical centers. Participants and Intervention Twelve healthy male volunteers were randomized (five active, one placebo) to escalating single oral doses (100, 200, 400, and 800 mg) of 11β-MNTDC or placebo given with or without food. Main Outcome Measures (i) In vitro 11β-MNT/11β-MNTDC human receptor binding and transactivation and (ii) safety and tolerability, pharmacokinetics, and quantification of serum gonadotropin and testosterone concentrations for 24 hours following dosing. Results 11β-MNT avidly binds and activates human androgen and progesterone receptors, but 11β-MNTDC has minimal activity. Single oral doses of 11β-MNTDC were well tolerated without serious adverse events. Administration of 11β-MNTDC with food markedly increased average 11β-MNTDC and 11β-MNT serum concentrations (P < 0.001 for all doses) compared with fasting with a significant dose-related effect on average serum drug concentrations (P < 0.0001). The 200-, 400-, and 800-mg doses significantly suppressed average serum testosterone concentrations (P < 0.05). Conclusions A single, oral dose of 11β-MNTDC up to 800 mg administered with food is safe and well tolerated in healthy men. The active drug 11β-MNT has androgenic and progestational activity, rapidly suppresses serum testosterone, and is a promising candidate for an effective once-daily oral male hormonal contraceptive.
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Affiliation(s)
- Sherry Wu
- Department of Medicine, University of Washington, Seattle, Washington
| | - Fiona Yuen
- Department of Medicine, Division of Endocrinology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Ronald S Swerdloff
- Department of Medicine, Division of Endocrinology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Youngju Pak
- Department of Medicine, Division of Endocrinology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Arthi Thirumalai
- Department of Medicine, University of Washington, Seattle, Washington
| | - Peter Y Liu
- Department of Medicine, Division of Endocrinology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - John K Amory
- Department of Medicine, University of Washington, Seattle, Washington
| | - Feng Bai
- Department of Medicine, Division of Endocrinology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Laura Hull
- Department of Medicine, Division of Endocrinology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Diana L Blithe
- Contraception Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Bradley D Anawalt
- Department of Medicine, University of Washington, Seattle, Washington
| | - Toufan Parman
- SRI International Biosciences Division, Menlo Park, California
| | - Kyuri Kim
- SRI International Biosciences Division, Menlo Park, California
| | - Min S Lee
- Contraception Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - William J Bremner
- Department of Medicine, University of Washington, Seattle, Washington
| | - Stephanie T Page
- Department of Medicine, University of Washington, Seattle, Washington
| | - Christina Wang
- Department of Medicine, Division of Endocrinology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
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Amouroux M, Mieusset R, Desbriere R, Opinel P, Karsenty G, Paci M, Fernandes S, Courbiere B, Perrin J. Are men ready to use thermal male contraception? Acceptability in two French populations: New fathers and new providers. PLoS One 2018; 13:e0195824. [PMID: 29813095 PMCID: PMC5973589 DOI: 10.1371/journal.pone.0195824] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 03/30/2018] [Indexed: 11/21/2022] Open
Abstract
Background Since the 1970s, international research has actively pursued hormonal male contraception (HMC) and, to a lesser extent, thermal male contraception (TMC). Although the efficacy of TMC has been confirmed in limited populations, its acceptability has not been studied in either potential users or potential prescribers. Methods A cross-sectional descriptive multicentre study of potential male users of TMC (new fathers) and potential prescribers of TMC (new providers) was conducted between November 2016 and February 2017.The participants completed a 3-part survey, and their responses were evaluated to i) determine their socio-demographic profiles; ii) identify personal experiences with contraception; and iii) gauge the participants’ knowledge, interest and preference for male contraception, particularly TMC. For new providers only, the survey included a fourth part to evaluate professional experience with male contraception. Results The participation rate was 51% for new fathers (305 NFs) and 34% for new providers (300 NPs, including 97 men (male new providers, MNPs) and 203 women (female new providers, FNPs)). Only 3% of NFs and 15% of NPs knew about TMC (including 26% of the MNPs and 10% of the FNPs, p<0.01). After reading information on TMC, new fathers were significantly less willing to try TMC (29%) than were new providers (40%) (p<0.01). The 3 main advantages of TMC for the new fathers included the following factors: “natural” (52%), “without side effects” (38%) and “non-hormonal” (36%). The main disadvantages were “lengthy wear time” (56%), “daily undergarment wear” (43%) and “concern about possible discomfort” (39%). Conclusions Young male and female providers have limited knowledge of male contraception, are interested in further information and would generally prescribe TMC to their patients. Successful expansion of the use of male contraception, including TMC, would require distribution of better information to potential users and providers.
