Next Stop for Male Contraception: The Vas Deferens

Soumya Vemuganti

One of the most promising non-hormonal male contraceptives in the pipeline is a gel that would leave sperm unable to fertilize eggs.

Men
today have two options when it comes to birth control: condoms or vasectomy. 
Condoms are a low-tech barrier method and can prevent both pregnancy
and transmission of STDs.  However, the effectiveness of a condom
is dramatically decreased if not used correctly, and studies have shown
a more realistic 15%
failure rate
Vasectomy promises permanent birth control, through
an invasive procedure which cuts the vas deferens, creating a block
in the tube which sperm pass through before ejaculation.  While
the surgery alone may turn off some men, the delay in effectiveness
is also unappealing, since it can take up to 3 months for a vasectomy to be successful.  Some
men experience swelling of the epididymis due to the blocking of fluid
passing through the vas deferens, a condition called epididymitis. 
While vasectomy
reversal
is an option,
often fertility does not return to pre-vasectomy levels.  Vasectomy
is not ideal for many men due to the need for surgical incision, a delay
in effectiveness, and reduced fertility following reversal.

When
we track the complete cycle of male fertility, other possibilities for
male contraception emerge.  Male fertility begins with the production
of sperm in the testes, followed by the sperm’s journey through the
male reproductive tract.  This voyage starts in the epididymis
(a set of tightly twisted tubes where sperm are stored and mature) and
continues in the vas deferens, a second tube that connects to the epididymis
and serves as the passageway for sperm when they are released from the
body.  Researchers are exploiting the fact that sperm make this
journey before reaching the egg (in the female reproductive tract) by
targeting sperm in the vas deferens or immediately after they released. 
These targeted male contraceptive approaches are non-hormonal, resulting
in fewer systemic side effects.    

One
of the most promising non-hormonal male contraceptives in the pipeline
is RISUG, or Reversible Inhibition of Sperm Under Guidance.  Researchers
in India have developed a polymer gel that once injected into the vas
deferens coats the wall of the tube.  This gel will come in contact
with sperm passing through the vas deferens and burst the cell membranes, leaving sperm unable to fertilize an egg. 
The polymer does not completely block the vas deferens and allows for
fluid to pass through, diminishing the chances of fluid buildup and
subsequent epididymitis.  It only takes minutes for the polymer
to bind and contraceptive effects are seen immediately, within days not months like a vasectomy.  Both application
and reversal of RISUG use no-scalpel methods, and therefore do not involve
cutting of the vas deferens.  Despite the non-invasive and immediate
effectiveness of RISUG, the beauty of this contraceptive lies in its
name:  RISUG is reversible.  A simple injection can flush out the
polymer and restore fertility within 150 days; however, this has only
been tested in primates.  The obvious next step would be to test
reversibility on human subjects, some of which have been using RISUG
for over 10 years.  RISUG is in phase
III clinical trials
in
India as of March 2007.  Clinical studies of RISUG must be repeated
on a larger scale using US and international guidelines before it can
be considered for human studies in other countries. 

Another
very similar non-hormonal male contraceptive is the intra vas device,
or IVD.  This method requires much
less cutting
when compared
to a vasectomy, and works by a plug inserted into the vas deferens. 
Clinical trials in Minnesota are using a soft silicone based plug while Chinese scientists are using a plug made from urethane
and nylon.  This approach prevents sperm from passing through the
vas deferens, but allows for some fluid to pass through.  Again,
reversibility has only been tested in primates, but the results are very promising with fertility
returning to pre-IVD levels one month following removal.  The FDA
approved clinical trials of the IVD in 2006 and it is currently in clinical trials on 90 individuals across the US.   

