Contraceptive Methods and Compositions

This invention relates to improved methods and compositions useful in human and veterinary medicine for the control of fertility.

Contraceptive methods involving the administration of chemical substances are widely practiced among women who desire to limit pregnancies. Such methods control fertility through various biological mechanisms. Among the presently used chemical methods of fertility control, the most important are those which act by means of the following: (a) suppression of ovulation through inhibition of gonadotropin release; (b) alteration of the female reproductive tract to prevent migration of sperm to the site of fertilization or, if fertilization occurs, to block implantation of the zygote (nidation); or (c) spermicidal action.

The oral contraceptives are the most prominent chemical contraceptive agents. These agents are of two types: (a) an estrogen combined with a progestin, and (b) a progestin alone. The contraceptives of the combined type act primarily by suppressing ovulation by negative feedback to prevent gonadotropin (LH and FSH) release by the hypothalamus, but alterations in the reproductive tract may also contribute to the antifertility effect. Such alterations include changes in the cervical mucus (which increase the difficulty of sperm migration) and in the endometrium (which decrease the likelihood of nidation). The action of a progestin alone in a very low oral dose (the "mini-pill") appears to involve primarily alterations in the female reproductive tract, but ovulation suppression may also occur. Although the oral contraceptives are highly effective, their use is associated with unpleasant side effects (such as nausea, depression, weight-gain, and headache) and an increased long-time risk of severe disease (such as thromboembolism, stroke, myocardial infarction, hepatic adenoma, gall bladder disease, and hypertension). Bleeding irregularities (such as break-through bleeding, spotting, and amenorrhea) are also frequent. A progestin, when administered alone, causes an increased incidence of changes in menstrual patterns, especially a marked increase in the amount and duration of menstrual bleeding.

Besides the oral route of administration a progestin alone may be administered systemically by various sustained-release dosage forms which include: (a) depo injection (IM) of an insoluble progestin (e.g. medroxy progesterone acetate), (b) a subdermal implant, or (c) an intravaginal insert. With these methods of administration, the progestin is absorbed into the body continuously at a very low daily dose, and the systemic effects are similar to those produced by oral administration of a progestin. However, as with the oral progestins, the sustained release methods may cause serious menstrual flow irregularities.

A recent method of contraception involves the sustained release of progesterone locally within the uterine lumen. In this method the progesterone is incorporated into a chamber within a flexible intra-uterine device (IUD) formed from a polymer which is capable of releasing progesterone continuously into the uterine fluids at a slow rate over a prolonged period of time. The progesterone acts primarily locally to produce progestational alterations in the cervical mucus and endometrium. However, the antifertility action may also be caused by the reaction of the endometrium to the device itself ("IUD effect") or by systemic absorption of progesterone through the uterine membrane. Again, as with other progestin-only therapies, there is an increased incidence of menstrual flow irregularities. Another disadvantage of this method, is the increased risk of ectopic pregnancy.

Another recent development is the flexible IUD bearing metallic copper. The contraceptive action of this device results from the combined effects of the copper (which very slowly dissolves in the uterine fluids), which acts on the blastocyst and on the cervical mucus or endometrium, and of the IUD itself, which causes a foreign body reaction in the endomentrium.

Other chemical methods of contraception include the post coital administration of estrogens (e.g. diethylstilbestrol or ethynylestradiol) to prevent nidation or of prostaglandins which act as abortifacients. Both of these methods, at present, are limited to emergency situations. Still in the very early stages of development are immunological methods (vaccination) and methods involving the direct control of LHRH secretion from the pituitary by LHRH agonists or antagonists.

Another group of chemical contraceptive agents are the local spermatocides, such as nonoxynol or octoxynol, which are placed into the vagina immediately prior to coitus in the form of creams, foams, jellies, or suppositories. The spermicidal action takes place either in the vagina or elsewhere in the reproductive tract. For the latter to occur, the spermicidal agent is either adsorbed on sperm membranes or is transported into the uterus under the influence of uterine contractions. The spermicidal methods are less reliable in preventing pregnancy and are inconvenient to use.

