Forget the male pill, get set for the sperm switch! A safe oral contraceptive for men has eluded scientists for decades, now technology may provide a very unusual alternative

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Bill Gates is the tech nerd who pioneered home computers, built up a $600 billion software firm on the back of this and was named the world’s richest man for 16 years.

The Microsoft founder is no slouch when it comes to philanthropy either. The Bill & Melinda Gates Foundation, which he founded with his wife in 1994, has cut polio cases by 99 per cent worldwide and revitalised the international push for scientific solutions to global health problems.

One of these solutions is better access to contraception for the 220 million women in developing countries lacking the information and the means to control their fertility. It is a long-term goal of the foundation to reduce the annual 90 million unintended pregnancies and 50 million abortions worldwide.

In 2012, the foundation set the ambitious aim of providing contraception for 120 million more women and girls by 2020, but now the target is slipping from reach.

John Naish examined the latest scientific projects aspiring to offer men the choice of using contraception (file image) 

To keep the hope alive, the organisation is upping its contribution to the project by a quarter, providing an extra £95 million — and some of that money is being invested in creating a safe and effective male contraceptive pill.

This is a challenge that, for decades, has confounded some of the best scientific minds in the world.

So far, their efforts have come to nothing, because where contraception is concerned, Mother Nature stubbornly thumbs her nose at sexual equality.

While women have access to a range of contraceptives — from barrier methods (female condoms, diaphragms, caps) to hormonal solutions (the Pill, injections, rings, patches, implants) and devices such as the coil — men still have only one safe method: the condom, which has been around since the mid-17th century.

The other time-honoured tactic is coitus interruptus, or the withdrawal technique, although it is so ineffective, statistically it hardly counts. Studies suggest a failure rate of up to 28 per cent, compared with about 0.3 per cent for the Pill.

So a gap in the market exists, and that’s where the male pill comes in.

But will Gates’s money — £730,000 of which will go initially to the University of Dundee — and all the other vast funds committed to the pursuit of this Holy Grail of contraception ever deliver?

One thing is for certain: it’s going to take an awful lot of faith. Not only faith in science — but faith in men, too. For even if scientists are successful, critics argue, it will never be practicable.

The solution, if it does arrive, may be technological, rather than pharmaceutical. Incredible as this sounds, it could involve a switch implanted in the body to turn sperm ducts on and off.

One possible solution for male contraception could be a switch implanted in the body to turn sperm ducts on and off (file image)

However, the odds of finding a male contraceptive are stacked against Gates, if history is anything to go by. Two fears have long dogged the project. The first is the belief men simply won’t take a contraceptive pill, perhaps out of fear that it would diminish their masculinity or harm their fertility — or a stubborn belief that birth control is a woman’s responsibility.

The other is that women would never fully trust men who said: ‘Relax, Darling, I’m on the Pill.’

The Gates Foundation seems to have put its faith in evidence from a recent study in the scientific journal Human Reproduction, which suggests that both fears are unfounded.

When Edinburgh University researchers asked more than 1,800 men worldwide whether they would use a male contraceptive pill, up to 83 per cent said ‘yes’. And when 1,800 women were asked if they would trust their partners to use a male pill, more than two-thirds declared they would rely on this method.

Others, however, treat such survey evidence with great caution. What people tell researchers they are prepared to do in a hypothetical situation is often very different from what they would do in real life.

And regardless of human behaviour, there are still huge scientific obstacles — which even the wonders of modern pharmaceutics have failed to beat for 50 years.

Scientists began testing a male pill in the Fifties however their work was abandoned due to side effects including heart palpitations, sweating, nausea and vomiting (file image) 

Stopping men producing viable sperm might sound simple when set against miracles of modern medicine such as heart-lung transplants, stem-cell therapies and test-tube babies.

However, it is very difficult indeed to achieve.

In evolutionary terms, priority No. 1 for males of any species is to spread their genes — by reproducing as often as possible. And most men make 1,000 sperm every second and release 250 million during orgasm.

Women, by contrast, produce only one or two eggs a month.

Shutting down the male reproductive system without causing damaging effects on bodies and brains has so far proved impossible.

Scientists first tried to create a male pill in the Fifties — before the female version was invented.

Initially, it seemed all too easy. Pharmacologists at the now-defunct American company Sterling Drug had invented a drug to eliminate parasite infections, and trials showed that it made male laboratory rats temporarily infertile. Would it do the same for men?

Researchers tested the compound, called WIN 18,446, on prisoners at the Oregon State Penitentiary. (In those days, there were no medical ethics committees to stop this.) Within three months, sperm counts had plummeted. And when the inmates stopped taking the drug, their sperm production rebounded. What’s more, there seemed no harmful side-effects.

Until, that is, some of the jailbirds partied on bootleg whisky. They became violently ill with heart palpitations, sweating, nausea and vomiting. The mix of the drug with alcohol proved so dangerous, the researchers abandoned their work.

Perils stemming from side-effects such as this are made all the more serious by the fact that men, with their long reproductive lifespans, may need birth-control pills for decades longer than women.

