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COSO, an ultrasound-based and reversible approach to male contraception (jamesdysonaward.org)
41 points by gpvos on Oct 13, 2021 | hide | past | favorite | 69 comments


I see a couple of acceptance problems with the device.

First, men a notoriously squeamish when it comes to their testicles. "Heating" without telling the temperature won't fly with many. I guess it doesn't have to be hot as it probably only needs to be warm enough to relax the cremaster muscles. If it has to be uncomfortably hot, I see little chance in the market.

Second, I'd expect the ultrasound to hurt. The epididymis is pretty sensitive to pain.

Third, it will feel like gambling as the female partner doesn't really know whether all sperm is killed or whether she will end up pregnant. And for the male, it will be a leap of faith as well. That should improve if a lot of users report no unwanted pregnancies, but in the beginning...


Even so, providing direct control of fertility by a male partner is an important problem. Currently, the only control option that permits unprotected sex is a vasectomy -- this is expensive, requires many months, and is not always reversible. On the female side there is the UID and hormonal interventions -- both of which have downsides for the female partner.


> Currently, the only control option that permits unprotected sex is a vasectomy

This isn't really true. Despite getting disparaged often - pulling out is an effective form of birth control (If done correctly, only slightly less effective than condoms: 96%).

Combined with tracking periods and being extra careful around ovulation dates, it works quite well.

Even if we assume improper methods in real world conditions, it's still about 75% effective.

It's not a method I recommend for casual encounters, but with a long term partner you trust - it can be extremely effective without the downsides of other birth control.


Why is it an important problem? We have hormonal and non-hormonal UIDs, many different types of pills, rings, and not to mention _condoms_ which actually prevents STDs. I don't have a problem with other guys heating their balls up, but where is the important problem?


Why must women must be the ones that compromise by having a medical intervention? Don't they also have the right to be "squeamish" about having an IUD or their hormones altered?


Use condoms.

>don't they get the right to be squeamish about having an IUD or their hormones altered?

IUD exist without any hormones, and taking hormones generally are safe and extemely well tested. Saying "hormones altered" shows your bias, and you don't think blasting your balls with heat "alters" your hormones? Certainly men who get vasectomies produce less testosterone.


>>Certainly men who get vasectomies produce less testosterone.

It literally doesn't, it's a weird repeated myth about vasectomies.

https://www.vasectomy.org.au/faqs/sex-life-myths/#:~:text=A%....

>> and taking hormones generally are safe and extemely well tested.

Well, if you are willing to accept an increased risk of cancer, sure, "extremely safe". Like, don't get me wrong, it's still one of the best options for pregnancy prevention, but let's not pretend like the pills are candy - they aren't.

https://www.cancer.gov/about-cancer/causes-prevention/risk/h...


> Saying "hormones altered" shows your bias

What is "Shows your bias" supposed to mean here? Look: There are women who don't like hormonal birth control. They feel bloated &etc. Trust me on this.

> IUD exist without any hormones

Yes, and theoretically and by the numbers it's effective, but did you know that it hurts to put one in? It's actually not a small ask. If a woman chooses it herself without prompting, fine. And in the context of a really long term relationship where you can "have a conversation", maybe. But it's not a little thing. In fact, it hurts enough that it can create a fair amount of resentment.

> you don't think blasting your balls with heat "alters" your hormones?

Actually no, that's not the mechanism at work here.

> Use condoms.

Well, that's reasonable advice, though you still do want to use multiple methods.


We have tested methods of birth control for women. We have untested and/or not as effective and/or not as safe methods for men. These methods also alter your hormones, the testicles are where the male hormones are produced. (We also have condoms guys)

The "important problem" should be to have _even safer_ birth control, not male birth control.


A vasectomy does not inhibit testosterone production and the hormones in existing birth control have been shown to cause blood clots, migraines and other serious issues for women taking them.

Condoms require proper use every time and are not as effective as other methods.


The increased risk is very slight, and there are contraceptive pills without estrogen which do not have any increased risk at all.


Power and control.

Females have a wide range of birth control options, all highly effective. However, they are all entirely under the woman's control. They can stop birth control without the man even knowing about it.

