The Future of Birth Control

"The Future of Birth Control." Denise Mann, July 17, 2003 http://www.medicinenet.com/script/main/art.asp?articlekey=52189

Where are we going in the field of contraception? The past several years have seen more advances in birth control than the previous several decades. With so many new hormones, drugs, and methods of contraception, many believe that we are beginning to hit the limitation of innovation with contraception. However, reproductive health experts indicate that future contraceptives will kill two birds with one stone: prevent pregnancy in addition to protectagainst cancers, sexually transmitted infections, or some other maladies. A male contraceptive to protect against testicular cancer? Why not. But is the coupling of disease treatment with contraception such a good idea?

Canadian researchers are currently experimenting with a birth control pill that conforms to current social attitudes toward pregnancy. The pill will not only delay ovulation when undesired in the teens and 20s, but resumes ovulation when women are ready to have children, and will delay menopause, thereby extending the years of fertility, well into the 50s and 60s. The pill may function to slow down the biological clock in women by preserving the eggs that would have been wasted in their 20s until they want to have children, as more and more women do, in their 40s and 50s. This idea seems fantastic for those women who want to develop a career without the interruption of childrearing. Yet, pregnancies are already considered high risk for women in their 40s. Do we want/need pregnant 60-year-olds? This poses dilemmas not only from a biological and health standpoint, but from a cultural and societal standpoint as well.

The near completion of a birth control pill for men is encouraging researchers to explore new possibilities with this new technology. New male hormonal therapy may be engineered to prevent pregnancy as well as protect against prostate and testicular cancer. The hormonal treatment may even treat acne and baldness. Current experts predict that birth control will be prescribed for those desiring the side benefits and not necessarily the contraceptive aspect of the pill. As great as it sounds to protect against cancer in men, should we be encouraging the use of hormonal therapy in men? How will these hormones affect their bodies and their progeny? Further research is definitely required.

Other projects in the works include a topical cream that will provide dual protection against pregnancy and STDs and a vaccine against pregnancy (termed immunocontraceptives and used successfully in animals, such as deer). It is certainly good news to hear that measures are being taken to protect against cancer, extend the biological clock of fertility, and protect against sexually transmitted infections. However, do these protective measures need to be coupled with birth control? Will they be? Only the future can tell…

When Birth Control Goes Too Far

"Norplant: A New Contraceptive with the Potential for Abuse." ACLU, January 31, 1994.

http://www.aclu.org/reproductive-freedom/norplant-new-contraceptive-potential-abuse

Throughout this blog, we’ve discussed various types of birth control, ranging from oral contraceptives to non-surgical alternatives to tubal ligation, but the controversial nature of birth control has been only quickly alluded to thus far. This topic easily creates many differences in opinion about what is appropriate or moral.

Norplant, six silicon capsules that are implanted in a woman’s upper arm and slowly release progestin for five years, is one of the most controversial types of birth control. However, the issues surrounding this method are different from those that traditionally surround contraception. For medications such as Plan B, the opposition often argues in favor of the sanctity of life. They feel that the fetus has a right to live, and the mother does not have the right to take the life of her potential unborn child. However, in Norplant, the controversy does not revolve around the rights of the unborn child. Instead, it involves the rights of the mother to conceive that child. In the early 1990s, Norplant was used by the governments of several states as a method of punishment that borders the line on eugenics. Women who convicted of either child abuse or drug use while pregnant were told that they had to choose between having Norplant implanted or serving time in jail. Other bills that did not pass would have paid women who were below the poverty line if they received the contraception, or taken away their welfare money if they did not.

Because these women are not in situations in which they can make an unbiased decision about whether they want to undergo the insertion of the device, it is unethical for them to be bribed or coerced into using this highly effective method of birth control. As we as a society continue to develop newer and more effective methods of contraception, we should make sure that they are being used for their intended purpose: to prevent unwanted pregnancies, not to control who is allowed to have children.

Photo: http://www.magazine.ayurvediccure.com/what-is-norplant/

No Gaining Weight, No Nausea, No Cramping, No Irritation, No Babies.

