Medicine: Pregnancy Control

The 400 experts assembled in Cincinnati by the American Society for the Study of Sterility devoted more than half of their three-day meeting (ended this week) to the 10% of U.S. couples who want but cannot have babies. But the biggest news concerned the other 90%—the couples who, without contraceptive measures, would have more babies than they want. The consensus: research into the chemical, medical and social aspects of the problem is fast progressing to the stage where simplified but still safe contraception will be available at prices that most of the world's people can afford.

In the U.S., with its high standard of living, physicians have prescribed the diaphragm-and-spermicide combination (see box} almost to the exclusion of other methods for about 30 years, though it is somewhat cumbersome as well as costly. Drs. Edward T. Tyler and Henry J. Olson of the Los Angeles Planned Parenthood Center wondered whether adequate control oi pregnancies could be achieved without the diaphragm, relying on spermicidal jelly or cream alone. For more than 2^ years they tried it with 757 women, got a pregnancy rate somewhat higher than with the diaphragm combination (the most effective so far discovered), but low enough to be acceptable to most husbands and wives.

Oral Progestin. Striving for still greater simplicity, the doctors also tested spermicidal tablets to be inserted by the wife shortly before intercourse. Some of these are called foaming tablets because they include an additional chemical to promote the rapid spread of the sperm-killing substance. Drs. Tyler and Olson used the plain kind; 642 patients got results about equal to those with jelly or cream.

Most controversial of contraceptive methods now under medical investigation is the use of pills to be taken orally, one a day, made of synthetic steroid chemicals called progestins (TIME, Oct. 21, 1957). After trying six, the Los Angeles physicians narrowed their choice to two, norethynedrol (G. D. Searle & Co.'s Enovid) and norethindrone (Parke, Davis & Co.'s Norlutin). By now, they have had 1,286 patients on the pills, with a pregnancy rate about equal to that with jelly or tablets. But many women cannot tolerate the incidental effects—nausea, cramps, weight gain. Another disadvantage: the pills have to be taken 20 days each month, and even highly intelligent women had trouble with this schedule.

A forthright answer to more serious objections came from Harvard's Professor Emeritus John Rock, whose tests in Puerto Rico (TIME, Oct. 21, 1957) are the most exhaustive to date. There had been fear that the pills might permanently reduce a woman's fertility, so that if she were using them to space pregnancies, and stopped taking them to have another baby, she might be unable to conceive. Not so, said Dr. Rock: "The pregnancy rate of women who have stopped taking the pills is phenomenal.'' By a rebound effect, the pills may actually increase fertility.