The search still continues for the perfect contraceptive. Some of the research is directed at developing totally new concepts in birth control, but any entirely new method would have to pass such stringent evaluations that it would be unlikely to be available widely before the end of the century. Much more of the research is being directed at improving _ the reliability and acceptability of existing methods. Some of these methods will never succeed, or will never obtain full medical or social acceptance. Others may be made available within the next few years. Some methods will open up new ethical dilemmas for Christians — others will be welcomed wholeheartedly.
Contracap. This is a barrier method designed by a gynaecologist and a dentist. A custom-made rubber cap is produced from a mould of the woman’s cervix, and is such a close fit that it remains in place on the cervix through surface tension alone. The cap contains a one-way valve which, theoretically, allows the menstrual flow out but prevents sperm from reaching the uterus. Researchers hope that the cap could be left in place for months at a time.
NSFFD. These initials stand for ‘no spermicide, fit-free diaphragm’ method. An American doctor is researching the possibility of using a single size of diaphragm for all women, without spermicide. The diaphragm is worn continuously, and removed once a day for washing.
Starch polymers. One suggested way of blocking the vagina is with a gel-forming polymer which expands as it absorbs moisture from the vagina. Spermicides could be incorporated for extra safety.
Spermicides. Most spermicides contain nonoxyno1-9 as the main sperm-killing agent. Other substances are being researched which inhibit the enzymes that enable the sperm to penetrate, and so fertilize, the ovum.
IVD. Intra-vaginal devices are cylinders of silicone rubber rather like menstrual tampons. They are impregnated with spermicide, and designed to be worn for about a month.
Hydrophilic sheaths. These are sheaths made from a substance which absorbs moisture; the intention is that the sheath then feels more like natural skin to the man and the woman.
Ovulation predictors. The main problem in the rhythm methods is in predicting when ovulation is going to take place, and to give sufficient warning to avoid sex in the ‘unsafe’ days before that time. Ways being tested of accurately predicting ovulation include miniature computers checking the basal body temperature, and urine testers. The urine testing kits act on the ‘dipstick’ principle to test for the metabolites of certain; as these levels rise, the dipsticks show the warning colours.
Ovutime Tackiness Rheometer. This is a mechanical device which measures the consistency of the cervical mucus.
Ultrasound. Ultrasound scans can be used to detect and monitor the growth and rupture of the follicle, although this method could not easily be made generally available.
Tail-less IUDs. These are very popular in the East. Tail-a less IUDS are now being tested in the Western world as it is thought that they might reduce the incidence of infection. One theory is that infective agents travel up the IUD tail-strings and so into the uterus.
Post-partum IUDs Fitting IUDS in women who have just given birth tends to be difficult as the expulsion rate is high. It is possible that this could be overcome by using biodegradable sutures or prongs to anchor the IUD to the uterus wall until the uterus has regained its customary shape and size.
Anderson leaf. This is a silicone rubber WD impregnated with copper or zinc or both.
Levonorgestrel-releasing IUD. This is the one IUD which seems, on all the evidence available so far, to work by preventing the passage of the sperm into the uterus. The WD is coated in silastic material impregnated with the drug, which is then released slowly. It seems to act as a cervical barrier to bacteria as well as to sperm, and this IUD also seems to reduce menstrual bleeding and spotting. This IUD could be very good news for women who would like the efficiency of an IUD but who also want to prevent conception rather than implantation.
ICDs. Intra-cervical devices, as their name suggests, are worn in the cervical canal; small arms protrude into the uterus to help hold the device in place. The ICD is covered in a drug reservoir — chemicals being tested include spermicides, norgestrol and norethindrone. It seems from animal tests that the presence of higher levels of progestogens actually in the cervical mucus prevent sperm migration and so prevent fertilization, even though ovulation has taken place. Lower levels appear to work by preventing implantation of the fertilized ovum.
Vaginal rings. Quite extensive tests have been carried out on rings worn around the cervix at the top of the vagina. The rings are worn for 21 days at a time, then removed for 7 days for a breakthrough bleeding. Each ring contains enough chemical to last for at least six months. Different chemicals have been tried. Some (norethindrone and norgestrol) can inhibit ovulation; others use progestogens to alter the cervical mucus and/or inhibit the sperm. Other trials have used spermicide. Effectiveness in trials with progestogens is around 98%. Some trials have used rings containing oestrogens as well as progestogens — interestingly natural progestogens can be absorbed via this route although they cannot be taken orally, which may reduce the potential oestrogen-related problems. Some organizations are researching a ring which could be left in place for three months.
Postage-stamp pill. Some women have difficulty in swallowing tablets, however small, so some researchers are working on impregnating the chemicals into a substance like rice-paper. The woman simply tears off and eats a square each day!
Monthly pills. These are not, unfortunately, contraceptive pills which need to be taken only once a month. Rather they are a postcoital method; the researchers are trying to find a drug regime which can be used to produce bleeding once a month, even if conception has taken place, thus inducing an early abortion. The drugs may work by interfering with the corpus luteum, or by causing uterine contractions to expel the pregnancy.
Postcoital pessaries. These use prostaglandins in a vaginal pessary to induce an early abortion.
Monthly injectables. These take various forms in trials done so far. The main types are progestogen-only, and oestrogen and progestogen. The progestogen-only regimes are similar to the other injectables but at shorter intervals. The addition of oestrogen reduces menstrual disruption and appears to produce one hundred per cent effectiveness — presumably the addition of oestrogen also helps to prevent ovulation. Oestrogen cannot be used in injection regimes longer than a month, as its effect diminishes rapidly; also it is not advisable to expose the body to three months’ dosage of oestrogen in one go. Data on monthly injectables are scant, but one formulation (known as injectable No 1) accounts for one per cent of all contraceptive use in the Peoples’ Republic of China.