"Biotech Patch Offers No-Risk Birth Control." Mark Henderson, Oct. 17, 2007.

http://www.timesonline.co.uk/tol/life_and_style/health/article2672902.ece

Many women find the side effects of oral birth control pills or any other hormonal based contraceptive to be not only interrupting to their daily lives but also painful and discomfortable. However, the majority of side effects are due to the drug manipulating the hormone levels in the body. Now, there is research in developing a birth control method using the revolutionary new concept of iRNA (interference RNA) regulation.

iRNA are double-stranded RNA able to switch off certain genes when they enter a cell’s genome. This biotechnology concept earned the Nobel Prize for Medicine last year, and is going to be utilized in all forms of medicine over the coming years. Although the best method of delivery of these iRNA strands to the target cells is up for debate, there is no question that iRNA has the potential to revolutionize the pharmaceutical industry.

In birth control research is being conducted to determine how iRNA can be used in contraception. The targeted gene in research is the ZP3 gene which is shown to be active only in mature female sex cells. It is responsible for the formation of the egg’s outer layer, the zona pellucida. This layer is necessary for the sperm to bind to before fertilization. Without this layer, the sperm will swim around aimlessly not able to bid to the egg and eventually will die in the uterus or fallopian tube. When iRNA is not being delivered to the sex cells, ZP3 gene expression should continue as normal in developing cells making this method nonpermanent.

Although this method is millions of dollars and years away, it is a significant leap in the field of contraception. Removing the side effects of contemporary birth control in a new method would be appealing to the masses of women that struggle with the physiological implications of taking today’s hormonal methods. Considering that there has been virtually no progression in birth control since the development of the IUD, iRNA regulation is very promising. Perhaps soon, for the first time in over fifty years, women will have another option besides hormones, the IUD, and barrier methods.

Photo: http://www.bio.miami.edu/~cmallery/150/gene/c7x19.9.RNAi.jpg

How Much Do YOU Know About Plan B?

"Doctors Not Telling Women About Plan B." Daniel J. DeNoon, June 19, 2008.

http://www.webmd.com/sex/birth-control/news/20080619/doctors-not-telling-women-about-plan-b?page=2

Walk into any gynecologist’s office and you will undoubtedly stubble upon several women looking for advice concerning birth control methods and sexual health. Their physicians may recommend the pill, the patch, or IUDs--but a recent study addressed in this article shows that only about three percent of doctors discuss Plan B with their patients. This lack of communication has resulted in an overall void in the understanding of Plan B among the American public, and in some cases, has led women to avoid its use.

Plan B is an emergency contraceptive that works by preventing fertilization by the sperm or the implantation of the embryo in the uterus. It has been proven to be 75% effective by users if taken within a small timeframe in relation to intercourse. A controversial issue since its release on the market, Plan B can be viewed either as a distant relative to abortion, or as an excellent way to ward off pregnancy in unexpected or nonconsensual intercourse. In the health care debate, most politicians try to avoid the subject of birth control coverage for that very reason. However, organizations like Planned Parenthood are fighting for continued government support in the realms of women’s health and contraceptives. Availability of Plan B is not an exception to this debate. Up until 2006, Plan B had only been available with prescriptions, however since then it has become available over the counter to all women over eighteen. What the future holds of accessibility to birth control options like Plan B is something that only time can tell.

Statistics show that most women only use Plan B in emergency situations, and that they rarely take it more than once--proving that it is not being used as a regular form of birth control.Yet, a large percent of the female population is still largely misinformed about this contraceptive--confusing it with an abortion pill. That’s where doctors, like Dr. David M. Plourd, become frustrated with the lack of communication on the part of their peers. If more women knew the mechanisms and proper uses of Plan B, they would be more likely to feel comfortable making use of it. It would also be helpful if they kept the drug on hand, so that if a situation arises that would necessitate its use, they would be able to quickly receive its effects--which is key in the efficacy of Plan B. With this secondary option to the more notable birth control methods, women would feel more confident that they would be able to prevent any unwanted pregnancies in the future.

