TEDMED 2017
John Amory: How a male contraceptive pill could work
John Amory: Como funcionaría unha pílula anticonceptiva masculina
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O andrólogo John Amory está desenvolvendo un método anticonceptivo innovador para os homes, que lles dá unha nova opción para responsabilizarse por si mesmos da prevención de embarazos non desexados. Explica a ciencia que se está a desenvolver -e por que o mundo precisa desta pílula.
John Amory - Male reproductive health expert
John Amory is leading research into novel options for male contraception, male infertility and hypergonadism. Full bio
John Amory is leading research into novel options for male contraception, male infertility and hypergonadism. Full bio
Double-click the English transcript below to play the video.
00:12
When I tell people
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Cando lle digo á xente
que tento desenvolver unha pílula
anticonceptiva para homes,
anticonceptiva para homes,
00:14
that I'm trying to develop
a contraceptive pill for men,
a contraceptive pill for men,
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00:18
the response usually varies
along gender lines.
along gender lines.
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as respostas varían dependendo do sexo.
00:23
Women say something like,
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As mulleres din cousas coma:
00:25
"Fantastic. It's about time. When?"
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" Que ben! Xa era hora. Para cando?"
00:28
(Laughter)
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(Risas)
00:29
Men have one of two responses.
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Os homes só teñen dúas respostas.
00:31
They either love the idea,
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Ou ben lles soa ben
00:34
or they look at me a little warily
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ou miran cara a min preocupados
00:36
and wonder what exactly
I have in store for their testicles.
I have in store for their testicles.
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mentres pensan en que ando a argallar
para os seus testículos.
para os seus testículos.
00:39
(Laughter)
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(Risas)
00:42
So why does the world need a male pill?
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Entón, por que é necesaria
unha pílula masculina?
unha pílula masculina?
00:47
Well, what if I told you
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Que pensades cando vos digo que
00:49
that of the six million pregnancies
annually in the United States,
annually in the United States,
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dos 6 millóns
de embarazos anuais nos EE.UU.
de embarazos anuais nos EE.UU.
00:53
three million of them are unintended?
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3 millóns son non desexados?
00:56
That's half.
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Iso é a metade.
00:57
That's a really surprising number.
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É un número moi sorprendente.
01:00
And those three million
unintended pregnancies
unintended pregnancies
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E eses 3 millóns non desexados
01:02
account for the vast majority
of the more than one million abortions
of the more than one million abortions
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explican os máis dun millón
de abortos anuais
de abortos anuais
01:06
annually performed in the United States.
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que se levan a cabo nos Estados Unidos.
01:09
Happily, the rate of unintended pregnancy
has fallen in the last few years
has fallen in the last few years
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Por sorte, a taxa de embarazos
non desexados minguou
non desexados minguou
01:13
by about 10 percent.
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nos últimos anos
ao redor dun 10 %.
ao redor dun 10 %.
01:15
This is because more women
are using effective, long-acting,
are using effective, long-acting,
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Isto débese a que máis mulleres
usan métodos anticonceptivos
usan métodos anticonceptivos
01:18
reversible forms of contraception.
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efectivos, reversibles e a longo prazo.
01:21
But we still have a long way to go.
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Pero aínda queda moito por facer.
01:25
One approach that's finally
becoming a real possibility
becoming a real possibility
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Unha estratexia que á fin
estase volvendo realidade
estase volvendo realidade
01:28
is better contraceptive options for men.
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é a de mellores opcións
anticonceptivas para homes.
anticonceptivas para homes.
01:32
Think about it.
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Pensádeo.
Temos unha ducia de métodos
anticonceptivos femininos:
anticonceptivos femininos:
01:33
We have over a dozen methods
of contraception for women:
of contraception for women:
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01:37
pills, patches, IUDs,
shots, sponges, rings, etc.
shots, sponges, rings, etc.
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pílulas, parches, DIU,
inxeccións, esponxas, aneis...
inxeccións, esponxas, aneis...
01:44
For men, we've had the same two options
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Para os homes sempre tivemos
as dúas mesmas opcións
as dúas mesmas opcións
01:48
for more than a hundred years:
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durante máis dun século:
01:49
condoms and vasectomy.
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preservativos e vasectomía.
01:52
Despite having only two options,
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A pesar de termos só dúas opcións,
01:54
both of which have significant drawbacks,
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ambas as dúas teñen grandes desvantaxes.
01:57
men currently account
for 30 percent of all contraceptive use,
for 30 percent of all contraceptive use,
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Os homes representan o 30 %
do uso total de anticonceptivos,
do uso total de anticonceptivos,
02:02
with 10 percent of couples
relying on vasectomy
relying on vasectomy
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das cales un 10 % das parellas
confían na vasectomía
confían na vasectomía
02:04
and 20 percent of couples using condoms.
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e un 20 % usan o preservativo.