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While
devices that effect sperm passing though the male reproductive tract
are effective contraceptives, they do not provide any STD protection. 
Spermicides that are also microbicides can offer both contraceptive
and STD protection. They are often used as lubrication alone or with
condoms and work by binding to the sperm membrane, thereby blocking
sperm movement.  Nonoxynol-9 , a popular detergent-based spermicide, was
shown to promote HIV and HPV transmission through vaginal and cervical
abrasions caused by detergents.  Taking into consideration the
adverse side effects, the FDA has mandated warning labels on nonoxynol-9
containing products, leaving a void of safe and effective spermicides
available for consumers.  However, there are a few promising non-detergent
based spermicides that offer both contraceptive and STD protection. 
These include spermicides which create a physical barrier (UsherCell and Pro2000) and ones which acidify the environment and
utilize natural defense mechanisms (BufferGel and Acidform).  Many of these spermicides are in clinical trials; however, there still remains a concern about
the effectiveness of spermicides as contraceptives.  Alone they
have a high failure rate of
29%
with typical use, however
when used in combination with condoms, spermicides can increase the effectiveness of both products. 

Finally,
it is easy to imagine a contraceptive that would block sperm from binding
to the egg.  The closest to this is a "sugar
pill
", in simple terms,
an enzyme inhibitor being developed by a US
scientist
that mimics the
sugary coating of the egg.  This sugar mimic is added to sperm
in the epididymis and binds to the sperm head, thus preventing treated
sperm from binding to the egg.  This contraceptive is in early
developmental stages, as it was found to be 90%
effective
in rats with
no side effects. 

Scientists
across the world are working toward developing a safe and effective
male contraceptive.  They are using a diverse set of approaches,
including arresting sperm production, blocking sperm entry into the
female reproductive tract, and interfering with sperm-egg binding. 
Compared to systemic hormonal methods, targeted mechanisms promise fewer
side effects.  However, the future of male contraception depends
upon not only the bright minds that fuel the research, but the funds
to support the development and testing required for implementation. 
With an increase in public interest hopefully we will find a rise in
funding, with the ultimate goal of developing an effective, non-hormonal,
male contraceptive.

News Politics

Anti-Choice Democrats: ‘Open The Big Tent’ for Us

Christine Grimaldi & Ally Boguhn

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

Democrats for Life of America gathered Wednesday in Philadelphia during the party’s convention to honor Louisiana Gov. John Bel Edwards (D) for his anti-choice viewpoints, and to strategize ways to incorporate their policies into the party.

The group attributed Democratic losses at the state and federal level to the party’s increasing embrace of pro-choice politics. The best way for Democrats to reclaim seats in state houses, governors’ offices, and the U.S. Congress, they charged, is to “open the big tent” to candidates who oppose legal abortion care.

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

Democrats for Life of America members repeatedly attempted to distance themselves from Republicans, reiterating their support for policies such as Medicaid expansion and paid maternity leave, which they believe could convince people to carry their pregnancies to term.

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Their strategy, however, could have been lifted directly from conservatives’ anti-choice playbook.

The group relies, in part, on data from Marist, a group associated with anti-choice polling, to suggest that many in the party side with them on abortion rights. Executive Director Kristen Day could not explain to Rewire why the group supports a 20-week abortion ban, while Janet Robert, president of the group’s board of directors, trotted out scientifically false claims about fetal pain

Day told Rewire that she is working with pro-choice Democrats, including Sen. Kirsten Gillibrand and Rep. Rosa DeLauro, both from New York, on paid maternity leave. Day said she met with DeLauro the day before the group’s event.

Day identifies with Democrats despite a platform that for the first time embraces the repeal of restrictions for federal funding of abortion care. 

“Those are my people,” she said.

Day claimed to have been “kicked out of the pro-life movement” for supporting the Affordable Care Act. She said Democrats for Life of America is “not opposed to contraception,” though the group filed an amicus brief in U.S. Supreme Court cases on contraception. 

Democrats for Life of America says it has important allies in the U.S. House of Representatives and the U.S. Senate. Sens. Joe Donnelly (IN), Joe Manchin (WV), and Rep. Dan Lipinski (IL), along with former Rep. Bart Stupak (MI), serve on the group’s board of advisors, according to literature distributed at the convention.

Another alleged ally, Sen. Bob Casey (D-PA), came up during Edwards’ speech. Edwards said he had discussed the award, named for Casey’s father, former Pennsylvania Gov. Robert P. Casey, the defendant in the landmark Supreme Court decision, Planned Parenthood v. Casey, which opened up a flood of state-level abortions restrictions as long as those anti-choice policies did not represent an “undue burden.”

