One Saturday in January 2010, Devendra Deshpande left his home in the Delhi suburbs and drove into the city to get a vasectomy. He was 36 years old, married with two young kids, and he thought it was time.
He arrived at the hospital around midday and met Hem Das, then the hospital’s chief vasectomy surgeon. Das had an interesting question for Deshpande. Rather than receive a traditional vasectomy, would Deshpande like to be part of a clinical trial for a new contraceptive procedure?
Das explained that the new method did not have some of the drawbacks associated with a regular vasectomy. First, sperm would still be able to escape Deshpande’s body normally, which meant he would be free of the pressure and granulomas that sometimes accompany a vasectomy. More important, it could be reversed easily, with a simple follow-up injection.
“I am normally not adventurous when it comes to getting myself operated on,” Deshpande deadpans. But the new method sounded good to him, and according to the published studies he read on his smartphone in the waiting room, it seemed safe. He gave his wife, Vinu, a call, and although she sounded nervous on the phone, she said she was fine with it. Deshpande decided to try the experimental method.
When his turn came, he lay down on the table, and an orderly draped his lower body with a green surgical cloth that covered everything but his scrotum. Then Das moved in with a needle containing a local anesthetic. Once the drug had taken effect, Das gathered a fold of skin, made a puncture, and reached into the scrotum with a fine pair of forceps. He extracted a white tube: the vas deferens, which sperm travel through from the testes to the penis. In a normal vasectomy, Das would have severed the vas, cauterized and tied up the ends, and tucked it all back inside. But rather than snipping, Das took another syringe, delicately slid the needle lengthwise into the vas, and slowly depressed the plunger, injecting a clear, viscous liquid. He then repeated the steps on the other side of the scrotum.
The procedure is known by the clunky acronym RISUG (for reversible inhibition of sperm under guidance), but it is in fact quite elegant: The substance that Das injected was a nontoxic polymer that forms a coating on the inside of the vas. As sperm flow past, they are chemically incapacitated, rendering them unable to fertilize an egg.
If the research pans out, RISUG would represent the biggest advance in male birth control since a clever Polish entrepreneur dipped a phallic mold into liquid rubber and invented the modern condom. “It holds tremendous promise,” says Ronald Weiss, a leading Canadian vasectomy surgeon and a member of a World Health Organization team that visited India to look into RISUG. “If we can prove that RISUG is safe and effective and reversible, there is no reason why anybody would have a vasectomy.”
But here’s the thing: RISUG is not the product of some global pharmaceutical company or state-of-the-art government-funded research lab. It’s the brainchild of a maverick Indian scientist named Sujoy Guha, who has spent more than 30 years refining the idea while battling bureaucrats in his own country and skeptics worldwide. He has prevailed because, in study after study, RISUG has been proven to work 100 percent of the time. Among the hundreds of men who have been successfully injected with the compound so far in clinical trials, there has not been a single failure or serious adverse reaction. The procedure is now in late Phase III clinical trials in India, which means approval in that country could come in as little as two years.
But RISUG is garnering interest beyond India. Every week, Guha’s inbox fills with entreaties from Western men. They’ve heard about RISUG on Internet forums or from occasional mentions in newspaper and magazine articles. Some of them even volunteer to travel to India, offering themselves as lab rats. Guha puts them off gently but politely; for now, the trials are open only to Indian men. Everyone else has to wait. “Our options suck,” fumes one frustrated correspondent, a Florida real estate manager who emailed Guha a few years ago. “I’d gladly put my balls on the chopping block for the benefit of mankind.”
He may yet have that opportunity. Thanks to a novel collaboration between Guha and a San Francisco reproductive health activist, RISUG could soon be on the road to FDA approval in the US.
In both the East and the West, the need for better contraceptives couldn’t be clearer. India will soon surpass China as the world’s most populous nation; in the poorest Indian...Continued...