This isn't some conspiracy theory, either. Women do show up to gynecologists to ask them to remove their IUDs with the explicit intent to have a child regardless of their partner's wishes. This is not considered rape.

Male contraception eliminates this problem. Men are now in direct control of whether their sperm is able to fertilize. Just like women are currently in control of whether they ovulate.


If your relationship balance and trust is based on whether or not your partner can secretly make babies with you without your consent, that is something to be addressed (in a human way, not by using ultrasound on your testicles).


Relationships are hard and often imperfect. People often lie and act irrationally. I've seen justifications like "he won't leave me if I have a baby with him".

As men, this is absolutely something that we should worry about.


They are hard and can be imperfect. More importantly, you cannot have a good relationship founded on this kind of thinking:

> People often lie and act irrationally.

If that is your fundamental truth in interacting with your partner(s), your relationships will never really get anywhere. It is just not good advice to tell people to do so, unless you want them to never create meaningful connections with their partners.


My experiences with relationships are overwhelmingly positive. However, there's always a non-zero risk that such a maneuver can happen. I've seen it happen, many times. Even in otherwise happy couples. Are you willing to bet your future on it?


Your partner can also kill you in your sleep, life is never a guarantee


Somehow cold blooded murder of a defenseless person doesn't seem at all comparable to an unplanned pregnancy.


Betting your future on your partner is the whole point of having a shared household. You and I must have a significantly divergent of what a positive relationship looks like.


> You and I must have a significantly divergent of what a positive relationship looks like.

I guess. I've never had reason not to be open about these issues and it's never disrupted trust in the relationship. I've discussed these ideas with every partner I've ever had. They weren't offended, they understood. Many even had their own stories of unplanned pregnancies to share.

My girlfriend lets me give her the trimestral birth control injections.


Finally a real answer, and not an increase of 2% chance of blood clots for a certain type of contraceptive pill.

But this doesn't make a difference either because now the man can stop going to the ball blasting session.

The main issue is trust, and why are you having unprotected sex with people you don't trust in the first place?


> But this doesn't make a difference either because now the man can stop going to the ball blasting session.

It makes a huge difference. Actually it changes everything. With male birth control, there are 4 possible outcomes:

  1. Man and woman don't use birth control.
     Conception is likely.

  2. Man uses birth control. Woman doesn't.
     Conception is unlikely.

  3. Man doesn't use birth control. Woman does.
     Conception is unlikely.

  4. Man and woman use birth control.
     Chance of conception is astronomically low.
Notice how conception is only likely when both partners want it.

When only women have access to effective birth control, they have a lot more leverage and therefore power:

  1. Man has no birth control. Woman doesn't use hers.
     Conception is likely.

  2. Man has no birth control. Woman uses hers.
     Conception is unlikely.
Currently, the choice to have children rests almost entirely on the female. All she needs to do is secretly stop her birth control.

> The main issue is trust, and why are you having unprotected sex with people you don't trust in the first place?

Trust should not be necessary for a matter of this importance. Children should only be born when both partners consent. It's as simple as that.

Also, condoms are not particularly effective at contraception. The statistics assume perfect use and that doesn't happen in reality. Their main purpose is protection against sexually transmitted diseases. That isn't perfect either.


What kind of relationship do you think you're building without any trust and explicitly telling your partner you don't trust her by both of you using contraceptives?

Let the fairer sex have some power


> What kind of relationship do you think you're building without any trust and explicitly telling your partner you don't trust her by both of you using contraceptives?

One where I don't end up with children I didn't plan to have.

> Let the fairer sex have some power

They do have the power to prevent conception. That's nice.

They should not have the power to have our children without our consent. The reasons for this should be obvious to anyone. I'm honestly surprised it's not considered rape.


>>The main issue is trust, and why are you having unprotected sex with people you don't trust in the first place?

I guess you never had a condom break? As rare as it is, it happens.


Actually I've had it happen quite a few times, but it's been my own fault every time either for using condoms that were too thin or the wrong size when I first started using condoms or being drunk when putting them on.