“Last night I happened to have the opportunity to speak to Sen. Bob Casey, and I told him … I was in Philadelphia, receiving this award today named after his father,” Edwards said.

The Louisiana governor added that though it may not seem it, there are many more anti-choice Democrats like the two of them who aren’t comfortable coming forward about their views.

“I’m telling you there are many more people out there like us than you might imagine,” Edwards said. “But sometimes it’s easier for those folks who feel like we do on these issues to remain silent because they’re not going to  be questioned, and they’re not going to be receiving any criticism.”

During his speech, Edwards touted the way he has put his views as an anti-choice Democrat into practice in his home state. “I am a proud Democrat, and I am also very proudly pro-life,” Edwards told the small gathering.

Citing his support for Medicaid expansion in Louisiana—which went into effect July 1—Edwards claimed he had run on an otherwise “progressive” platform except for when it came to abortion rights, adding that his policies demonstrate that “there is a difference between being anti-abortion and being pro-life.”

Edwards later made clear that he was disappointed with news that Emily’s List President Stephanie Schriock, whose organization works to elect pro-choice women to office, was being considered to fill the position of party chair in light of Rep. Debbie Wasserman Schultz’s resignation.

“It wouldn’t” help elect anti-choice politicians to office, said Edwards when asked about it by a reporter. “I don’t want to be overly critical, I don’t know the person, I just know that the signal that would send to the country—and to Democrats such as myself—would just be another step in the opposite direction of being a big tent party [on abortion].” 

Edwards made no secret of his anti-choice viewpoints during his run for governor in 2015. While on the campaign trail, he released a 30-second ad highlighting his wife’s decision not to terminate her pregnancy after a doctor told the couple their daughter would have spina bifida.

He received a 100 percent rating from anti-choice organization Louisiana Right to Life while running for governor, based off a scorecard asking him questions such as, “Do you support the reversal of Roe v. Wade?”

Though the Democratic Party platform and nominee have voiced the party’s support for abortion rights, Edwards has forged ahead with signing numerous pieces of anti-choice legislation into law, including a ban on the commonly used dilation and evacuation (D and E) procedure, and an extension of the state’s abortion care waiting period from 24 hours to 72 hours.

Analysis Human Rights

Activists Seek Justice as Verdict Looms for Officer Involved in Freddie Gray’s Death

Michelle D. Anderson

Freddie Gray, 25, died from spinal cord injuries in April 2015, a week after police arrested and took him into custody. Last year, Baltimore City State's Attorney Marilyn J. Mosby brought criminal charges against six of the officers involved with his arrest. Since then, three officers' trials have been completed without convictions.

The bench trial of Lt. Brian Rice, the highest-ranking Baltimore Police Department officer involved in the 2015 death of Freddie Gray, began on Thursday, July 7. Rice faces involuntary manslaughter, second-degree assault, and reckless endangerment; the state dropped a misconduct charge after acknowledging Rice was not directly involved in Gray’s arrest. The closing arguments in his trial are scheduled for this Thursday; the judge is expected to share his verdict Monday.

The Rice trial started just as the public began grappling with the deaths of Philando Castile and Alton Sterling—and the subsequent murder of five police officers at a Dallas protest.

Castile and Sterling, both Black men, died during encounters with police in Falcon Heights, Minnesota, and Baton Rouge, Louisiana, triggering nationwide protests against police brutality and implicit racial bias that have continued into this week.

And just like the days following Gray’s death, social media sites like Twitter and Facebook were flooded with images, videos, and hashtags demanding justice.

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Gray, 25, died from spinal cord injuries in April 2015, a week after police arrested and took him into custody. Activists and some Maryland legislators accused police of giving Gray an intentional “rough ride,” when inmates or persons in custody are transported in police vans without a seat belt and subjected to frantic driving, ultimately causing them injury. Last year, Baltimore City State’s Attorney Marilyn J. Mosby brought criminal charges against six of the officers involved with his arrest. Since then, three officers’ trials have been completed without convictions—and as activists on the ground in Baltimore wait for more verdicts, they are pushing for reforms and justice beyond the courtroom.