The intrauterine device (IUD) is the most common alternative to the oral contraceptives. The anti-fertility effect of the IUD is not caused by chemical activity. Instead the material forming the IUD induces a foreign body reaction (irritation) in the contiguous endomentrium which appears to interfere in some way with nidation. The use of the IUD is complicated, however, by serious problems including the possibility of intrauterine perforation, pelvic inflammation, discomfort, or aggravated menstrual periods.

From the foregoing, it is evident that the presently available methods of contraception are inadequate for various reasons because they: (a) may produce unpleasant side effects or increase the risk of serious disease, (b) may be unreliable, or (c) may be inconvenient and intrude on sexual enjoyment. Although many women practice contraception in spite of these inadequacies, a need exists in medicine for improved methods which combine effectiveness with increased safety and convenience. Such improvements are afforded by the present invention.

It has now been surprisingly found that a class of alkyl sulfonate salts (to be more fully described below) will effectively prevent fertilization when introduced in very small amounts in the female reproductive tract prior to coitus. The alkyl sulfonate salts, being non-steroidal, do not produce hormonal effects either locally or systemically, and, hence, they offer significant advantages over the oral contraceptive steroids and the sustained release progestin compositions heretofore used. The antifertility effect of the alkyl sulfonate salts has been demonstrated in female rabbits using standard pharmacological test procedures whereby the test compound is introduced locally within the reproductive tract of the animal, the animal is then bred to a fertile buck, and the genital system of the animal is then examined to determine the number of embryos.

The alkyl sulfonate salts can be delivered satisfactorily within the femal reproductive tract by slow release from silicone rubber compositions. Silicone rubber is known to be a useful vehicle for sustained delivery of certain medicaments. Administration of an alkyl sulfonate salt by means of a sustained release silicone rubber composition will provide a more convenient and acceptable method of contraception than have heretofore been employed in the prior art.

The invention sought to be patented in its method of use aspects constitutes:

1. A method of contraception in a female mammal which comprises continuously introducing within the uterine lumen of said female, over a prolonged period of time at a controlled rate, an effective amount of a pharmaceutically acceptable, non-toxic cation salt of a straight chain or branched chain alkyl sulfonate having from 11 to 16 carbon atoms; or

2. A method of contraception in a female mammal which comprises continuously introducing within the vaginal cavity of said female, over a prolonged period of time at a controlled rate, an effective amount of a pharmaceutically acceptable, non-toxic cation salt of a straight chain or branched chain alkyl sulfonate having from 11 to 16 carbon atoms, whereby the alkyl sulfonate salt is transported into the uterine fluids with sperm during or after coitus; or

3. A method of contraception in a female mammal which comprises introducing into the vaginal cavity immediately before coitus an effective amount of a pharmaceutically acceptable, non-toxic cation salt of a straight chain or branched chain alkyl sulfonate having from 11 to 16 carbon atoms whereby the alkyl sulfonate salt is transported into the uterine fluids with sperm during or after coitus.

In its composition aspects, the present invention contemplates:

1. A contraceptive composition suitable for insertion and comfortable retention in the uterine lumen which comprises: (a) about 1 to about 40 percent by weight of a pharmaceutically acceptable, non-toxic cation salt of a straight chain or branched chain alkyl sulfonate having from 11 to 16 carbon atoms, and (b) about 60 to about 99 percent by weight of a biocompatible, bioinsoluble, flexible silicone rubber carrier matrix, said matrix being capable of continuously releasing said alkyl sulfonate salt into the uterine fluids at a controlled rate over a prolonged period of time; or

2. A contraceptive composition suitable for insertion and comfortable retention in the vaginal cavity which comprises: (a) about 1 to about 40 percent by weight of a pharmaceutically acceptable, non-toxic cation salt of a straight chain or branched chain alkyl sulfonate having from 11 to 16 carbon atoms, and (b) about 60 to about 99 percent by weight of a biocompatible, bioinsoluble, flexible silicone rubber carrier matrix, said matrix being capable of continuously releasing said alkyl sulfonate salt into the vaginal fluids at a controlled rate over a prolonged period of time; or

3. A contraceptive foam, jelly, cream, suppository, or sponge composition suitable for comfortable insertion into the vaginal cavity immediately prior to coitus which comprises: (a) an effective amount of a pharmaceutically acceptable, non-toxic cation salt of a straight chain or branched chain alkyl sulfonate having from 11 to 16 carbon atoms and (b) a pharmaceutically acceptable, non-toxic vaginal excipient.

