Posts Tagged ‘contraception’

Are We Replacing Ourselves?

Tuesday, September 8th, 2009
Where are you? Green means high and red means low.

Where are you? Green means high and red means low.

When a couple decides to have children, they rarely, if ever, contemplate the effect this has on the nation. But population scientists do. The effect that birth rates have on society is critical—as basic as knowing whether a nation is sustaining their population or not. But, trying to figure out if birth rates are going up or down is also complex, not unlike taking our temperature by feeling our foreheads.

A good barometer of birth rate assesses the average number of births per woman, and is generally noted by country. For a country to sustain its population in the future, the replacement rate is 2.1, or 2.1 births to every woman. What has occupied the minds of population scientists over the past 20 years is the fact that birth rates have dropped around the world, especially in Europe, but also in China and Japan. Interestingly, many countries in Africa do not have this problem, with birth rates well above 4. 

Also notable is the fact that in the past 20 years, the population of the world has dropped, falling an average of 1% per year. You can imagine how much this issue has occupied the minds of population scientists who seek to explain the phenomenon. Contributing factors include changing attitudes about family size, the cost of raising a child and the wider availability of contraceptives. The birth rate may also be dropping because child mortality on the whole has dropped. Or, because women who choose to have children later create a temporary lull in the birth rate. One concern with population drops is that countries whose populations become too small may not be able to afford to support its infrastructure, causing economic decline. So, on the one hand, it’s expensive to raise a child. On the other, it’s also expensive not to.

A recent study however, does show a change in these trends. Fertility rates now show a recent increase in developed nations. For years it has been thought that for some reason, developed nations, including most of Europe, have steadily dwindling populations. But this may not actually be the case. For example, in the 1970s, the US fertility rate was at a low of 1.74; lately it’s been relatively stable at 2.05. It appears that children are still wanted in a modernized world.

It’s quite hard to see these trends in my daily medical practice, as I perform as many vasectomies as I do vasectomy reversals. It’s even harder to render an opinion when the information is so diffuse and generational. So, to population scientist, I am a professionally “neutral contributor” to fertility rates. Like to think I do more good than that though…

  • Share/Bookmark

Tags: , , , , , , ,
Posted in sexual health | 4 Comments »

The Ailing Male Pill

Thursday, August 6th, 2009
What shape will the male pill take?

What shape will the male pill take?

A male birth control pill certainly sounds like a good idea. But after 25 years and millions of dollars of research, there’s still no pill. We put a man on the moon faster than we’ve invented a male pill.

The question isn’t really whether it can be done, because it can. The production of sperm is linked to testosterone levels in the body. When testosterone levels are too high, the body stops producing sperm. Witness the testis shrinking (atrophy) that occurs with anabolic steroid use. Such pills have been tested, and are successful. One problem, though, is that the ability of hormone-based male pills to work perfectly (which they really need to do) varies with a man’s ethnicity. Works for some, but not all. This issue alone may prove fatal for the male hormone pill.

Besides this, there is a litany of concerns regarding the physical side effects of a hormone-based male pill. Immediate concerns have been a big issue in past trials- adult acne, weight gain, moodiness and the like. But what about possible long term effects? The female contraceptive pill has been linked with higher rates of heart disease and breast and liver cancer in women. Although not completely comforting, at least we know these issues in women. But little to no research has addressed similar issues with long term “pill” use in men.

Despite all of this, there is still a healthy interest in a male birth control pill. Studies have shown that men in committed relationships are more interested than single men in a pill– no surprise here. Single men are interested in using condoms for the added bonus of protection against STDs. A male birth control pill might also be a better contraceptive alternative for men who want more control over family planning than that offered by vasectomy. That said, there is still the eternal question of whether or not a pill would sell successfully– would women, in the end, trust their partners to be consistent and compliant in taking the pill? The answer to this question varies from couple to couple, but to get a sense of things, ask yourself how often you fail to take something as simple and uneventful as a daily multivitamin to get an idea of the magnitude of this problem.

There simply aren’t enough options for male contraception on the market today. The main ones are abstinence, rhythm method, withdrawal, condoms, and vasectomy. Given this lineup, there is certainly room for more, and more reliable, contraceptives for men. One thing seems reasonable clear: given the safety and effectiveness of vasectomy, and fact that daily compliance is not needed to keep it effective, anything new has to be this good or better. How about a truly reversible vasectomy? Or a long term, implantable hormonal device? In the end, these are likely to become tasty alternatives to a male pill.

  • Share/Bookmark

Tags: , , , , , , , , ,
Posted in men's health | 1 Comment »

Pulling Out is In

Thursday, July 30th, 2009
Barrier contraception faces stiff competition...

