Contraception for the year 2020

Novel methods for the regulation of human fertility in the post-HIV era are discussed, based on the control of regulatory peptides and their respective genes. Three mechanisms are examined, each representing a step-wise increase in target or functional specificity. These centre on the selective control of the genes encoding the gonadotrophins and/or the interception of circulating gonadotrophins by receptor antagonists or binding proteins, the selective neutralisation 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. A brief consideration is given to the use of vaccination procedures and somatic gene therapy for the long term regulation of fertility. By 2020, it is predicted that contraception, abortion and unplanned pregnancy could be replaced by reversible sterilisation based on the molecular interception of events involved in sperm-oocyte recognition and fusion. Contraceptive-like steroids will still be available but their use will be targeted to the provision of positive health care, with particular regard to breast cancer, osteoporosis and well-being.