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Affiliation(s)
- Marie Amouroux
- Département Universitaire de Médecine Générale Faculté de Médecine de Marseille Aix-Marseille Université, Marseille, France
| | - Roger Mieusset
- Université Toulouse III-Paul Sabatier, Groupe de Recherche en Fertilité Humaine (Human Fertility Research Group), Toulouse, France
- Andrologie-Médecine de la Reproduction, Hôpital Paule de Viguier, CHU de Toulouse, Toulouse, France
| | - Raoul Desbriere
- Service de Gynécologie-Obstétrique, Pôle Parents Enfants, Hôpital Saint-Joseph, Bd de Louvain, Marseille, France
| | - Pierre Opinel
- Centre Hospitalier Pays d'Aix, Aix-en-Provence, France
| | - Gilles Karsenty
- Service d’Urologie et Transplantation Rénale, Aix Marseille Université, CHU La Conception, Marseille, France
| | - Marine Paci
- Aix Marseille Univ, INSERM, GMGF UMR_S 910, Marseille, France
- AP-HM La Conception, Centre Clinico-Biologique d'Assistance Médicale à la Procréation -CECOS, Marseille, France
| | - Sara Fernandes
- Laboratoire de Santé Publique, bd Jean Moulin–Marseille, France
| | - Blandine Courbiere
- AP-HM La Conception, Centre Clinico-Biologique d'Assistance Médicale à la Procréation -CECOS, Marseille, France
- Aix Marseille Univ, CNRS, IRD, Avignon Univ, IMBE UMR 7263, Marseille, France
| | - Jeanne Perrin
- AP-HM La Conception, Centre Clinico-Biologique d'Assistance Médicale à la Procréation -CECOS, Marseille, France
- Aix Marseille Univ, CNRS, IRD, Avignon Univ, IMBE UMR 7263, Marseille, France
- * E-mail:
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Capurchande R, Coene G, Roelens K, Meulemans H. "If I have only two children and they die… who will take care of me?" -a qualitative study exploring knowledge, attitudes and practices about family planning among Mozambican female and male adults. BMC WOMENS HEALTH 2017; 17:66. [PMID: 28830390 PMCID: PMC5568310 DOI: 10.1186/s12905-017-0419-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 08/08/2017] [Indexed: 11/16/2022]
Abstract
Background By focusing upon family planning counselling services, the Mozambican government has significantly enhanced the general health of female and male clients. However, little is known about the experiences of family planning by female and male adults. This article focuses on knowledge, attitudes and practices regarding contraceptive methods and fertility intentions. Methods An in-depth qualitative study of female and male clients was conducted in two settings in Maputo province – Ndlavela and Boane. A total of sixteen in-depth interviews, four informal conversations, and observations were equally divided between both study sites. The analysis followed a constructionist approach. Three steps were considered in the analysis: examining commonalities, differences and relationships. Results Although there was a high level of family planning knowledge, there were discrepancies in clients’ everyday practices. Male and female clients are confronted with a variety of expectations concerning fertility intentions and family size, and are under pressure in numerous ways. Social pressures include traditional expectations and meanings connected to having children, as well as religious factors. Short interaction time between clients and health workers is a problem. Additionally, imposed contraceptive methods, and typically brief conversations about birth control between couples only adds to the burden. Because family planning is largely viewed as a woman’s concern, most clients have never attended counselling sessions with their partners. Attitudes towards responsibility for contraceptive use and risk-taking are strongly gendered. Conclusions Female and male clients have differing expectations about contraceptive use and fertility intentions. They participate differently in family planning programs leading to their inconsistent and ambivalent practices as well as vague perceptions of risk-taking. Therefore, policymakers must address the reasons behind ambivalence and inconsistency regarding contraceptives and family planning.