Additional Source: http://www.plannedparenthoodaction.org/positions/health-care-reform-76.htm

Photo: http://www.plannedparenthoodaction.org/positions/health-care-reform-76.htm

Vasectomy: New Methods, New Progress

"Vasclip, an Alternative to Vasectomy, Receives FDA Clearance." Surgistrategies, April 30, 2003.

http://www.surgistrategies.com/hotnews/34h307215.html

While researchers look for new methods of contraception for men in the realm of hormonal treatments and oral medications, one must look towards current methods that men turn to for birth control. One of the most effective methods that comes to mind would be vasectomy procedures, which ultimately provides relatively permanent sterility. About 4 million men undergo vasectomies each year worldwide, according to this article from SurgiStrategies, published in 2003. It typically costs from $500 to $1,000, which is significantly less expensive than female sterilization surgery--making it more attractive to couples. Currently, most medical insurance companies cover the cost of this surgery, however, there is no news about whether or not this will change under the health care reform movement (although one can assume that it most likely will remain covered).

The surgery involves the clamping, blocking, or cutting of the vas deferens--thus preventing sperm from entering the semen that is ejaculated during intercourse. Although this is a quick procedure, it is known to involve pain, swelling, and bruising at the site of the incision, that is, the scrotum. While new methods of operation, such as no-scalpel vasectomy (which uses a clamp rather than a scalpel to enter the scrotum, minimizing the size of the incision and the risk of bleeding), have developed, most still involve the cutting of the vas deferens--which can result in heightened pain and increased risk for complications.

However, this article prevents a relatively new technology that minimizes the pain and complications involved in cutting, cauterizing, or suturing the vas deferens tubes. Called the Vasclip, this tiny polymeric device--as small as a grain of rice--clips around the vas deferens, inhibiting the flow of sperm through the vessels. Approved by 99% of test subjects in clinical trials, Vasclip shows great promise in the realm of male birth control. Studies show that it decreases the risk of swelling by up to 14% and lowers the risk of infection by up to about 7%. Moreover, with around 5% of men who received vasectomies looking for reversal methods, the simple removal of this clip offers easier procedure reversal for patients.

Despite all these positive results in clinical trials, several recent studies have come to show that clipping off the vas deferens may not be as effective as traditional vasectomies in preventing release of sperm. Yet, the availability of a second option is beneficial for men looking to undergo the procedure.

Additional Sources: http://www.vasectomy.com/ArticleDetail.asp?siteid=V&ArticleId=10

http://www.webmd.com/sex/birth-control/vasectomy-14387

Photo:http://www.californiaurologist.com/no-scalpal-vasectomy-urology-san-jose-ca.htm

Essure; the Latest Alternative to Tubal Ligation

"Essure Procedure Offers Women a New Form of Birth Control." University of Wisconsin, Feb. 29, 2008.

http://www.uwhealth.org/news/essure-procedure-offers-women-a-new-form-of-birth-control/12796

For those women looking for a permanent form of birth control but not interested in a surgical procedure like tubal ligation, there is a breakthrough new option from Conceptus called Essure. Essure is a device inserted into both fallopian tubes to completely block eggs from entering the uterus during ovulation. The procedure for insertion does not require any incisions or anesthesia and does not tamper with hormone levels. The device, a flexible micro-insert, is simply inserted using a catheter into the fallopian tubes by going through the cervix and uterus. The body then naturally grows cells (scar tissue) into the micro-insert blocking the pathway sperm would take into the fallopian tube to be fertilized. Three months after the procedure, a test is done to make sure that the fallopian tubes have been sufficiently blocked.

This method of birth control is very revolutionary because it does not interfere with the natural hormone levels that the body maintains, which is the cause of many side effects that occur with other forms of birth control. Also, the alternative of tubal ligation is more costly and is associated with more health risks. Also tubal ligation has the potential to fail more often. And many times the procedure is not performed correctly and a pregnancy post-surgery will occur. With the Essure test that occurs three months after the procedure, the effectiveness of the procedure can be tested easily. The micro-inserts are also made of polyester fibers, nickel-titanium and stainless steel making them durable in the body to hold up against wear and tear.

The excitement surrounding this procedure is mostly due to the fact that in clinical trials there have been zero pregnancies in participation women over the four years that this procedure has been used. This is definitely the future for women’s sterilization procedures.