Right, as you yourself admit - it has nothing to do with trust. You can absolutely trust or not trust someone, and a condom can still break, maybe because you made a mistake, maybe for some other reason, but trust isn't the "main" issue.


This guy was talking about female contraceptions, not condoms


Men also have a second option that preserves power and control: Just avoid penile-vaginal sex until pregnancy is desired. I.e., say "no".


Yeah, sure. I want to be happy though. Why can't we have our own pill?


Sure, I don't disagree. But, you know, my post contained a little bit of a payload; I wasn't saying you need to be celibate.


Condoms are not very reliable (historically about 90% pregnancy prevention effectiveness over a year) due to issues with using them.

The other methods can fail due to misuse (missing a pill or get the timing wrong) or be removed without the partners knowledge - which does happen surprisingly often.


It's 98% for one year according to the NHS.

IUDs dont fail, and certainly a guy can miss his ball heating session or stop without the partners knowledge.


>>IUDs dont fail

They absolutely do, and it's often life threatening when it happens. It's very unlikely, but it's not absolute protection.

https://www.webmd.com/sex/birth-control/get-pregnant-iud


It does say that the baby's and the mother's health could be in danger, but where does it say it's often life threatening?

Never heard about an IUD failing at all so thanks for the link anyhow


It says that with an IUD if you get pregnant it's more likely that it will be an ectopic pregnancy, and those are by very definition extremely dangerous to the mother and treated as medical emergencies most of the time.

"It is the most common cause of death among women during the first trimester at approximately 6-13% of the total"

https://en.wikipedia.org/wiki/Ectopic_pregnancy


> where does it say it's often life threatening?

IUDs greatly reduce overall risk of pregnancy. The risk is not zero, though. When IUDs do fail, and they will, they increase the risk of ectopic pregnancies. The vast majority of those are located in the uterine tubes. Those are life threatening. There is no space for the fetus in the tube, it will rupture and cause severe bleeding which can and will kill the mother if left untreated. It's an important cause of acute abdomen.


Had it happen once with a partner (copper IUD, and it has been installed correctly), it was pretty terrible emotionally and physically.


The little asterisk you see on those 98% numbers is important, as it ignores the real life variables that come up. At least according to this planned parenthood link [https://www.plannedparenthood.org/learn/birth-control/condom...] found when tracking down some data (they do a lot of birth control), it’s actually even worse - 15 out of 100 couples using them consistently get pregnant every year, so 85% real world effectiveness.

Not saying either side is the only one who ever does weird things - noting that ideally, each side would be able to make a choice and have it stick, and it would require both sides consent for a child.


98% if used correctly, which they aren’t. Now I guess one could say “well then that’s a personal problem - people should just use them correctly”.

But the problem we want to solve is poor control over family planning, not blaming people for making human mistakes. We do that by developing better contraception options, for both men and women.


> It's 98% for one year according to the NHS.

Assumes perfect use. The real figure is lower. Condoms simply can't compete with other contraception methods. Their main purpose is prevention of sexually transmitted diseases.


Women with health complications and healthy partners, women concerned about future fertility, etc.


Uhh Id be concerned about this for the same reason, do we know the effects of repeatedly microwaving my balls on cancer and future fertility (both ability to get a woman pregnant and rate of birth defects)?


> First, men a notoriously squeamish when it comes to their testicles.

That's quite an inaccurate blanket statement.

> Second, I'd expect the ultrasound to hurt.

Ultrasound treatments are actually used to treat pain. Maybe you have evidence of ultrasounds causing pain, but I can't find anything of the sort.

> Third, it will feel like gambling as the female partner doesn't really know whether all sperm is killed or whether she will end up pregnant.

Unprotected sex is always gambling, for BOTH parties, not just the female.


>Maybe you have evidence of ultrasounds causing pain

Anecdotally, I had an ultrasound years ago and it was most certainly uncomfortable. The body of the testicles was fine, but moving over the epididymis wasn't that great.

And no, no inflammation or anything.


Testicular ultrasound can hurt, but usually it's only an issue if there's an existing issue like infection or torsion.