One of the big objections to implanted contraceptives is that the capsules have to be removed when the drug is used up. Biodegradable capsules are being researched which will disintegrate harmlessly at the end of the drug regime.
Biodegradables are being researched to meet the demand for carriers of long-acting hormones (or other substances) which will release at a constant rate into the body, and also be broken down by the body when the drug is used up. In some cases, if the delivery system is near the reproductive organs, much lower doses than usual can be used (1/10th or even 1/100th) as the drug does not have to pass through the liver, which metabolizes a large proportion. Many of the combined pill’s adverse effects are thought to be the result of having to use such high doses — local injections of biodegradables could side-step this problem.
Some of the delivery systems tried are:
Microcapsules — small synthetic hollow cells containing the drug.
Microsponges — microscopic membranes with lots of pockets to hold the drug.
Microspheres — solid beads of polymer with the drug dispersed in the material or used to coat the surface.
Erythrocyte ghosts — red blood cells which have been emptied then refilled with the drug and resealed. Liposomes — tiny particles which coat a liquid-based drug.
The carriers may be taken by mouth, via vaginal pessaries, or injected into the bloodstream, under the skin, into the muscles, or into the peritoneal cavity. All of these systems are still in the early stages of research.
Nasal spray. This method ofis based on daily sniffs of LHRH (luteinising hormone releasing hormone). The hormone has been tested on both males and females. In women it can prevent ovulation, and also make the body unable to sustain a pregnancy. It does also seem to interrupt the menstrual cycle in some women.
Male hormonal. Putting out of action the millions of sperm produced every day by the average man is not easy, which is one reason why male hormonal lags far behind similar developments for women. Also, sperm formation and storage takes about three months, so effects would not be noticeable until after that time.
Gossypol has become notorious as a potential male pill; it was isolated and extracted from cottonseed after extensive research linked an outbreak of male infertility in China with the consumption of food cooked in cottonseed oil. Since 1972 over 4,000 men have been treated with gossypol tablets; a very low sperm count, low enough to prevent conception, occurred in up to ninety-nine per cent of the men treated. The drug suppresses sperm production and also alters the structure and motility of any sperm that are formed. Potential side-effects include decreased libido, nausea, changes in appetite, weakness, and lowered blood potassium levels. In high doses the drug can induce cardiac irregularities. Fertility appears to return completely after a few months without the drug.
LHRH (luteinising hormone releasing hormone) has also been tried as a male contraceptive. Both of these drugs will require many more years of satisfactory tests before they could be approved for general use. A further method being investigated involves administration of a drug which immobilizes the sperm or causes them to agglutinate — clump together.
Vaccination. The concept of vaccination against pregnancy is based on producing antibodies that either block conception or prevent implantation. Some antibodies work on the zona pellucida around the ovum and prevent fertilization from occurring — these have been used to produce short-term and long-term infertility in animals. Other antibodies work to destroy the corpus luteum, and so prevent successful implantation of the fertilized egg.
Abortion pill. A pill has been developed in France that induces abortion in early pregnancy.
Many methods have been found to block the fallopian tubes, and many more are being researched. The introduction of various chemicals into the uterus via the vagina and cervix can block the tubes without the need for an operation. Chemicals tested include silver nitrate, zinc chloride, phenol, plastic and silicate blocking agents, and tissue adhesives. Also an IUD which releases a blocking agent is being tested. Other trials have blocked the tubes using heat cauterization or cryosurgery (freezing) via the vagina and uterus rather than the abdomen. Another method uses a uterine reservoir containing a viscous liquid; every time the uterus contracts, the liquid is slowly pushed up the tubes.
Reversibility is always an ideal of sterilization operations, and various devices are being tested with this in mind including one rather like a rawplug and screw! Others consist of silicone plugs that cure in situ, but have a retrieval loop on the uterine end. Still other techniques use plastic or silastic meshes in the fallopian tubes.
So, after all this information, what can we deduce about the role of contraception in a Christian marriage?
First of all, we have seen that sex within marriage is a part of God’s good plan for humankind, and that it is not right just to restrict it to procreation. Every couple has the justification, if they choose, to enjoy this part of their marriage without a constant fear of pregnancy. Contraception is one of the factors which makes this full enjoyment possible. There is noargument which prohibits the use of contraception.
The thoughtful use of contraception also helps to protect the health of the woman between children, and the health of subsequent children. It also helps the couple to avoid the emotional, financial and even spiritual strains of conceiving a child too soon or at the wrong time. From the point of view of Christians as world citizens, it also helps to keep a small check on the national and worldwide population level.
However, there is no perfect contraceptive. The perfect method would be one hundred per cent effective, totally and instantly reversible, ethically unquestionable, would not interrupt lovemaking, and would have no side-effects or extra effects whatsoever on wife, husband or subsequent children. As Guillebaud says: ‘All our present reversible methods are tried and found wanting in some way.’ All have drawbacks — some are not reversible, some are messy, some are unethical, some can be dangerous, some interfere with sex, some are unreliable, some delay the return of fertility, and so on and so on. Research is constantly trying to minimize these drawbacks, but like most things in this world, contraception is always going to present problems.
Nevertheless the acceptable choices are still numerous for most couples, and you may not want to use the same method for every stage of your marriage. Some methods will suit your own preferences, age, stage of marriage and lifestyles more than others. You have to weigh up the risks and benefits of each method and make your choice before God. Tim and Beverly La Haye say: ‘Realistically speaking, each couple should prayerfully and thoughtfully bring into the world the number of children they can properly train to serve God.’