Contraception - Update and Trends

Journal für Reproduktionsmedizin und Endokrinologie - Journal of Reproductive Medicine and Endocrinology 2010; 7 (Sonderheft 1): 18-38

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Keywords: Familienplanung,  Fertilität,  Kontrazeption,  Ovulation,  Spermatogenese,  contraception,  familiy planning,  female,  Fertilisation,  fertility,  Implantation,  Male,  Ovulation,  spermatogenesis

Fertility control in the future will focus on the improvement of existing methods (efficacy, side effects, easy use, duration of action, manufacturing process, costs), on new approaches (mode of action) bringing additional health benefits, and on new targets for nonhormonal contraception. Counselling of women in view to contraceptive choices based on the individual risk (e. g. cardiovascular disease, thrombophilia, family risk of breast cancer, sexually transmitted diseases) will gain more and more importance. Only a few companies can afford research in contraception such as Bayer-Schering-Pharma, and MSD. Female contraception: Ovulation inhibition: preselection of patients to minimize the individual risk. New oral contraceptive (OC) regimen, OC with new progestins, OC with estradiol or estradiol esters, new ovulation inhibitors with new progestins and new regimen including long cycles and continuous delivery of steroidal contraceptives, new contraceptive patches, vaginal rings andsprayon contraceptives. Recently identified genes involved in the ovulation process as new targets for ovulation inhibitors. Fertilisation inhibition: new intrauterine systems have been developed: a smaller Mirena intrauterine system releasing levonorgestrel (LNG) and a new frameless progestinreleasing intrauterine systems (IUS). Various new contraceptive barriers have been introduced. Research is ongoing on substances acting both as spermicide and as microbicides as a dualprotection method reducing both the risk of unwanted pregnancy and the risk of sexually transmitted diseases. New implantable systems and improved injectables (with improved pharmacokinetic profile, decreased side effects and a safer delivery system) have been made available recently. Various new approaches in female sterilisation include non invasive method of tubal occlusion Immunocontraception for the female will not be available in the near future. Implantation inhibition: selective progesterone receptor modulators (SPRMs) are tested for ovulation suppression, morphological changes of endometrium surface inhibiting implantation, postcoital contraception and for longterm use and drug safety. Male contraception: Condoms and vasectomy are the only methods available for male contraception. The development of parenteral hormonal contraceptives for men has been stopped recently by the industry but other organizations continue the search for appropriate methods such as combinations of androgen and progestin in implants and also transdermal gels STD: Furthermore clients of contraceptive methods must be informed about the risk of sexually transmitted diseases and the way how to prevent them (e. g. safer sex methods)