Endocrine Abstracts (2018) 56 PL1 | DOI: 10.1530/endoabs.56.PL1

Contraception: past, present, and future

Philippe Bouchard


50 years after the approval in the USA of the first oral contraceptive, it is quite remarkable that this considerable medical advance, may be the greatest medical discovery in the last century, the combined pill, which replaced condoms and unreliable natural methods, is still a matter of controversy. Recently, fear for hormones is more and more common in women in relation with the pill scares observed in UK and in France, and in relation with the media noise on Endocrine disruptors. However, it must be remembered that 40% of all pregnancies are still undesired, thus leading to a large number of pregnancy terminations, and also in the maternal consequence of unintended pregnancies. The pill is still a method of choice, safe and efficient, provided women are selected with exclusion of high risk individuals of some methods. Contraception is not only important for individual and couples but play an important role in population dynamics. Further long acting contraception methods such as implants or IUS, and OCs are now available, while new estrogens are also on the market or near commercialization such as Estetrol containing pills. Implants and vaginal rings, are safe and well tolerated, and IUS and IUDs are more and more user friendly. The most recent and remarkable developments are the progress in Emergency contraception using Ulipristal Acetate, a very efficient and risk free method. Finally, the recent discovery of beneficial effects of progestins in particular on brain function are now clear and provides a new advantage. Finally, while the pill is less used in women, the last progress come from the development of male contraception methods. Following the failure of the development of methods by the Pharma industry, new methods supported by NIH, using DMAU, dimethylandrolone undecanoate oral pill, Nestorone-testosterone gel, NES implants, are in development and preliminary results show a remarkable tolerance and a good efficacy. These methods produce a very high rate of extreme oligospermia, and are very promising for a near availability on the market. In addition, research into the development of non-hormonal contraception for men is progressing in several laboratories. The non-hormonal approach aims at inducing reversible infertility without interfering with hormones secreted by the hypothalamus, pituitary gland, and testis. New research target spermiogenesis, differentiation, maturation of sperm, or factors inhibiting sperm motility. Antagonists to the testis-specific Bromo Domain Protein, or to the retinoic acid receptors, involved in meiosis, proved effective in inhibiting spermatogenesis. Adjudin or H2-gamendazole, two modified lonidamine derivatives, cause premature spermiation and infertility. Eppin (epididymal protease inhibitor) secreted by Sertoli cells is also a potential target. Anti-Eppin antibodies inhibit human spermatozoa motility. Blocking CatSper (cationic channel of sperm), a novel and complex ion channel mediating Ca2+ entry in sperm flagellum, or the sperm-specific glyceraldehyde-3-phosphate dehydrogenase (GAPDS) result in reduced sperm motility. New formulations designed to deliver specifically such antagonists are also under early testing. Contraception is a treasure, all the methods available should eradicate the need for abortions, and the most recent methods are safe and user friendly. Research in particular on methods impacting on oocyte fertilization should continue. Novel technologies include research on nanoparticles, microarray patch, drug-eluting fibers, as well as improved long-acting reversible contraceptives including new intra uterine systems, novel design of vaginal rings, and microchip technology. Research on genomics and proteomics is needed to define new targets for future development. Continuing funding is absolutely needed. Unmet needs in family planning remain a significant challenge worldwide. As a result, women continue to bear the burden of more than 85 million unplanned pregnancies and 48 million abortions each year. Novel male contraceptives could play a meaningful role in averting unintended pregnancies especially in settings where novel methods can attract new contraceptive users.

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