The first police trial, which involved charges against Officer William Porter of involuntary manslaughter, second-degree assault, reckless endangerment, and misconduct in office, ended in a mistrial in December 2015 after jurors failed to reach a verdict.

Baltimore City Circuit Court Judge Barry Glenn Williams acquitted Officer Edward M. Nero of all charges in May. Mosby had charged Nero with misconduct, second-degree assault, and reckless endangerment for putting Gray into the police van without a seat belt.

But many viewed the trial of Caesar R. Goodson Jr., who drove the van, as the most critical of the six. Last month, Judge Williams announced that Goodson, too, had been acquitted of all charges—including second-degree depraved-heart murder, the most serious of those brought against the officers.

Kwame Rose, a Baltimore activist, told Rewire he was not surprised.

“The judicial system of America shows that police are never held accountable when it comes to the death of Black people,” said Rose, who was arrested in September and December during peaceful protests related to Gray’s death.

During Goodson’s trial, Williams said there were several “equally plausible scenarios,” that could have transpired during Gray’s arrest. He also rejected the state’s argument that police intentionally gave Gray a “rough ride,”according to a New York Times account.

Ray Kelly, community relations director for the No Boundaries Coalition of West Baltimore grassroots group and a community interviewer for the West Baltimore Community Commission on Police Misconduct, said he was disappointed by the Goodson verdict. However, he noted that he was heartened by Mosby’s decision to bring criminal charges against the officers in the first place. “It’s a small change, but it is a change nonetheless,” Kelly said in a recent interview with Rewire.

In addition to the charges, Gray’s death eventually sparked a major “pattern or practice” investigation by the U.S. Department of Justice (DOJ). Local activists, including the No Boundaries Coalition, which issued in March a 32-page report that detailed police misconduct in Baltimore and helped to trigger the DOJ, expected the findings of the DOJ investigation in late June.

However, the document has yet to be released, said Kelly, who is a native of the same West Baltimore neighborhood where Gray was detained.

Kelly is expecting a consent decree—similar to the ones in Ferguson, Missouri, and Cleveland, Ohio—and a continued partnership with federal officials in the near future.

For Kelly, the trials—and the lack of convictions—have proved what leaders in groups like the No Boundaries Coalition have been saying in their advocacy. One of those messages, Kelly said, is that the community should continue to focus less on the judicial process for theoretically punishing officers who have committed wrongdoing and more on initiating policy changes that combat over-policing.

Baltimore Bloc, a grassroots group, seemed to echo Kelly’s sentiment in a statement last month. Two days after the Goodson verdict, Baltimore Bloc activists said it was a reminder that the judicial system was not broken and was simply doing exactly what it is designed to do.

“To understand our lack of faith in the justice system, you must first recognize certain truths: the justice system works for police who both live in and out of the city; it works against Black people who come from disinvested, redlined Black communities; and it systematically ruins the lives of people like Keith Davis Jr., Tyrone West and Freddie Gray,” Baltimore Bloc leadership said, referencing two other Baltimore residents shot by police.

The American Civil Liberties Union, citing the U.S. Supreme Court decision in Illinois v. Wardlow, said in a May blog post that police had legal case for stopping and arresting Gray, but also said the action constituted racially biased policing and diminished rights for Black and Latino citizens.

“The result is standards of police conduct that are different in some places than other places. It is a powerful example of institutionalized and structural racism in which ostensibly race-neutral policies and practices create different outcomes for different racial groups,” ACLU leaders said.

Right before issuing its statement in May, ACLU released a briefing paper that said at least 21 individuals had been killed in police encounters across Maryland in 2015. Of those fatal encounters, which included Gray, 81 percent were Black and about half were unarmed.

The ACLU said it was impossible for the agency to determine whether any officers were disciplined for misconduct in most cases because the police refused to release crucial information to the public.

The ACLU began compiling information about police custody deaths after learning that Maryland officials were not tracking those cases. In 2015, state politicians passed a law mandating law enforcement agencies to report such data. The first set of statistics on police custody deaths is expected in October, according to the ACLU. It is unclear whether those will include reports of officer discipline.

In line with those efforts, activists across Maryland are working to bring forth more systemic changes that will eliminate over-policing and the lack of accountability that exist among police agencies.