Additional Source: www.essure.com

Photo: http://bmc-tx.com/?page=procedures&id=6

Contraceptive Computers: iBirthControl?

"Fertility Computers." Epigee. 2009.

http://www.epigee.org/guide/computers.html

A contraceptive computer may be the newest innovation in non-hormonal contraception. Hormonal pills are currently being studied to establish determine if a relationship exists between hormonal contraceptive therapy and an increased risk of breast or ovarian cancer. The elevated risk from birth control pills may be especially prevalent in women with genetic predisposition to cancer on the BRCA1 and BRCA2 gene. To avoid this potential danger, women may be able to use a small, personal, contraceptive fertility computer. Approved for uses in Europe and Canada, these computers very clearly indicate which days a woman is fertile, using a red light, and which days she is not, using a green light. The personal devices determine fertility every morning by storing daily basal temperature readings and detecting the slight temperature increase associated with ovulation. Some models may ask for a urine test to analyze the concentration of hormones if the body temperature test is inconclusive. Two such models are the LadyComp, BioSelf, and Persona, which each boast a failure rate of approximately 5 percent in users who use the monitors properly.

Clinical trials are now under way by the FDA to approve fertility computers as a means of contraception, but these devices are not currently for sale in the United States. Using these devices would avoid the introduction of chemicals and hormones into the body and serve as a much more natural means of contraception. Thus, there are no side effects or disruptions of the body’s natural homeostasis. These devices do, however, have several disadvantages. The personalized computers are rather expensive, costing upwards of $400, and may require the replenishing of testing materials such a urine sticks. Furthermore, using the computer as a means of contraception is only recommended for women whose cycles are between 23 and 35 days, and further research is still needed to determine the accuracy for women with both regular and irregular cycles. Maybe Apple should start on a new production project. Pretty soon, there might be an app for that!

Additional sources and photo: http://www.contracept.org/computers.php

http://ladycomp-babycomp.com/show.php/en/contraception

The Pill: Coming Soon for Men?

“Testosterone Tested as Male Contraceptive.” Salynn Boyles, May 6, 2009.

http://www.webmd.com/sex/birth-control/news/20090506/testosterone-tested-as-male-contraceptive

When you think of birth control, what comes to mind? You may rattle off a few notable oral contraceptive pills, IUDs, or birth control patches, whose advertisements are filled with beautiful, driven young women who are taking control of their sexual health. What do all of these popular methods have in common? Indeed, they are all used by women. But what about their male partners? Should they not also take responsibility for their sexual endeavors? Yes, condoms and other barrier methods such as spermicides are often used, however, what if there was an option for men that provided consistent protection against conception?

This article which was written by Salynn Boyles and appears on WebMD Online presents results from a study which was recently published in The Journal of Clinical Endocrinology & Metabolism which display the effectiveness of hormonal birth control in men. The study took a look fertility in 1,000 Asian men after they were given monthly injections of the hormone testosterone, which at high levels is proven to decrease signals sent from the brain that encourage sperm production. The injections proved to be 99% effective in preventing pregnancy in the studied population, and no major side effects were observed. Administered monthly, the treatment’s effects would last for up to about six and a half months, and have been proven to have minimal effects on future fertility. The medium of administration would have to be injections due to the fact that the oral technique was less effective and caused an increase risk of liver damage.

While this method seems to be a viable new technology, several issues remain. It seems that while the testosterone treatments work for Asian men, in Caucasians, another hormone might be necessary to increase efficacy--progestin. In addition, several members of the science community fear a lack of backing from the pharmaceutical industry, which considers monthly injections hardly attractive for consumers. This would mean that further developments would have to be spearheaded by the government and non-profit associations, for example, the Gates Foundation. Although the current political landscape does offer more liberalities in the development of birth control methods, one must ask if our economical situation truly allows the government to firmly back these technological advancements. Indeed, the ground for hormonal--and non-hormonal--contraceptives for men is present, however, whether or not we will see them on the market in the near future is something that only time can tell.

Additional Source: http://www.malecontraceptives.org

The Contraceptive Injection?