The alkyl sulfonate salts used in the contraceptive methods and compositions hereindescribed have the formula:

wherein R is a straight-chain or branched-chain alkyl group having from 11 to 16 carbon atoms (i.e. undecyl, dodecyl, tridecyl, tetradecyl, pentadecyl, hexadecyl), and M is a pharmaceutically acceptable non-toxic cation e.g. sodium, potassium, lithium, calcium, magnesium, copper, aluminum, pyridinium, substituted pyridinium, zinc, ammonium, or substituted ammonium). Straight chain alkyl groups are preferred. It will be appreciated by those skilled in the art that when the cation (M) has a valency greater than one, more than one alkyl sulfonate moiety will be associated with the cation. The alkyl sulfonates are either known compounds or can be made from known compounds by methods well known in the art of chemistry. The straight chain C.sub.11 --C.sub.16 alkyl sulfonates are available commercially in the form of the sodium salt, and the sodium salts are preferred for the purposes of this invention. Other salts can be prepared by methods well known in the art of chemistry.

The alkyl sulfonate salts represented by Formula I control fertility by inhibiting an enzyme which is required during fertilization to allow sperm to penetrate the outer investments of the ovum. An ovum contains three outer investments-the cumulus oophorus, the corona radiata, and the zona pellucida-which are barriers to fertilization. In the male and when first deposited in the female, sperm is incapable of fertilizing an ovum since it lacks the capacity to penetrate the outer investments. Before fertilization can occur, specific hydrolytic enzymes emanating from the sperm must digest each investment so as to form a passage for sperm penetration. The process by which sperm achieve the ability to penetrate the ovum is know as "capacitation". Capacitation involves the labilization of sperm membranes and the release, activation, or exposure of the ovum penetrating enzymes as needed to attack each investment. There is evidence that the activation of the ovum penetrating enzymes may involve the removal of specific inhibitors of the enzymes. The exact biochemical transformations occurring during capacitation are not fully understood, but the enzymes must exert their action either while bound to the sperm membranes or upon release from sperm after the sperm and the ovum make contact in the fallopian tube. For a review of the biochemistry of capacitation and of the inhibition of ovum penetrating enzymes, see McRorie et al., Am. Rev. Biochem., 43, 777 (1974) and E. S. Hafez, Ed., "Human Semen and Fertility Regulation in Men", C. V. Mosby Co., St. Louis, Mo., 1976, pages 201 to 242 and 563 to 582.

It has been found that the alkyl sulfonate salts of Formula I inhibit in vitro the action of acrosin, the sperm acrosomal enzyme which is known to be responsible in vivo for the penetration of the zona pellucida, by causing the degradation of the glycoproteins of the zona pellucida. Inhibition of acrosin in vivo will lead to interruption of the ovum penetration process thereby effectively preventing fertilization and pregnancy. The tetradecyl sulfonate salts are the most effective inhibitors of acrosin.

The ability of the alkyl sulfonate salts to prevent digestion of the zona pellucida has been demonstrated in in vitro tests wherein an isolated ovum from a rabbit is observed under a microscope while being incubated in calcium-free Ringer's solution in the presence of acrosin with and without the alkyl sulfonate salt being present in the medium. In the absence of sodium tetradecyl sulfonate, complete removal of the zona pellucida is observed. With the compound present, the zona pellucida remain substantially intact.