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Affiliation(s)
- Rehana Capurchande
- Department of Sociology, Eduardo Mondlane University, Maputo, Mozambique. .,Campus Universitário Principal, 257, Maputo, CP, Mozambique. .,Centre of Expertise in in Gender and Diversity, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium.
| | - Gily Coene
- Department of Philosophy and Ethics, Centre of Expertise in Gender and Diversity, Vrije Universiteit Brussel (VUB), Pleinlaan 2, B-1050, Brussels, Belgium
| | - Kristien Roelens
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Herman Meulemans
- Department of Sociology and Centre for Longitudinal and Life Course Studies, Universiteit Antwerpen (Antwerp University), Sint-Jacobstraat 2, BE-2000, Antwerpen, Belgium.,Centre for Health Systems Research and Development (CHSR&D), University of the Free State, Bloemfontein, South Africa
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Piotrowska K, Wang C, Swerdloff RS, Liu PY. Male hormonal contraception: hope and promise. Lancet Diabetes Endocrinol 2017; 5:214-223. [PMID: 26915313 PMCID: PMC4993687 DOI: 10.1016/s2213-8587(16)00034-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/05/2016] [Accepted: 01/12/2016] [Indexed: 02/01/2023]
Abstract
Family planning is a shared responsibility, but available male-directed contraceptive methods are either not easily reversible (vasectomy) or not sufficiently effective (condom). However, roughly 20% of couples using a contraceptive method worldwide, and up to 80% in some countries, still choose a male-directed method. Male hormonal contraception is highly effective, with perfect use failure rates of 0·6% (95% CI 0·3-1·1) if sperm concentrations of less than 1 million per mL are maintained. After cessation of male hormonal contraception, sperm output fully recovers in a predictable manner, resulting in pregnancies and livebirths. Spontaneous miscarriage and fetal malformation rates after recovery of sperm output overlap those in the general population. Short-term adverse events-acne, night sweats, increased weight, and altered mood and libido-are recognised, but are generally mild. Further optimisation of specific androgen-progestin regimens and phase 3 studies of lead combinations are still needed to successfully develop an approved male hormonal contraceptive and to identify long-term side-effects.
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Affiliation(s)
- Katarzyna Piotrowska
- Division of Endocrinology, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute (LA BioMed) Torrance, CA, USA
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute (LA BioMed) Torrance, CA, USA
| | - Ronald S Swerdloff
- Division of Endocrinology, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute (LA BioMed) Torrance, CA, USA
| | - Peter Y Liu
- Division of Endocrinology, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute (LA BioMed) Torrance, CA, USA.
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Hardee K, Croce-Galis M, Gay J. Are men well served by family planning programs? Reprod Health 2017; 14:14. [PMID: 28115004 PMCID: PMC5260026 DOI: 10.1186/s12978-017-0278-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/04/2017] [Indexed: 11/24/2022] Open
Abstract
Although the range of contraceptives includes methods for men, namely condoms, vasectomy and withdrawal that men use directly, and the Standard Days Method (SDM) that requires their participation, family planning programming has primarily focused on women. What is known about reaching men as contraceptive users? This paper draws from a review of 47 interventions that reached men and proposes 10 key considerations for strengthening programming for men as contraceptive users. A review of programming shows that men and boys are not particularly well served by programs. Most programs operate from the perspective that women are contraceptive users and that men should support their partners, with insufficient attention to reaching men as contraceptive users in their own right. The notion that family planning is women’s business only is outdated. There is sufficient evidence demonstrating men’s desire for information and services, as well as men’s positive response to existing programming to warrant further programming for men as FP users. The key considerations focus on getting information and services where men and boys need it; addressing gender norms that affect men’s attitudes and use while respecting women’s autonomy; reaching adolescent boys; including men as users in policies and guidelines; scaling up successful programming; filling gaps with implementation research and monitoring & evaluation; and creating more contraceptive options for men.
