Kelly Hall considers herself an old hand at contraception. At 34, the engineer employed by the city of Seattle (Washington) and mother of three believes she has "tried just about everything." The pill, of course, or rather pills. "Apart from the inconvenience, above all it was that I was unable to remember it every day. I'd forget and have to wait for the next cycle." The hormonal injection, supposed to block ovulation for 12 weeks: "I didn't have a period for nine months." She then tried the implant, inserted under the skin of the arm, for a period of three years: "I bled for nine weeks. The doctor took it out." She settled on the vaginal ring, but it fell out, as did the first IUD she had fitted. "The second one perforated my uterus and ended up in my intestine. I had to have emergency surgery. Let's just say I haven't had much luck with female contraceptives."
So when she and her husband, Jon, an engineer at Blue Origin, the space company founded by Jeff Bezos, saw the announcement published by the University of Washington in 2019, they responded immediately. Stephanie Page's team was looking for volunteers to take part in the international clinical trial of a male contraceptive called NES/T, piloted by the National Institutes of Health (NIH), representing the federal medical research agency. This time, he would be the one smearing a hormonal gel on his shoulders once a day for a year, made up of a progestin, Nestorone, and a testosterone derivative, capable of suppressing sperm production. "I wasn't worried about forgetting, I already take a daily medication because of thyroid disease. If there were to be any side effects, let's just say it would be my turn. For a long time, I'd wanted to do my bit and ease Kelly's burden but I wasn't emotionally ready for the vasectomy. This was reversible, and with this trial, we were advancing science."
The results, based on 200 volunteers, are due to be made public in the coming months. But "they will exceed all our hopes," said Diana Blithe, who is coordinating the research at the NIH. A self-professed "cautious person who often sees the glass as half empty," she is already talking about the upcoming phase 3 trial and the commercialization that will follow. "We've been saying 'in 10 years' for 30 years, but this time I'm pretty convinced: In 10 years, we should have an effective, reversible and practical contraceptive for men."
If this prediction were to come true, it could lead to a revolution, if not a scientific one, then at least a contraceptive one, as the balance is currently so unequal. Nearly a century after the invention of the IUD and 63 years after the first contraceptive pill came onto the market, women now have a dozen ways of protecting themselves against the risk of pregnancy – Hall can testify to this. Under optimal conditions, contraceptive pills are close to 100% effective. Men, on the other hand, have three ways: condoms, withdrawal and vasectomy, techniques which were invented in the 19th century, or even earlier, which are archaic but also risky. While the failure rate for condoms when used perfectly is no more than 4%, the latest World Health Organization (WHO) study on the subject estimates it to be 13% in real life. That of withdrawal is even worse, exceeding 20%. In contrast, vasectomy – blocking the vas deferens, which carry sperm from the testicles to the penis – has a virtually zero failure rate. But the operation is irreversible, or to be more precise, is considered as such by the French Health Authority (Haute Autorité de Santé), with repair only succeeding about half the time. In the UK, the Netherlands and the USA, many men take the plunge, with vasectomy accounting for around 10% of total contraception. In France, on the other hand, despite a marked increase over the last 10 years, it accounts for less than 1% of all contraception.
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