Contraception for the year 2020
Lincoln, D.W.
British Medical Bulletin 49(1): 222-236
1993
ISSN/ISBN: 0007-1420 PMID: 8324611 DOI: 10.1093/oxfordjournals.bmb.a072600Document Number: 575766
Novel methods of human fertility regulation in the post-HIV era are discussed, based on the control of regulatory peptides and their respective genes. 3 mechanisms are examined: selective control of the genes encoding the gonadotropins and/or the interception of circulating gonadotropins by receptor antagonists or binding proteins; the selective neutralization of hCG and other signals involved in the maternal recognition of pregnancy by receptor antagonists and antibodies; and the interception of the putative disintegrin-integrin recognition events involved in sperm-oocyte recognition and fusion. By 2020, contraception, abortion, and unplanned pregnancy could be replaced by reversible sterilization based on the molecular interception of events involved in sperm-oocyte recognition and fusion. Contraceptive-like steroids will be targeted to positive health care, with regard to breast cancer and osteoporosis. The permanent ablation of the gonadotrophs could provide a reversible form of sterilization for both men and women beyond the age of 30 years requiring longterm use of steroid replacement therapy which could support libido and provide protection against cancer and osteoporosis. A first-generation prototype vaccine has been developed in which beta-hCG-carboxy terminal peptide (beta-hCG-CTP) has been linked to a carrier conjugate (diphtheria toxoid), mixed with a synthetic immuno-stimulant, and formulated into a viscous water emulsion. The disintegrin-integrin motives expressed by sperm and oocytes could be used as targets for female contraception. Strategies of vaccination and gene therapy could circumvent the problems of dose, time, and location for the longterm regulation of fertility. In the vaccination strategy, the immune system provides both great specificity and a long duration of action. Gene therapy is currently the subject of a massive research endeavor designed to develop treatments for some of the 2500 inherited diseases afflicting humans.