02:08
Why are 20 percent of couples
relying on condoms for contraception
relying on condoms for contraception
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Por que o 20 % das parellas
confían no preservativo
confían no preservativo
02:13
when condoms have a one-year
failure rate of over 15 percent?
failure rate of over 15 percent?
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se estes teñen un índice
de erro anual de máis do 15 %?
de erro anual de máis do 15 %?
02:17
It's because many women
can't either safely take
can't either safely take
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Débese a que as mulleres
ou ben non poden tomar de forma segura
ou ben non poden tomar de forma segura
02:21
currently available female contraceptives,
for reasons such as blood clots,
for reasons such as blood clots,
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os anticonceptivos dispoñibles
por motivos como coágulos de sangue,
por motivos como coágulos de sangue,
02:24
or they can't tolerate the side effects.
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ou ben non dan tolerado
os efectos secundarios.
os efectos secundarios.
02:28
So if we think a male contraceptive
would be useful, the next question is:
would be useful, the next question is:
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Así que se pensamos que sería útil
un anticonceptivo masculino,
un anticonceptivo masculino,
o seguinte é preguntarse
como poderiamos desenvolvelo.
como poderiamos desenvolvelo.
02:32
How do we go about developing one?
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02:35
Well, there's two general approaches.
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Ben, hai dous enfoques xerais.
02:37
The first approach is to try and interfere
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O primeiro é tentar interferir
no xeito en que o esperma
no xeito en que o esperma
02:39
with the way the sperm
swim towards or bind to the egg.
swim towards or bind to the egg.
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nada cara ao óvulo ou se une a el.
Este enfoque resulta ser
verdadeiramente complicado
verdadeiramente complicado
02:44
This approach turns out
to be really difficult,
to be really difficult,
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02:47
because it's hard to get enough medication
in the small volume of the ejaculate
in the small volume of the ejaculate
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porque é difícil concentrar medicación
abondo nese pequeno volume de esperma
abondo nese pequeno volume de esperma
e que siga facendo efecto ao longo
do tracto reprodutor feminino.
do tracto reprodutor feminino.
02:51
and have it still work inside
the female reproductive tract.
the female reproductive tract.
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02:55
This is why there's been a lot more work
done on the second approach,
done on the second approach,
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Por iso se investigou moito máis
na segunda opción,
na segunda opción,
que trata de frear totalmente
a produción de esperma.
a produción de esperma.
02:59
which is turning off
sperm production entirely.
sperm production entirely.
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03:03
This is also challenging.
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Tamén é unha técnica desafiante.
03:05
Why? Turns out
that men make a lot of sperm.
that men make a lot of sperm.
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Por que? Resulta que os homes
producen moito esperma.
producen moito esperma.
(Risas)
03:09
(Laughter)
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03:10
Men make a thousand sperm every second
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Un home produce mil
espermatozoides por segundo
espermatozoides por segundo
e para obter un anticonceptivo eficaz
03:15
and to have an effective contraceptive,
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03:17
you need to get that level
of sperm production
of sperm production
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tense que reducir ese nivel de produción
03:19
down to one percent of its normal value.
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ao 1 % do seu valor normal.
03:23
The good news is, this is possible,
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As boas novas son que isto é posible,
03:26
almost.
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ou case.
03:27
The most studied approach has been to use
hormones to suppress sperm production.
hormones to suppress sperm production.
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A técnica máis estudada foi usar hormonas
para deter a produción de esperma.
para deter a produción de esperma.
03:33
Testosterone and progesterone,
when administered together,
when administered together,
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A testosterona e a proxesterona,
administradas á vez,
administradas á vez,
03:37
will suppress the signals from the brain
to the testes to make sperm,
to the testes to make sperm,
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reprimen os sinais do cerebro
aos testículos para crearen esperma,
aos testículos para crearen esperma,
03:41
and in about 90 percent of men,
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e nun 90 % dos homes,
03:43
sperm production after
three to four months will stop.
three to four months will stop.
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a produción cesa despois de 3-4 meses.
03:47
Unfortunately, 10 percent of men
don't respond to these hormonal regimens
don't respond to these hormonal regimens
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Por desgraza, o 10 % dos homes
non responden a estes tratamentos
non responden a estes tratamentos
03:51
for reasons that aren't understood.
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por razóns descoñecidas.
03:54
For the last several years,
my colleagues and I
my colleagues and I
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Nos últimos anos,
os meus compañeiros e mais eu
os meus compañeiros e mais eu
03:57
have been taking a different approach
to male contraceptive development,
to male contraceptive development,
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estivemos a desenvolver unha vía
distinta para a pílula masculina,
distinta para a pílula masculina,
unha que non implique hormonas.
04:00
one that doesn't involve
the administration of hormones.
the administration of hormones.
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04:04
Specifically, we are looking to block
the function of vitamin A in the testes.
the function of vitamin A in the testes.