In order to prevent pregnancy, an effective, amount of the alkyl sulfonate salt must be present at the site of fertilization in the fallopian tube when sperm and the ovum make contact prior to penetration of the ovum. The alkyl sulfonate salt can be administered by introduction locally either within the uterine lumen or vaginal cavity. By both modes of administration, the alkyl sulfonate salt is carried to the site of fertilization either by adsorbtion onto sperm membranes or by transport through the fluids of the reproductive tract. In uterine fluids, the alkyl sulfonate salt reaches the fallopian tube by means of diffusion or active transport. In vaginal fluids, the compound passes to the uterine fluids either adsorbed on sperm membranes or by active transport under the influence of uterine contractions. The preferred method of administration from the stand point of convenience to the female user is to introduce the alkyl sulfonate salt continuously within the uterus or vagina during the fertile period of the female (i.e. the period three to four days after ovulation when an ovum is present in the fallopian tube). By this method an effective amount of the active compound is present within the reproductive tract each day to prevent fertilization if coitus should occur during the fertile period. Such a method would be independent of the sex act and would avoid the inconvenience of repeated independent dosages.

The continuous administration of the active compound can be accomplished effectively by incorporating it into an organopolysiloxane (silicone rubber) composition and placing said composition into the uterine lumen or vaginal cavity. The active compound is slowly introduced into the uterine or vaginal fluids by release from the silicone rubber at a controlled rate, an effective amount of the compound being present continuously in such fluids. The silicone rubber acts as an insoluble carrier matrix for supporting the active compound while it is being introduced into the uterine or vaginal fluids. Silicone rubber is bioinsoluble and biocompatible (i.e. it is non-toxic, insoluble, and physiologically inert when in contact with body tissues and fluids) and is flexible enough to avoid uterine perforation and to prevent or minimize an IUD effect on the contiguous endometrium. The silicone rubber carrier can be formed in any shape or size suitable for insertion and comfortable retention in the uterine lumen or vaginal cavity. For example, for intrauterine use it can be in the form of a Lippes loop, butterfly, coil, Birnberg bow, or T configuration, or modifications thereof, which configurations are well known in the art to be useful for retention in the uterus. [See, for example, U.S. Pat. Nos. 3,234,938; 3,533,406; 3,935,860; 3,077,879; 3,250,271; and 3,319,625.] For intravaginal use, it can be formed as a flexible ring, similar in configuration to that of the retaining ring of a diaphragm, which is known in the art to be useful for retention in the vagina. [See, U.S. Pat. Nos. 3,545,439 and 3,920,805.]

Organopolysiloxanes are described in U.S. Pat. No. 3,279,996 (Long et al), the disclosure of which is incorporated herein by reference. This patent describes implants for releasing a drug in the tissues of living organisms comprising the drug enclosed in a capsule formed of silicone rubber or the drug dispersed in a prosthesis made from silicone rubber. A number of biocompatible insoluble silicone rubbers are described in the Long et al. patent. A preferred silicone rubber is dimethylpolysiloxane which is curable at room temperature or above with an appropriate curing agent. Suitable dimethylpolysiloxane rubbers are sold commercially as liquid elastomers which are mixed with a curing agent to obtain the solid rubber. Among such commercially available rubbers are those sold by Dow-Corning Corporation identified as Silastic 382 and MDX-4-4210. Such rubbers consist of two components, a first component comprising liquid uncured rubber, and a second component comprising a curing agent. The two components are mixed and the mixture is allowed to cure. Heating can be employed to enhance curing, if desired. Another suitable type of dimethylpolysiloxane rubber is a high consistency medical grade elastomer such as that sold by Dow-Corning Corporation under the designation MDF-0198. For preparing carrier compositions suitable for intrauterine or intravaginal use, the active compound, preferably in a very fine particle size, in the amount desired is throughly mixed mechanically with the uncured dimethylpolysiloxane rubber. The curing agent is then added, and the mixture is placed, e.g. by injection, in a mold having a cavity of the desired size and shape. The elastomer is allowed to cure at an appropriate temperature and time. Upon completion of the curing, the molded composition is removed at room temperature. Using the above described procedure there is obtained a dimethylpolysiloxane in which the active compound is uniformly dispersed. When in contact with body fluids in which the compound is soluble (i.e. the uterine or vaginal fluids), the compound is released into the fluids.