Barrier contraception faces stiff competition...

Hold on now. Wait a minute. Don’t get too excited. If you thought “pulling out” was a feeble and ineffective method of contraception for the reckless and unprepared, well it is. At least at first glance. But given that at least 38 million couples use it worldwide, coitus interruptus warrants a second look. 

Coitus interruptus, with its ancient yet undistinguished history, is very easily dismissed as an effective contraceptive because of the widely accepted belief that the pre-ejaculate contains sperm. There is actually no conclusive evidence that this is the case. No one has actually found sperm in pre-ejaculatory fluid. In addition, it is all-natural, organic, hormone- and side effect-free, and affordable. It needs no tool that nature hasn’t already given us, except rigorous and unerring self-control. Well, in fact this is the big downside. Who has rigorous and unerring self-control? We are men, not robots. Pulling out doesn’t protect you from sexually transmitted diseases, either.

That said, a recently published study has shown for the first time in the modern era that withdrawal is more effective a contraceptive than one might think. Maybe we should look at the pull-out with a little more respect. The withdrawal method, when used with perfect technique, has a 4% failure rate. This falls behind vasectomy (0.1%), birth control pills (0.3%), IUDs (0.6%), and condoms (2%), but not by much. The actual (real life) failure rate is likely somewhere between 15-25%, which is really not far behind the actual failure rate of condoms, at 10-18%.  So withdrawal is not that bad after all, only a little less effective than condoms. Perhaps men deserve a pat on the back for this. Well done. 

However, if this were a contraceptive pill, a 15% failure rate would send its inventors back to the drawing board. For coitus interruptus is inherently flawed, and women who seek more control over whether or not they become pregnant are more likely to reject this method over the long term. One study revealed that women of higher economic status and education are more likely to insist upon a more surefire method of contraception. It appears that women simply don’t trust men’s timing, their control, and perhaps even the male sense of responsibility when it comes to contraception. They want more control in the matter. What does this mean for a male contraceptive pill? More on that next week.

  • Share/Bookmark

Tags: , , , , , , ,
Posted in sexual health | 15 Comments »

The Vasectomy Hoopla

Monday, April 20th, 2009

Thoughts as elemental as the ocean

Thoughts as elemental as the ocean

These are times fraught with uncertainty. A sunny day isn’t just a sunny day anymore; it’s evidence of global warming. America has been at war for almost a decade, trusted financial institutions are folding and our economy appears to be on the verge of collapse. It seems only natural that people would look at our unstable world, ask themselves dark-night-of-the-soul type questions, and choose what is right for them.

In the last several months, since the scope of our financial crisis has made itself known, there has been a spike in the number of vasectomies being performed. Some Planned Parenthoods are reporting that vasectomies are on the rise, up thirty percent from the same period last year. Several doctors have also made the same observation. The New York Times recently attributed the increase to the bleak outlook of America’s economy. They postulate that men are reacting out of fear that they can’t afford a child. This is too simplistic a conclusion. A man’s life is long, as is the ability to reproduce, and can easily outlast a financial deep freeze. And people don’t stop wanting children simply because they are expensive. The desire to procreate runs too deep; as deep as the need to eat.

There could be other reasons for the increase, if in fact there really is an increase. For one thing, reproductive impulses move with the seasons. It has been observed that, like most of nature, human reproduction is seasonal. It is widely accepted in the scientific community that birthrates swing up and down as the year progresses, with more babies born in the spring. Just like lambs. Despite our seeming transcendence of the animal world, reproductive urges remain firmly guided by biology. We could simply be seeing a downswing in this urge at this time.

It’s also possible that the new year, especially this one, gave people a desire to make a fresh start, and are putting their plans into action while they feel motivated. No doubt there will be a lull in vasectomy business when everyone runs off for vacation in the summer. Mai-tai or vasectomy? You choose.

One observation that throws a wrench in the New York Times’ argument is that right now, in my practice, I am seeing a surge of interest in vasectomy reversals. With these couples, just as with men seeking vasectomies, there is a level of urgency. Across the board, I hear the same thing from both groups — it’s now or never.

I am inclined to think that the grim reality of the recession, the wars, the rise in global temperature (will that affect sperm production?) — threats such as these crystallize thoughts and focus actions, helping us to clarify in our minds what we truly want. I think men are simply putting into action what they were already planning to do, while it is still possible. Whether it’s a man who seeks a vasectomy before he’s laid off, or a couple who thinks the clock is ticking just a little louder, times like these can reveal to people what is truly, fundamentally important to them.

  • Share/Bookmark

Tags: , , , , , ,
Posted in Uncategorized | 1 Comment »