The failure of the Oregon study established a pattern that was repeated over the decades — each new drug heralded as the new dawn of contraception was later found to have side-effects.

The bitter joke among researchers is that for the past five decades, the male contraceptive has always remained ‘only five years away’.

And so, the saga continues.

A recent test for a drug that men could possibly use as contraception had side effects including depression and muscle pain (file image) 

One of the most promising recent possibilities is a drug that combines a synthetic version of the male hormone testosterone with progestin — a hormone involved in pregnancy and used in birth-control pills for women.

In tests, the combination was found to inhibit sperm production in male lab animals. But in 2016, a World Health Organisation trial involving men had to be halted prematurely — despite success in making men temporarily infertile — because of yet more worrying side-effects.

Nearly a fifth of those taking part reported emotional problems, such as depression. Others suffered muscle pain and skin disorders. Yet the volunteers were reluctant to stop taking the drug because, due to the synthetic testosterone, it had intensified their sex-drives.

Despite the mental problems and pain, more than three-quarters of the men said they were happy to continue with the trial.

A new drug, however, may not be the answer. With every passing year, it gets harder to win official approval for new formulations because of the public’s understandable concerns about side-effects.

Experts are united in thinking that the female contraceptive pill would never pass today’s more stringent drug-safety requirements — not least because it can raise women’s risk of blood clots and high blood pressure.

This is one reason why the Gates Foundation has selected the research programme at the University of Dundee. Scientists there are trawling through tens of thousands of existing drugs — many of which may have safety approval already — to see if any can inhibit sperm production as a by-product of their principle, or intended, use.

Many experts believe the female contraceptive pill wouldn't pass today's drug-safety requirements because of it's ability to increase blood pressure (file image) 

But many drugs that have met safety requirements still don’t make it to pharmacy shelves.

‘At the end of two years, we will have very good information if there are drugs currently on the market or in the pipeline that could be tweaked for contraception,’ says Christopher Barratt, professor of reproductive medicine at the University of Dundee.

Meanwhile, other scientists are still trying to develop a new formula. The U.S. National Institutes of Health’s Contraceptive Development Programme is about to trial a gel containing testosterone and progesterone that is rubbed regularly into men’s backs and shoulders.

The hope is that, by delivering the drug through the skin, it will have a slower release into the body and might not trigger side-effects.

Other scientists are trying to create a male pill from a lethal poison used by African hunters.

Ouabain is a toxic extract from African plants that rapidly causes cardiac arrest — but it can also inhibit the mobility of human sperm.

In January, the researchers reported in the Journal Of Medicinal Chemistry that a synthetic version of ouabain worked on sperm but did not damage the heart. Again, however, this has yet to be safety-tested on men.

The hopes for any of these approaches remain slim — and not only because of the history of previous failures.

It takes about 12 years to take a new drug to market. On the way, 90 per cent fail safety and effectiveness tests. Meanwhile, the world is moving away from hormonal contraceptive pills.

Experts believe men are fearful of having a vasectomy because they would be unable to start a family with a new partner if desired (file image) 

Official figures indicate that over the past decade, women’s use of the Pill in the UK and the U.S. has dropped steadily in favour of more mechanical, non-hormonal methods — perhaps as a reflection of wider trends towards ‘clean’ drug-free lifestyles.

NHS England figures released this year showed that 39 per cent of women in 2017 chose to have a long-acting, reversible contraceptive fitted, such as the copper coil. This compared with just 21 per cent visiting NHS clinics in 2007.

So what about other options for men that do not involve drugs? A new form of vasectomy — which conventionally involves cutting or tying the vas deferens, tubes that carry sperm from the testes to the ejaculatory ducts — is one option.

The operation was first performed in the 1820s, but only became widely available during and after World War II. Over the past decade, vasectomies have fallen from favour in the UK — with the number of operations carried out dropping by more than 60 per cent.

Experts think that men are put off by fears that a vasectomy is painful or will damage their sex drive — or that if their current relationship broke up, they would be unable to start a family with a new partner.

Surgical vase- ctomy reversal has a high success rate, but now scientists in India and Germany are developing vasectomies that do not require surgery.

Professor Sujoy Guha, a biomedical engineer at the Indian Institute of Technology, has pioneered a system that involves injecting a chemical gel into the vas deferens to block sperm, rather than cutting or tying the tubes.

The vasectomy can be reversed with an injection that breaks down the gel.

Professor Guha claims that his trials have succeeded in about 540 Indian men for up to 13 years, and that the method will be widely available within the next two years.

Meanwhile, in Germany, Clemens Bimek, a professor of urology, has developed an electronic valve that can be implanted in sperm ducts and opened and closed with a switch less than 2cm long.

Implanted in the testes, it involves a 30-minute procedure under local anaesthetic.

Such an invention would have sounded outlandish a decade ago.

But it is now in sync with a technology-obsessed world where men (and women) want to keep chemicals out of their bodies — and keep their options open when it comes to their own fertility.

Although a male pill remains at least a decade away, it may be that the contraceptive switch — which brings a new meaning to the phrase ‘being turned on’ — is the best option yet.