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Affiliation(s)
- Karen Hardee
- Population Council, 4301 Connecticut Ave NW, Ste. 280, Washington, DC, 20008, USA.
| | | | - Jill Gay
- What Works Association, 54 Mills St, Morristown, New Jersey, 07960, USA
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Shattuck D, Perry B, Packer C, Chin Quee D. A Review of 10 Years of Vasectomy Programming and Research in Low-Resource Settings. GLOBAL HEALTH, SCIENCE AND PRACTICE 2016; 4:647-660. [PMID: 28031302 PMCID: PMC5199180 DOI: 10.9745/ghsp-d-16-00235] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/27/2016] [Indexed: 11/18/2022]
Abstract
Vasectomy is a highly effective and safe contraceptive method for couples who want to stop childbearing, but only 2.4% of men around the world use this method. We conducted an extensive review of the vasectomy research literature and programmatic reports, published between April 2005 and April 2015, to synthesize barriers and facilitators to vasectomy adoption. Of the more than 230 documents initially retrieved in our search, we ultimately included 75 documents in our review and synthesized the findings according to the Supply-Enabling Environment-Demand (SEED) Programming Model. Regarding promoting demand for vasectomy services, we found there was a general lack of awareness about the method among both men and women, which often fueled erroneous assumptions about how vasectomy affects men. Several types of programmatic activities directly addressed knowledge gaps and negative misperceptions, including community-based and mass media communications, employer-based promotion, and group counseling. For supply of services, the lack of or inaccurate knowledge about vasectomy was also prevalent among providers, particularly among community-based health workers. Programmatic activities to improve service delivery included the use of evidence-based vasectomy techniques such as no-scalpel vasectomy, whole-site trainings, task shifting, cascade training, and mobile outreach. Finally, programmatic approaches to building a more enabling environment included engagement of governments and other community and religious leaders as well as campaigns with gender transformative messaging that countered common myths and encouraged men's positive engagement in family planning and reproductive health. In summary, a successful vasectomy program is comprised of the mutually reinforcing components of continual demand for services and access to and supply of well-trained providers. In addition, there is an underlying need for enabling policies within the cultural and gender environments that extend beyond vasectomy and include men not just as default partners of female family planning clients but as equal beneficiaries of family planning and reproductive health programs in their own right. Accelerating progress toward meaningful integration of vasectomy into a comprehensive contraceptive method mix is only possible when political and financial will are aligned and support the logistical and promotional activities of a male reproductive health agenda.
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Affiliation(s)
- Dominick Shattuck
- Georgetown University's Institute for Reproductive Health, Washington, DC, USA.
| | - Brian Perry
- Duke Clinical Research Institute, Durham, NC, USA
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Ayoub R, Page ST, Swerdloff RS, Liu PY, Amory JK, Leung A, Hull L, Blithe D, Christy A, Chao JH, Bremner WJ, Wang C. Comparison of the single dose pharmacokinetics, pharmacodynamics, and safety of two novel oral formulations of dimethandrolone undecanoate (DMAU): a potential oral, male contraceptive. Andrology 2016; 5:278-285. [PMID: 27907978 DOI: 10.1111/andr.12303] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/20/2016] [Accepted: 10/20/2016] [Indexed: 11/27/2022]
Abstract
Dimethandrolone (DMA, 7α,11β-dimethyl-19-nortestosterone) has both androgenic and progestational activities, ideal properties for a male hormonal contraceptive. In vivo, dimethandrolone undecanoate (DMAU) is hydrolyzed to DMA. We showed previously that single oral doses of DMAU powder in capsule taken with food are well tolerated and effective at suppressing both LH and testosterone (T), but absorption was low. We compared the pharmacokinetics and pharmacodynamics of two new formulations of DMAU, in castor oil and in self-emulsifying drug delivery systems (SEDDS), with the previously tested powder formulation. DMAU was dosed orally in healthy adult male volunteers at two academic medical centers. For each formulation tested in this double-blind, placebo-controlled study, 10 men received single, escalating, oral doses of DMAU (100, 200, and 400 mg) and two subjects received placebo. All doses were evaluated for both fasting and with a high fat meal. All three formulations were well tolerated without clinically significant changes in vital signs, blood counts, or serum chemistries. For all formulations, DMA and DMAU showed higher maximum (p < 0.007) and average concentrations (p < 0.002) at the 400 mg dose, compared with the 200 mg dose. The powder formulation resulted in a lower conversion of DMAU to DMA (p = 0.027) compared with both castor oil and SEDDS formulations. DMAU in SEDDS given fasting resulted in higher serum DMA and DMAU concentrations compared to the other two formulations. Serum LH and sex hormone concentrations were suppressed by all formulations of 200 and 400 mg DMAU when administered with food, but only the SEDDS formulation was effectively suppressed serum T when given fasting. We conclude that while all three formulations of oral DMAU are effective and well tolerated when administered with food, DMAU in oil and SEDDS increased conversion to DMA, and SEDDS may have some effectiveness when given fasting. These properties might be advantageous for the application of DMAU as a male contraceptive.