It will be recognized by those skilled in the art that the silicone rubber compositions useful for the purposes of this invention can also be made by other methods which are conventional in the art. One method is to form a silicone rubber composition containing the dispersed active compound, using the molding technique described above, and then to coat the composition with a very thin layer of silicone rubber. For example, formed silicone rubber rods containing dispersed active compound can be coated with silicone rubber using conventional coating, bonding, or laminating techniques, such as by immersing the rods in a solution of uncured silicone rubber in a volatile solvent, removing the rod, evaporating the solvent, and curing the coating of silicone rubber formed thereby by heating. Alternatively, the rod containing the dispersed active compound can be fitted tightly inside a very hollow silicone rubber tube, and the ends can be sealed. If desired, the silicone rubber composition containing the active compound can be coated with, or enclosed tightly within, a microporous material through which the compound can pass by microporous flow, when the finished composition is bathed in vaginal or uterine fluids. The microporous material can be a microporous silicone rubber or other microporous polymer, the choice and use of which will be apparent to those skilled in the art.

Another method of making the compositions is by coating silicone rubber containing the dispersed active compound on an inert, biocompatible, insoluble, flexible core material. Preferably, the inert core is formed from silicone rubber, but other suitable conventional materials can be used.

It will also be understood that an effective amount of the active contraceptive compound can be releasably affixed to the outer surface of the silicone rubber composition so that when the composition is inserted into the uterus or vagina, there is an immediate release of the compound into the body fluids. The compound can be deposited or coated on the medicated silicone rubber compositions using conventional methods.

It will be apparent to those skilled in the art that, if desired, an effective amount of an X-ray contrast agent (e.g. barium sulfate) can be included in the compositions of the invention in order to render the compositions opaque to X-rays. It will also be apparent that, if desired, a non-toxic pharmaceutically acceptable filler can be added to the silicone rubber. The use of such fillers are well known in the art.

In general, the concentration of the active compound dispersed in the silicone rubber composition may vary from about 1 to about 40 percent by weight. A preferred range is from about 5 to about 20 percent. A concentration of about 10 percent has been found to be most preferred.

The rate of release of the active compound can be assessed by an in vitro test wherein the medicated carrier is placed in fresh water or fresh calcium-free Ringer's solution at 37.degree. for sucessive periods of time (e.g. 24 hours), and the amount of active ingredient released after each period is assayed from a determination of the acrosin inhibiting activity of the solution. For intrauterine use, a release rate equivalent to from about 1 to about 200 .mu.g. of the active compound per day is desired. A rate from about 50 to about 150 .mu.g. per day is preferred. For intravaginal use, a release rate of about 1 to about 5 mg. per day is desired.

It is desirable that the rate of delivery be substantially constant over the period in which the carrier composition is present in the uterine lumen or vaginal cavity. The duration of drug delivery should cover at least the fertile period of the female. Of course, for maximum convenience to the female, the delivery should extend over a prolonged period of time, preferably with intrauterine use one year or more, since this will avoid the inconvenience of repeated removal and reinsertion of the medicated carrier. For intravaginal use, the carrier composition is preferably removed at the start of the menstrual period and is reinserted after bleeding stops.

For administration to females, who for personal reasons do not wish to use a sustained release medicated intrauterine or intravaginal composition, an alternative method of administration of the active compound is by means of a pharmaceutically acceptable jelly, foam, cream, or suppository, which is inserted into the vagina immediately prior to coitus in a manner similar to that employed for administering spermicidal compositions [see the article entitled "Spermicides", Population Reports; Series H, Vol 7, No. 5, Sept. 1979, published by Population Information Program, The Johns Hopkins University, Baltimore, Md.]. The jelly, foam, cream, or suppository acts as a vehicle for carrying an effective amount of the active ingredient into the vaginal fluids from where it is carried into the uterus by adsorption on sperm membranes or by active transport. The active ingredient can be compounded into vaginal jellies, foams, creams, or suppositories according to procedures which are conventional in the art, by employing the usual excipients (buffer, emulsifier, preservatives, and the like), the choice and amount of which will be apparent to those skilled in the art.