"Women Struggle to Quit Depo-Provera." ABC News. October 26, 2009.

http://abcnews.go.com/Health/depo-provera-birth-control-injections-withdrawal-symptoms/story?id=8902273&page=3

For those women looking for another alternative to the aforementioned methods (pills, patch, IUDs, etc.), Pfizer produces Depo Provera, the more long-term, hormonal contraceptive injection. An injection, while being extremely effective and avoiding regular use of patches or consumption of pills, comes with its own cons – as does each hormonal or surgical contraceptive. Depo Provera is delivered every 11 to 13 weeks into the woman’s buttock or upper arm to prevent ovulation, and remains 97 percent effective at doing such. It functions by preventing the release of eggs by the ovaries and thickening the mucus of the cervix to make difficult the travel of sperm.

ABC News ran a segment on Depo Provera at the end of October 2009 and subsequently posted an article on their website on October 26. The article clearly takes the side of women suffering from withdrawal against Pfizer. In response to long term users of the contraceptive injection, ABC claims that cessation of the routine injection may cause the body to suffer adverse reaction, not dissimilar to those of drug withdrawal in addicts. Drug studies indicate weight gain, bone loss, and, after stopping the injections, delayed conception after stopping are associated with the injection, and women often have up to and 18-month lag in resuming ovulation. The symptoms of withdrawal – severe nausea, headaches, backaches, breast tenderness, and fatigue – are most commonly found in long-term users, while Pfizer clearly indicates on packaging that Depo Provera should not be used for more than 2 years unless there is no other effective alternative.

A contraceptive injection certainly sounds promising, yet several issues come into play. Depo Provera use is common among teenagers, who may not be responsible enough to regularly take birth control pills. However, more and more teenage girls are using the contraceptive injection as a means of hiding their sexual activity from their parents and thus remain on the treatment for more than the suggested time. Injections are often offered free of charge by pregnancy clinics and health insurance may cover all or part of the cost. Morality aside, there have been no studies of Depo Provera in women taking the drug for longer than two years, yet physicians and clinicians permit young women to do such. Furthermore, extended use of the injection is associated with loss of bone density and an increased risk of osteoporosis. Should we allow young girls in our society to receive the injection for years without us knowing the potential risks? With so many women and young girls using the injection for more than the allotted time, studies must be performed to determine the effects of extended Depo Provera use.

Additional source: http://www.webmd.com/sex/birth-control/birth-control-depo-provera

Photo: http://pimpinturtle.com/2008/04/13/birth-control-shot-for-men.aspx

Ortho Evra: The Patch

"FDA says patch has blood clot risks." Fortune 500. November 11, 2005.

http://money.cnn.com/2005/11/11/news/fortune500/patch/

Many women when searching for a method of birth control look for a low maintenance and relatively simple way to prevent pregnancy. Therefore, the idea of a patch applied to the skin that will prevent pregnancy without having to remember any oral dosages or worry about skipping days or taking doses on the wrong days is very appealing. The birth control patch Ortho Evra, from Johnson and Johnson, promises this convenience by offering woman a patch applied weekly that secretes hormones transdermally into the bloodstream. The patch is advertised as an option for “women on-the-go” and will not come off in the shower and is the perfect option for busy women whether “running errands or running late for class.”

However, after being on the market for a period of time, a positive correlation between the patch Ortho Evra and an increase in blood clots among women began to show in groups of women using the patch. After review by the FDA, the patch was found to have released up to 60% more estrogen than the average amount released by a daily oral contraceptive. The FDA said that Johnson and Johnson will be required to print a warning on the Ortho Evra product, but the correlation was not strong enough to completely pull the product off the shelf. After ten women who experienced stroke and/or blood clots filed a lawsuit in New Jersey against Johnson and Johnson and its affiliated pharmaceutical company Ortho McNeil Pharmaceuticals, the company maintains that if the patch is used according to instructions that it is a safe and effective form of birth control. Johnson and Johnson released the statement that “[t]he safety of the patients who use our products is our first priority, and we take all adverse event reports seriously”

Additional source: http://www.orthoevra.com/

Photo: http://bigbluewavenews.blogspot.com/2008_05_01_archive.html

What else is there?

