Since the invention of the birth control pill more than 50 years ago, some 200 million women have availed themselves of the option to control their own fertility, opening new opportunities for them in higher education, career advancement and financial independence. Yet the innovation also augured a societal shift to women disproportionately shouldering the burden of preventing unwanted pregnancies.
Today, in two thirds of heterosexual couples in the United States, women bear the sole or primary responsibility for contraception. Which is hardly surprising, given the panoply of highly effective birth control methods—hormonal and nonhormonal—available to them, and the relative dearth of options for men.
But men have a stake in controlling their reproductive destinies, too. "Men are already using the only two contraceptives they have—condoms and vasectomy—in great numbers," says Elaine Lissner. "At least in the United States, the idea that men aren't willing to participate is clearly out of date." That's why, for nearly 20 years, Lissner, '90, has championed an array of nonhormonal contraceptive methods for men.
For decades, a male version of the hormonal contraceptive pill has been just over the horizon. But for reasons both technical and institutional the research has yet to come to fruition. Whereas women are fertile only for a short time each month, following the release of a single egg, methods directed at hindering male fertility must contend with the 100 million sperm the average man produces per day. What's more, companies see little profit potential; funding agencies and policy makers think men won't use it; and, as Lissner once wrote in an article in Ms. magazine, "male researchers are reluctant to tinker with the male body."
But the demand and need for more options are real, Lissner contends. In a 2002 survey of 9,000 men across four continents, 55 percent said they would be willing to use a new male contraceptive if it became available. "Men have quite a few motivations," she says. For one, they are held socially and financially responsible for any children they father. And as much as skeptics may argue that women would never trust men to take a contraceptive pill, faith goes both ways: Men have to trust that their female partners are using birth control consistently and correctly.
Lissner cites the best evidence that contraception remains a pressing issue in the United States: Half of all pregnancies are unplanned. As one man wrote to her, "Condoms are a nice method. However, I have a 3-year-old that proves they are not 100 percent effective." Indeed, the failure rate for condoms is 2 percent with perfect use, and 18 percent with more typical use, according to a 2011 review.
Lissner can trace her interest in male contraception to her freshman year at Stanford. While procrastinating in the Roble dorm library, she stumbled upon a book that described a low-tech birth control method involving heating the testes in warm baths. It was shown to be effective by a Swiss doctor in the 1950s, but never went anywhere.
Later, she ended up researching the topic for a seminar class with Carl Djerassi, the Stanford chemist famous for his role in developing the orally-active synthetic hormone used in the first birth control pill. To her surprise, Lissner found that there were at least eight nonhormonal male contraceptive methods that were known to work.
At the same time, some of her female friends were experiencing problems with the pill, including horrible varicose veins and an unintended pregnancy due to concurrent use of antibiotics. Lissner wondered: Why isn't anyone pursuing these simple, effective male options?
She wrote several articles on the topic, including a 1992 piece in Ms. that generated more than 200 letters asking for more information. "That's when I realized that people really care about this." She started a nonprofit, the Male Contraception Information Project, to increase awareness about nonhormonal male contraception and convey the public's demand to policy makers.
Her initial attempts to raise funding were unsuccessful, and the project went on the back burner for several years after college. In 2001 her interest in the cause was reignited after a writer for Penthouse magazine contacted her. Digging into the topic again, she discovered that one of the most promising methods had progressed to phase III clinical trials in India.
Essentially a "no-snip" vasectomy, the technology is called reversible inhibition of sperm under guidance (RISUG). Instead of severing the vas deferens, a doctor injects a long-lasting polymer gel that chemically inactivates sperm as they pass through. It takes effect immediately so there is almost no wait-time before men can resume sexual activity. The polymer can later be dissolved with the injection of a second chemical, meaning that, in theory, the procedure is reversible.
Lissner made several visits to India to meet with RISUG's inventor, Sujoy Guha. In 2005 she founded the Parsemus Foundation to support further research into RISUG, among other things, using money from an investment in her father's construction company during the housing boom. In 2010 she bought the international rights to develop and test the product—rebranded as Vasalgel—in the Unites States. Her team has reformulated the polymer to meet FDA standards and begun animal trials. Already more than 7,000 people have signed onto her mailing list to get information about clinical trials, which could begin as early as 2013.
Lissner is working to promote other promising nonhormonal methods as well. Ultrasound applied to the testes, for example, is a painless, noninvasive way to stop sperm production for months or longer. Lissner is also enthusiastic about the so-called "dry orgasm" pill being developed in the U.K. This short-acting drug temporarily paralyzes the muscles that move the semen and sperm along. So a man has a normal orgasm without releasing any fluids—thus preventing both pregnancy and semen-related HIV transmission.
With articles about her efforts appearing in publications such as The New York Times, Wired and Scientific American, Lissner has almost single-handedly brought these methods to the public's attention. "I'm lucky because I happened into something at Stanford that was something that nobody else was really working on," she says. "It's a way to make a difference very up close and personal as well as on a global scale."
Kristin Sainani, MS '99, PhD '02, is a freelance writer and clinical assistant professor in the department of health research and policy.
