When some of the most innovative thinkers in contraception research meet to discuss the future of birth control this weekend, they won't just be discussing estrogen and IUDs.
They'll be talking about men.
Indeed, male birth control is a key focus of the Future of Contraception Initiative, which kicks off Saturday and is sponsored by the Bill and Melinda Gates Foundation. Researchers will be grappling with safe, realistic options that might soon be available -- expanding our current scant array of condom or vasectomy.
"The United Nations is predicting the world population is going to hit 7 billion people in the middle of this conference, and in a lot of those cases, it's women who get pregnant and did not want to," said Dr. William Bremner, professor and chair at the University of Washington's Department of Medicine and one of the organizing committee's members.
"Birth control helps couples and communities and nations to have more control," he continued. "Certainly, there's a huge need for new contraceptives."
A need, and also promise. Among the most imminent options are hormonal contraceptives for men.
By combining testosterone and progestin, the synthetic hormone also present in many female birth controls, researchers have found they are able to turn off sperm production in most, but not all, men. Bremner estimated there are 2,000 to 3,000 men in trials who have been on hormonal methods over the last 10 to 15 years.
Now, the question is when they might actually hit the market.
"The proof of concept has been demonstrated in hormonal products, so it is up to a commercial entity to move it forward to FDA approval and marketing," said Diana Blithe, Ph.D., program director for contraceptive development at the National Institute of Child Health and Human Development.
When available to consumers, they could be taken in pill form, implanted in the skin, or applied as a gel or patch.
But hormonal options aren't the only area of focus.
Researchers are also looking at non-hormonal contraceptives that directly interfere with sperm production. Conceptually, they would be very similar to a vasectomy, but reversible.
Blithe said researchers have identified some 20 possible targets in the body, but cautioned that the research is still far from use in practical application, as even the most promising options are still in the pre-clinical phase.
At the very best, she predicted non-hormonal barriers could become available in 10 years.
During the conference, researchers will also be tackling what may be the true million dollar question: If and when male contraceptives become a reality, will men actually use them? Or has preventing pregnancy become the woman's job?
A recent multi-national study in the journal Human Reproduction suggests men are, in fact, interested.
Looking at more than 9,000 males between ages 18 to 50 in nine different countries, researchers found that overall, more than 55 percent said they'd be willing to personally use or take a new agent to control fertility. In some populations, it was closer to three quarters of men who expressed enthusiasm for the idea.
In more current, concrete terms, the Centers for Disease Control states that between 2006 and 2008, condoms and vasectomy accounted for approximately 16 percent of all contraceptive use in the U.S. According to Bremner, other estimates have put that number at closer to 30 percent.
While this may not seem like much, he argued it substantiates the notion that men are indeed interested in using birth control.
"Vasectomy is very effective [at preventing pregnancy], but virtually irreversible, and condoms aren't as good and often men don't like them," Bremner said. "But even though those that are available have problems, men still use them fairly regularly."
Which means, then, that if better options were available, more men might be willing to use them, taking some of the burden off women.
Bremner believes that one of the biggest obstacles is simply generating attention around, and funding for, continued male contraception research. And this, he said, is what is so meaningful about the Gates foundation stepping in to providing funding for FOCI. In the roughly 20 years he has been working in male contraception research, he hasn't seen a real growth in the amount of money coming in from foundations, the government or the pharmaceutical industry -- money that would fuel advancement.
"We may be having a little mini renaissance in this area, in part because of this relentless growth in population worldwide," Bremner said. "There's a pretty common perception out there that men are useless, more or less, when it comes to contraception, and that may not be the case."