"Young Women Unfamiliar With the Safety, Effectiveness of IUDs." ScienceDaily, Dec. 16, 2006.

http://www.sciencedaily.com/releases/2006/12/061216104722.htm

Because “birth control” sometimes tends to be synonymous with “the pill” for U.S. women, oral contraceptives tend to be the first choice of women who want to prevent pregnancy, despite the fact that there are many other options available. However, this commonly used method requires a great deal of responsibility on the part of the patient. Missing a pill or (depending upon the type of hormone) even taking it at the wrong time can dramatically decrease the effectiveness.

This article discusses a practical but relatively unknown alternative method of birth control: IUDs. Intrauterine devices can be implanted during a routine gynecological visit, and can be left in for up to ten years. The level of effectiveness is similar to that of oral contraceptives when used correctly, but IUDs require no maintenance on the part of the user.

These devices come with relatively few controversies. One involves a disagreement in the medical community about when it can first be used. A majority of physicians dislike implanting them in patients who have never been pregnant, but there are a few who insist that it is possible to use them in any patient who desires this method.

Because this method is not widely understood, there may be less motivation for health insurance plans to cover it. It is cheaper than using oral contraceptives for the same amount of time (Planned Parenthood cites the cost of an IUD at anywhere between $175 and $650), but if insurance plans are willing to cover the monthly costs of birth control pills but not the lump sum costs of the IUD, women could be deterred from using this extremely practical method.

The relative obscurity of this device leads to various myths about its associated risks. Just as with other hormonal methods of birth control, some women have a misperception that an IUD can protect against STIs as well as pregnancy. Women who do not understand the physical positioning of the IUD commonly fear that it could be lost in their reproductive system and that their doctor would not be able to find it when it was time for it to be removed. Men having sex with women who use IUDs sometimes fear that they could be injured by the device, especially if they have never seen one. There have been many documented cases in which women were injured when their husbands or boyfriends insisted upon removing the device, which should only be taken out by a trained gynecologist. Increased education about this birth control method could prevent these misconceptions.

There has been a movement in community health centers to bring this method to women who are at high risk of repeat pregnancies. This model of care likely should be extended to other demographic groups as well, because the benefits that it provides are universal: highly effective pregnancy prevention, little inconvenience to the user, and long term protection that can be reversed at any time.

Additional source:

http://www.plannedparenthood.org/health-topics/birth-control/iud-4245.htm

To begin...

"Birth Control Pill." Planned Parenthood Association, 2009.

http://www.plannedparenthood.org/health-topics/birth-control/birth-control-pill-4228.htm

If someone mentions birth control, the majority of people will immediately think of birth control pills. However, the various options that fall under this category cannot simply be lumped into the category of “the pill.” Different brands can vary in drastic ways, and people often have preconceived notions of what they can expect from this type of birth control.

This article clarifies some of the major differences between types of birth control pills. A major variation is the type of hormone used. Combination pills use both estrogen and progestin, while others use only progestin. The difference can drastically affect the care with which patients must time their doses; the progestin-only pills are much less likely to work if they are not taken at the same time each day. Various types of pills also differ in their effects upon menstruation. While some allow women’s periods to stay on the same cycle as before they started the pill, others allow menstruation to occur only once every three months.

In debates about health insurance, birth control could easily become a controversial issue. With various options available, the lines of what is medically necessary become blurred. If progestin-only pills are cheaper than the combination pills, does the insurance company have an obligation to provide the combination pills, which have less risk of failure if taken incorrectly? Do the companies have an obligation to pay for the pills that have additional benefits such as a greater time between periods? Should birth control be covered for off-label uses, such as control of acne? Because the medical necessity of additional benefits of birth control is debatable, insurance companies are not as obligated to cover the cost of the prescription as they would be for other medications (statins, for example).

This article comes from the planned parenthood website, which is a logical jumping off point for an exploration into methods of birth control. Because this organization is well respected when it comes to information about various types of contraception, the general public will have a tendency to accept whatever is said as the most accurate analysis as a method of birth control. People should be careful, however, to make sure that they seek multiple sources of information before making a decision about their method of contraception.

Photo: www.watchmojo.com/ blog/health/2008/12/15/