Elizabeth Alex, the regional director for CASA Baltimore, a grassroots group that advocates on behalf of local, low-income immigrant communities, told Rewire many activists are spending less energy on reforming the judicial process to achieve police accountability.

“I think people are looking at alternative ways to hold officers and others accountable other than the court system,” Alex said.

Like the No Boundaries Coalition, CASA Baltimore is part of the Campaign for Justice, Safety & Jobs (CJSJ), a collective of more than 30 local community, policy, labor, faith, and civil rights groups that convened after Gray’s death. CJSJ members include groups like the local ACLU affiliate, Baltimore United for Change, and Leaders of a Beautiful Struggle.

CJSJ leaders said the Goodson verdict underlined the critical need for “deep behavioral change” in the Baltimore Police Department’s culture. For the past year, the group has pushed heavily for citizen representation on police trial boards that review police brutality cases. Those boards make decisions about disciplining officers. For example, the city’s police commissioner might decide to discipline or fire an officer; that officer could go to the trial board to appeal the decision.

This spring, recent Baltimore City mayoral candidate and Maryland Sen. Catherine Pugh (D-Baltimore), helped pass an omnibus police accountability law, HB 1016. Part of that bill includes a change to Maryland’s Law Enforcement Officer’s Bill of Rights (LEOBR) giving local jurisdictions permission to allow voting citizens on police trial boards. Republican Gov. Larry Hogan signed the changes into law in May.

That change can only happen in Baltimore, however, if the Baltimore Fraternal Order of the Police union agrees to revise its contract with the city, according to WBAL TV. The agreement, which expired on June 30, currently does not allow citizen inclusion.

In light of the current stalled negotiations, Baltimore Bloc on July 5 demanded Baltimore City Council President Bernard C. “Jack” Young instead introduce an amendment to the city charter to allow civilian participation on trial boards. If Young introduced the amendment before an August deadline, the question would make it onto the November ballot.

Kelly, in an interview with Rewire, cited some CJSJ members’ recent meeting with Baltimore Police Commissioner Kevin Davis as a win for Baltimore citizens. During that meeting, held on June 29, Davis outlined some of his plans for implementing change on the police force and said he supported local citizens participating on police trial boards, Kelly said.

This year, the Baltimore Police Department has also implemented a new use-of-force policy. The policy emphasizes de-escalation and accountability and is the first rewrite of the policy since 2003, according to the Sun.

The ACLU has welcomed the policy as a step in the right direction, but said the new rules need significant improvements, according to the Sun.

For example, the policy requires reporting to the department when an officer flashes or points a weapon at a suspect without shooting; the data will be reviewed by the police commissioner and other city officials. However, it doesn’t require the same from officers who use deadly force.

Notably, the policy requires officers to call a medic if a person in custody requests medical assistance or shows signs that they need professional help. Gray had requested a medic, but officers were skeptical and didn’t call for help until he became unresponsive, according to various news reports.

Rose, who recently received legal assistance from the ACLU to fight criminal charges related to his arrests last year, said citizens should continue to demand accountability and “true transparency” from law enforcement.

In the meantime, with four trials—including Rice’s case—remaining and no convictions, many are looking to see if Mosby will change her prosecution strategy in the upcoming weeks. Roya Hanna, a former Baltimore prosecutor, has suggested Mosby showed poor judgment for charging the six officers without “adequate evidence,” according to the Sun.

Meanwhile, Baltimore City’s police union has urged Mosby to drop the remaining charges against officers.

The trial of Officer Garrett E. Miller is slated to begin July 27; Officer William Porter, Sept. 6, and Sgt. Alicia D. White, Oct. 13. All officers charged pleaded not guilty.

Baltimore Bloc, citing its dissatisfaction with her performance thus far, demanded Mosby’s removal from office last month.

Kelly, who counts Baltimore Bloc among his allies, has a different outlook. Calling’s Mosby’s swift decision to charge the six officers last year  “groundbreaking,” the Baltimore activist said the ongoing police trials are justified and help give attention to police misconduct.

“She should follow through on the charges ….We need that exposure,” Kelly said. “It keeps the debate open and sparks the conversation.”