For reasons of convenience, esthetics, or more precise control of dosage, a vaginal suppository is preferred. The suppository composition must be chemically and physically stable under conditions of storage and handling, and also must be capable of melting and/or dissolving when inserted in the vagina to effect satisfactory release of the active compound into the vaginal fluids. A preferred suppository composition comprises an effective amount of the active compound in a suitable polyethylene glycol vehicle. Various polyethylene glycols, either alone or in combination, are known in the art to be useful for making vaginal suppository compositions, and the choice of a particular vehicle will be apparent to those skilled in the art.

For intravaginal use, an effective amount of the active compound can be absorbed into a biocompatible, bioinsoluble, non-toxic sponge-like soft polymer, which when inserted and retained in the vagina will release the compound by desorption into the vaginal fluids. The sponge can be allowed to remain in the vagina during coitus or it can be removed prior to coitus. Suitable polymers for this use are well known in the art, for example, a hydrophilic polymer, such as polymeric 2-hydroxyethyl methacrylate which, if desired, may contain a cross-linking agent (e.g. dimethacrylate).

The following examples illustrate the methods and compositions of the present invention.

The inhibition of acrosin is assessed in vitro using benzoyl arginine p-nitroanilide (BAPNA) as the enzyme substrate according to the following procedure: Acrosin (200 .mu.l, purified from boar sperm) and a solution (200 .mu.l.) of the test compound (10 mg/ml.) in 0.05 M triethanolamine buffer, pH 7.8, are incubated at room temperature for 5 minutes. A control using the buffer solution without the test compound added is also run. A 200 .mu.l.-sample of the incubation mixture is then withdrawn and is added to a cuvette containing BAPNA (1 ml.) and triethanolamine buffer (2 ml.). The mixture is stirred and placed in a Gilford recording spectrophotometer. The increase in optical density at 383 nm is measured. One unit of acrosin activity is defined as the amount of acrosin which will cause an increase in optical density at 383 nm of 0.001/minute. One unit of inhibitory activity is defined as the amount of inhibitor which will cause a reduction in the increase in optical density at 383 nm. of 0.001/minute.

The results of the testing of sodium n-alkyl sulfonates of Formula I for acrosin inhibition using the above described procedure are shown below in Table I.

Equal volumes of Ky-jelly.RTM. and either Ca.sup.++ free Ringers solution or a 10 mg./ml. solution of the compound to be tested in Ca.sup.++ free Ringers solution are well mixed. One milliliter of this is placed into the vagina of a virgin dutch belted female rabbit using a syringe. The female is then immediately bred to a fertile buck. The female is injected I.V. with 100 units of human chorionic gonadotrophin to assure a good ovulation rate.

After approximately 14 days the females are sacrificed by cervical dislocation and the genital system examined for the number of embryos.

When tested as above described sodium n-tetradecyl sulfonate gave the results shown below in II:

Female rabbits are given 100 units of pregnant mares serum (PMS), IM, and 134 units of HCG, IV. After 13 hours the animals are sacrificed and the ovaries are excised. The ovaries are submerged in calcium-free Ringer's solution. Ova are removed and placed in 1 ml. of calcium-free Ringer's solution. The solutions are all shaken vigorously for 5 to 10 minutes, which rids the ova of the cumulus oophorus and the corona radiata. Acrosin (isolated from boar sperm) (100 .mu.l., of a solution containing 2000 U/ml. in 0.1 M sodium acetate and 0.02 M calcium chloride) is added to each of 10 ova. To each of 10 other ova in the same medium is added 10 .mu.l. of solution of sodium tetradecyl sulfate (10 .mu.g./ml.) in calcium-free Ringer's solution. To 10 other ova is added 10 ml. of calcium-free Ringers's solution as a control. The solutions are all incubated at 37.degree. C. The zona pellucida is observed at 15 minute intervals with an American Optical stereomicroscope. In the absence of sodium n-tetradecxl sulfonate, the zona pellucida is completely removed. With sodium tetradecyl sulfonate present,, the zona pellucida remains substantially intact.