There are a lot of options for contraception today, from the pill to vasectomies, but they're not perfect. They can be high-maintenance (like taking a pill every day) and aren't always reliable (condoms break 3 percent of the time).
However, scientists are trying to come up with better options. Researchers are working on a number of new technologies, including a remote-controlled contraceptive for women, which could be turned on or off with a simple command, and options for the long-awaited "male pill."
Here's what you need to know about the future of contraception:
Men could get more options for reversible birth control
In the late 1950s, scientists tested a drug called WIN 18,446 on male prisoners. It was a new method of male birth control, and it worked extremely well. The prisoners' sperm was weaker, and they felt fine. But when testing moved onto the general population, there were problems. Men taking the contraceptive were vomiting, sweating profusely, and complained of headaches. The problem? The drug's interaction with alcohol.
Over 60 years later, scientists are still having problems getting male birth control just right.
About one-third of all contraception use in the US today is by men. About 20 percent of couples rely on condoms. And about 10 percent rely on vasectomy (a surgical procedure that sterilizes a man by sealing off the vas deferens duct, blocking sperm from leaving the body). But reversing a vasectomy requires outpatient surgery, condoms have a 18 percent failure rate with typical use, and there aren't other options for men.
Granted, there's a massive challenge with men's bodies — while women make just one egg a month, men make about one thousand sperm every second.
One of the most promising concepts for the future of male birth control is being developed right now in India. It's known as RISUG, which stands for reversible inhibition of sperm under guidance. A doctor injects the vas deferens with a gel that reacts with the sperm, making them unable to travel. The procedure lasts for years and can be reversed at any point with another injection.
Trials in India have showed that the procedure was 100 percent effective in preventing pregnancy. And a US drug-manufacturing company used the same concept to create Vasalgel, which is still in animal testing and years and years away from being on the market here.
Men who don't want to get shots into their sensitive areas will likely have some options in the future, as well. Researchers with the NIH are developing gels that stop sperm production with hormones — a similar approach to how the pill works for women. The work is happening with two partnerships with the University of Washington and UCLA.
This type of hormonal work in men can be a particular challenge because scientists want to get sperm production back to boyhood levels, while still leaving adult levels of testosterone intact for the rest of the body.
This contraceptive is based on gels currently used for hormone-replacement therapy in men with lower testosterone. In trials so far, a man applies two gels each day, a progestin hormone gel on the abdomen and a testosterone gel on the arm.
The progestin gel shuts down the process that makes testosterone in the testes, which halts sperm production. Then, the testosterone gel applied to the arm reintroduces the hormone to the blood, which allows it to do its job in creating muscle mass and libido and in enabling ejaculation.
"That’s worked really well at suppressing sperm production in human trials. It works if they use it every day, and even pretty well if they miss a day," says Diana Blithe, program director at the NIH's Contraceptive Discovery and Development Branch. The next research step will be to combine the two gels into a single, easier-to-use formula and make sure it still has the same effect. It'll take at least 10 years for the product to become available, Blithe says.
Meanwhile, Dr. John Amory, a male reproduction researcher at the University of Washington, has actually circled back to the WIN 18,446 trials from the '50s and is reexamining them with his team. They're testing molecules that would gum up an enzyme that plays a role in sperm maturation, with the hopes of stopping the process. If one works, they'll approach the FDA within the next few years to start clinical trials.
Women could get more long-lasting options
The pill is still the most commonly used contraceptive in the US. But because women have to take the pill every day, with normal use it has a failure rate of up to 9 percent. And for some people, it can cause side effects like nausea, mood swings, and — more rarely — stroke.
For these reasons, there's a push to develop new, long-acting reversible contraceptives, says Dr. Michael Thomas, OB/GYN at the University of Cincinnati's Center for Reproductive Health.
Right now, longer options include using an intrauterine device (IUD), a small T-shaped object inserted into the uterus that can stay in place for up to 12 years. (But changing your mind, to get pregnant, requires a trip to the doctor.) There's also Ortho Evra, a hormonal birth control patch that gets changed every week, and NuvaRing, a ring that releases pregnancy-preventing hormones into the vagina and is changed every three weeks.
One way to step up the women's birth control game? Changing the way the drugs are delivered.
With some financial help from the Gates Foundation, Massachusetts drug manufacturer MicroCHIPS Biotech is developing an implantable contraceptive for women. Contraceptive implants currently on the market are thin plastic devices that are put under the skin on the upper arm, where they release hormones for up to three years. If a woman decides she wants to have a baby, the implant needs to be removed.
But the MicroCHIPS implant will last up to 16 years, and women will be able to turn it off via remote control if they're trying to get pregnant. Trials in humans are expected to start next year, but the same microchip technology has been tested successfully in women with osteoporosis. MicroCHIPS Biotech says the implant could reasonably be on the market by 2018.
In addition, the pill could be getting an upgrade to reduce some side effects and increase its effectiveness for certain women. The NIH is partnering with researchers to develop a lower-dose version of emergency contraception Ella, which would work as a pill taken daily. It's a ways off, at least 10 years or likely longer, but the estrogen-free pill would be an option for obese women, who have higher failure rates when it comes to estrogen-based contraception.
Contraceptives that also prevent sexually-transmitted infections
One of the things that makes condoms so great is that they prevent both pregnancy and STDs at the same time, and why should the future of contraception be any different?
Researchers are working on other two-in-one options, including a team at Northwestern University. They're currently testing a contraceptive in women that's similar to the current Nuvaring (a ring put into the vagina that uses hormones to prevent pregnancy), but it also releases an antiretroviral drug to inhibit HIV and herpes.
Correction: This article originally misstated the interval at which the NuvaRing is changed. It is every three weeks.