The pill can feel like gambling too. Yet lots of people rely on it, either in isolation or combined with another method. It may well be that people feel like it's gambling on its own but still end up finding value in it combined with the pill or with condoms or both long before people feel confident about relying on it on its own.


4th, there's no data about return of fertility in humans after longterm use and if it raises birth defects.


And 5th, I have no idea how long sperm remains viable in the prostate, but I imagine that you would have to ultrasound your balls regularly or end up with live swimmers in a very unpredictable way.

I'd imagine you'd destroy them and maybe their precursors, then have protected sex for 2-3 times to get rid of the viable sperm and only after that end up with 1-2 weeks of infertility.


The links to data in other comments suggests a treatment would take about 2 weeks to become effective (rid the system of existing viable sperm), then last approximately 6 months.

Although, if you look at the graphs/numbers it seems there still are a small number of motile sperm (looks to me like approximately 50% reduction in count with 20% motility). Seems like it doesn't completely eliminate the possibility of pregnancy.


Yeah I physically cringed when I heard this, idk if I'd ever be able to make myself do it. Just stick to condoms.


Feels like snake oil. There's no data on how the device uses ultrasound to destroy sperm. There's no data on how often it must be used to keep live sperm from getting to the prostate where they cannot be destroyed. The biggest section is boasting about how they had a bunch of guys off the street draw up idea for the appearance of the device. Red flag, red flag, red flag.


I'd love to have effective male contraception.

But the previous work on this doesn't make it look like it's the answer: https://www.parsemus.org/humanhealth/ultrasound-male-contrac...

See the section "Effective contraception in humans remains elusive"


DMAU as a pill or injection appears to be very effective. Studies are still ongoing. It’s been studied for a long time, and finally it seems there’s an appetite from men widespread enough to make it feasible commercially.

https://endocrinenews.endocrine.org/one-step-closer-is-male-...

I’ve done two drug trials with this stuff and it’s pretty cool. It appears to make men totally infertile while they’re on the drug, with a quick recovery once off of it. It might help prevent balding, too.


That sounds amazing. It will come to late for me, but I wish it had been available when I was younger.


Yeah, those numbers don't look good - 20% motility and 50% of normal count sounds like potential for pregnancy. Maybe reduced, but still there.


Turns out "take a hot bath" doesn't make anyone any money. It's very common in poor countries such as India. (https://www.dontcookyourballs.com/)


>> The technology of the COSO is based on a study of the Parsemus Foundation from 2012 in which successful research was conducted on ultrasound contraception.

Isn't that the same organization that has been claiming to bring RISUG to the US for the last 10 years with ZERO results? I'm starting to think they're actually a shill claiming to tackle this issue so that nobody else will. Their goal seem to be the opposite of what they say.


I wonder how long the effect lasts? How often would a man have to do this to maintain continuous contraception? Seems like there might be some long term effects from repeated ultrasonic treatment of any human tissue.


How long but also how long does it take before the procedure is done and your sperm is sterile. Minutes? Hours? Days?


~2 weeks


"So far, the procedure has been applied to animals. Therefore, the technical parameters are hypothetically transferred to humans."


I'd love to see more innovation happening in this space. The one project I followed for a while seems to have stalled (or never really got off the ground) -- https://www.parsemus.org/humanhealth/vasalgel/ (which had solid results in India but got patented and locked up by a non-profit)


In the past men used to take really warm baths to temporarily become infertile, i assume this uses the same process

In related news: "coso" is used in italian to mean d.


To be fair, coso could be used to refer to any generic thing, male (in Italian language everything is male or female). Unfortunately given the context, this could only refer to that.


it's always a bad sign when the commercial slides and the nice 3D renders are ready before any scientific study of the device


The James Dyson award is a design award. On second view, this appears to be a master thesis project by a technical design student. So the product does not yet exist, and there are lots of problems with getting it there. I did not properly see all that before posting it; my apologies.

Nevertheless, it's an interesting idea to speculate about. And it seems to be one of the more promising ideas in this area.


Here is the 2012 project that this product was inspired by: https://www.parsemus.org/humanhealth/ultrasound-male-contrac...


How long does a ball heating session work for?




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