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Affiliation(s)
- R Ayoub
- Department of Medicine, Division of Endocrinology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - S T Page
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R S Swerdloff
- Department of Medicine, Division of Endocrinology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - P Y Liu
- Department of Medicine, Division of Endocrinology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - J K Amory
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - A Leung
- Department of Medicine, Division of Endocrinology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - L Hull
- Department of Medicine, Division of Endocrinology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - D Blithe
- Contraception Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - A Christy
- Contraception Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - J H Chao
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - W J Bremner
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - C Wang
- Department of Medicine, Division of Endocrinology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
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Dereuddre R, Van de Velde S, Bracke P. Gender inequality and the ‘East-West’ divide in contraception: An analysis at the individual, the couple, and the country level. Soc Sci Med 2016; 161:1-12. [DOI: 10.1016/j.socscimed.2016.05.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/15/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
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Waller D, Bolick D, Lissner E, Premanandan C, Gamerman G. Azoospermia in rabbits following an intravas injection of Vasalgel ™. Basic Clin Androl 2016; 26:6. [PMID: 27030808 PMCID: PMC4812607 DOI: 10.1186/s12610-016-0033-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 03/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vasectomy is currently the only long-acting contraceptive option available for men, despite increasing demand and potentially significant positive impacts on human health of additional male contraceptive options. Vasalgel ™ is a high molecular weight hydrogel polymer being developed as a non-hormonal long-acting reversible male contraceptive. Vasalgel consists of styrene-alt-maleic acid dissolved in dimethyl sulfoxide, which is distinct from styrene-alt-maleic anhydride materials previously studied. METHODS The goal of the study was to determine the contraceptive efficacy of two test articles with different levels of styrene maleic acid (100 %, and 80 % acid/20 % anhydride). The test articles were injected bilaterally in the vasa deferentia of mature male rabbits. Post-implantation analyses of semen parameters were completed over a 12 month period and compared to baseline measures of sperm concentration, motility and forward progression. RESULTS Both test articles were effective in blocking the passage of spermatozoa through the vasa deferentia in the 12 subjects completing the study. A significant decrease in sperm concentration occurred following implantation of the test material, with no measurable sperm concentration except for a few samples in one animal that were markedly oligospermic. Vasalgel produced a rapid onset of azoospermia, with no sperm in semen samples collected as early as 29-36 days post-implantation, and was durable over a 12 month period. CONCLUSION This study indicated that Vasalgel is an effective non-hormonal long-acting male contraceptive in a rabbit model.
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Affiliation(s)
- Donald Waller
- />Prelabs, LLC Inc., 33 W Chicago Ave., Oak Park, IL 60302 USA
| | - David Bolick
- />Seraphim Life Sciences Consulting, LLC, 2158 Bonaventure Drive, Suite 101, Vienna, VA 22181 USA
| | - Elaine Lissner
- />Parsemus Foundation, PO Box 2246, Berkeley, CA 94702 USA
| | - Christopher Premanandan
- />Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, 1925 Coffey Road, Columbus, OH 43215 USA
| | - Gary Gamerman
- />Seraphim Life Sciences Consulting, LLC, 2158 Bonaventure Drive, Suite 101, Vienna, VA 22181 USA
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