Story from Macleans Magazine

September 3, 2001
Birth control for men and women
Three new methods could change the face of contraception
KRISTIN JENKINS



Pollock, holding the intra-vas device,
is testing a reversible procedure for men

Photo: Christopher Morris for Maclean"s

Four decades after the pill transformed the sexual mores of the Western world, a new mini-revolution in contraception may be in the making. Researchers say three new devices under investigation in Canada -- two for women and one for men -- could once again change the face of birth control. One is an oral contraceptive called Yasmin that has a potentially popular feature -- it seems to cause less weight gain, the unfortunate side-effect most responsible for Canadian women deciding to stop taking the pill. A new intrauterine device (IUD) that appears to provide flawless birth control for up to five years may also reduce heavy menstrual bleeding. And for men, a plug that can be implanted in 20 minutes in a doctor's office to provide reversible birth control is under review.

"I'm an optimist," says Dr. Neil Pollock, a Vancouver physician testing the male contraceptive, which blocks the flow of sperm through the two tubes known as the vasa deferentia. "We have every reason to believe this will present a really wonderful option within four to five years." Pollock and colleagues in Quebec and Minneapolis are working to perfect the insertion and removal of the so-called intra-vas device in 150 men as they undergo vasectomy. The next step, says Pollock, will be to implant the device in men not being sterilized, then remove it after a year and confirm that sperm is flowing again. If the trials confirm the procedure is easily reversible, says Pollock, it could present a "reasonable choice" for men who want birth control for a year or two before re-establishing fertility.

Vancouver management consultant Julian Sharpe, 35, is among the patients who've consented to have Pollock practise inserting and removing the intra-vas device before performing his vasectomy. "I think it's an option for someone in a long-term relationship who isn't ready to have kids," says Sharpe. "There are so many negative issues with women's birth control."

Indeed. In the 1970s, safety problems with the Dalcon Shield discouraged many women from considering the IUD as a contraceptive option. Now, the Mirena IUD, which releases the hormone levonorgestrel into the lining of the uterus, has gained wide acceptance in Europe and Australia. Why? Because it's proving to be as effective as being sterilized -- except that it's reversible.

Now available in Canada, the Mirena must be replaced every five years. "It is a good option for the woman who's had children and wants to wait up to five years before another pregnancy," says Dr. Robert Lea, associate professor of obstetrics/ gynecology at Dalhousie University in Halifax. Another clinician familiar with the IUD, Dr. Michel Fortier of Universite Laval in Quebec City, affirms that it's even more effective than the pill. "There have been accidental pregnancies when women forget to take low-dose contraceptives," he notes.

The Mirena is now being studied in centres across Canada for control of menorrhagia, the heavy menstrual bleeding that many women experience. Results show the new IUD dramatically reduces bleeding and cramps in women who might otherwise have to consider a surgical fix. Up to six per cent of women using the Mirena stop having a period altogether. "Patients are very pleased," says Fortier. "Control of heavy bleeding is a plus."

In spite of such advances, the pill remains the most popular method of birth control in Canada. Approximately one-quarter of all women of reproductive age in Canada use oral contraceptives for birth control. But unacceptable side-effects -- weight gain, bloating, breast tenderness and bleeding between periods -- cause up to half to stop taking oral contraceptives after one year.

"What we're doing now for contraception doesn't seem to be good enough," notes Dalhousie's Lea. "We need to reduce the number of side-effects." Yasmin, a pill that has been undergoing tests in Canada for the past year, shows promising progress. Not only does it appear to cause less weight gain, but researchers report less breakthrough bleeding than with the pill. For women and men, the search continues for the perfect contraceptive.