Les contraceptions du futur chez l’homme

Abstract

Although many female contraceptives are available, data on uncontrolled population growth and abortion rate demonstrate that contraceptive choices are still inadequate and accessibility is poor. Broader contraceptive option is an ethical issue that would benefit not only the lives of families and women in particular but would also ensure the survival of our planet. In spite of the shortage of male contraceptives, about 30% of couples rely on a male method and men worldwide show interest in actively contributing to birth control. A variety of approaches has been undertaken in developing a male contraceptive but progress has been poor. The hormonal approach induces profound sperm production through a reversible suppression of gonadotropins and intra-testicular testosterone. In this context, androgen dependent physiological functions must be maintained by exogenous androgen administration. Hormone induced sperm suppression provides optimal pregnancy protection. Androgen-progestin regimens induce profound sperm suppression, and allow spermatogenesis to fully recover to levels consistent with normal male fertility in all men. This approach has many limitations such as the required time until sperm suppression is achieved and until fertility is regained after discontinuing. Even the most effective regimen suppresses spermatogenesis to the threshold useful for contraceptive protection in only about 90% of subjects. A recent multicenter efficacy study supported by CONRAD and the WHO tested the efficacy of the combined administration of eight weekly injections of NETE 200 mg and TU 1000 mg. The trial has been prematurely terminated due to mood-related side effects despite results show good sperm suppression and contraceptive protection.