Sir

Your Outlook supplement on fertility includes a Commentary article by J. F. Strauss and M. Kafrissen, “Waiting for the second coming” (Nature 432, 43–45; 2004), which is either an extraordinarily naive recommendation for developing fundamentally new “safer, more effective and more user-friendly” contraceptives or a disingenuous plea for more money. In this field, pouring additional funds into research without addressing the underlying problems is as illogical as getting nine women pregnant and expecting a baby in one month.

The opening sentence, “Even developed countries have a staggeringly high incidence of unplanned pregnancies”, leads the authors to conclude that currently available contraceptives “are simply not meeting the needs of society”. Yet it is primarily through the use of the Pill, intrauterine device (IUD), condom, sterilization and abortion that the reproduction rate in every European country except Albania and Malta is now below replacement level. Even in Japan, where the Pill was legalized only in 1999, the rate fell below replacement level years ago. A combination of almost static contraceptive ‘hardware’ and the more dynamically changing ‘software’ — the cultural, economic, public health, educational, political (notably in China) and women's-rights issues — has proved crucial to the decline in much of the world's population growth.

Hence it is shameless grantsmanship to claim that promising leads will result from more money for “forays into ‘glycomics’ and ‘lipidomics’ [and] new technologies for large-scale analysis of carbohydrates and lipids”. Such leads will have nothing to do with practical contraception within the reproductive lifetime of any living infant.

Of the 20 largest pharmaceutical companies in the world, only two (Johnson & Johnson and Wyeth) market female contraceptives and do a modest amount of R&D to improve existing steroid contraceptives. None of the 20 is active in the male-contraceptive field. None has been willing to continue contraceptive-vaccine research initiated by the World Health Organization. The types of incentives listed by the Commentary authors to encourage a re-entry of the pharmaceutical industry, now fixated on blockbuster drugs for geriatric populations, are largely a rehash of earlier proposals (see C. Djerassi Science 245, 356–361; 1989) for which there is no political will for implementation.

There are no short cuts to establishing the authors' illusory goal of “safer” birth control (safer than condoms, IUDs or sterilization?) without demonstrating clinically that consumption of a fundamentally new contraceptive for 10–20 years by women or 20–40 years by men is indeed safe. Who will pay the hundreds of millions of dollars required for such studies?

It makes more sense to focus on the reproductive realities described by other articles in your Fertility Outlook: research on conception, infection and the extension of female fertility. Or the enormous practical advances made in assisted reproduction, which do not require the pharmaceutical industry for research or practical implementation. Consider that in China and the United States, sterilization has now surpassed the Pill and other contraceptives among married couples.

As sex and fertilization become increasingly separated, the cryopreservation of semen by young men followed by sterilization and subsequent use of artificial insemination to create their future one or two children (see C. Djerassi and S. P. Leibo Nature 370, 11–12; 1994) may one day make contraception superfluous.