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Concretamente, buscamos impedir
a función da vitamina A nos testículos.
a función da vitamina A nos testículos.
04:09
Why? Well, for over 90 years
it's been known
it's been known
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Por que? Ben, sábese
dende hai máis de 90 anos
dende hai máis de 90 anos
04:12
that you need vitamin A to make sperm.
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que a vitamina A é necesaria
para producir esperma.
para producir esperma.
Os animais privados de vitamina A
na súa dieta
na súa dieta
04:15
Animals who are deprived
of vitamin A in their diet
of vitamin A in their diet
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deixan de producir esperma
04:19
stop making sperm
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e comezan a producilo cando a vitamina A
se reintroduce de novo.
se reintroduce de novo.
04:20
and restart making sperm again
when the vitamin A is reintroduced.
when the vitamin A is reintroduced.
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04:25
The vitamin A that we ingest
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A vitamina A que nós consumimos
é transformada en ácido retinoico
por unha familia de enzimas.
por unha familia de enzimas.
04:28
is converted by a family of enzymes
to something called retinoic acid.
to something called retinoic acid.
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04:33
One of these enzymes
is found only in the testes.
is found only in the testes.
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Un destes enzimas
atópase só nos testículos.
atópase só nos testículos.
04:37
It's this enzyme
that we are attempting to block.
that we are attempting to block.
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Nós tentamos bloquear este enzima.
Ao bloquear este enzima, deberíase
privar aos testículos de ácido retinoico
privar aos testículos de ácido retinoico
04:40
The blockade of this enzyme
should deprive the testes of retinoic acid
should deprive the testes of retinoic acid
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e paralizar a produción de esperma
04:44
and stop sperm production
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sen afectar as funcións da vitamina A
no resto do corpo.
no resto do corpo.
04:46
without affecting vitamin A's functions
elsewhere in the body.
elsewhere in the body.
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04:50
We're testing this approach in animals
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Estamos probando esta técnica con animais
04:52
and hope to move to human testing soon.
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e esperamos iniciar as probas
en humanos moi axiña.
en humanos moi axiña.
04:57
Obviously, the impact
of such a male contraceptive
of such a male contraceptive
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Por suposto, o impacto
deste anticonceptivo masculino
deste anticonceptivo masculino
05:00
would go well beyond reproductive biology.
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vai máis aló da bioloxía reprodutiva.
05:03
It's interesting to speculate
about the effect that it would have
about the effect that it would have
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É interesante especular
sobre os efectos que tería
sobre os efectos que tería
nas relacións entre homes e mulleres.
05:06
on relationships between men and women.
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05:09
One intriguing possibility
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Unha posibilidade interesante
05:10
is that a man could monitor
his contraceptive status over time.
his contraceptive status over time.
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é que os homes poderían monitorizar o seu
estado contraceptivo en calquera momento.
estado contraceptivo en calquera momento.
05:15
In the last several years,
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Nos últimos anos,
05:17
two groups have introduced
home sperm-testing devices
home sperm-testing devices
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dous grupos presentaron aparellos
de análise de esperma
de análise de esperma
05:21
that are iPhone-based
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que funcionan co teléfono móbil
05:23
and that are easy to use.
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e son sinxelos de usar.
Poderíase facer
un reconto de espermatozoides
un reconto de espermatozoides
05:25
A man could test his sperm count
and share the result with his partner.
and share the result with his partner.
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e compartir o resultado coa parella.
05:29
If the man's sperm count were zero,
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Se o reconto fose cero, sentiríanse
cómodos ao confiar no método.
cómodos ao confiar no método.
05:31
the man and his partner
would feel very comfortable
would feel very comfortable
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05:34
relying on his contraceptive.
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Unha ferramenta coma esta,
xunto co contraceptivo masculino,
xunto co contraceptivo masculino,
05:37
A tool like this,
coupled with a male contraceptive,
coupled with a male contraceptive,
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podería axudar o papel do home
na prevención de embarazos non desexados.
na prevención de embarazos non desexados.
05:40
could greatly increase the role for men
in preventing unintended pregnancy.
in preventing unintended pregnancy.
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05:46
The researchers who are working
on male contraception
on male contraception
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Os investigadores que traballan nisto
intentan facer un futuro
mellor para as parellas,
mellor para as parellas,
05:49
are trying to create
a better future for couples,
a better future for couples,
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un futuro onde a anticoncepción non
sexa considerada só "cousa de mulleres",
sexa considerada só "cousa de mulleres",
05:52
a future where contraception is no longer
considered just "a woman's issue,"
considered just "a woman's issue,"
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senón unha cousa que as parellas
deben decidir xuntas.
deben decidir xuntas.
05:57
rather an issue
for couples to decide together.
for couples to decide together.
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Entón, por que o mundo precisa
unha pílula masculina?
unha pílula masculina?
06:01
So why does the world need a male pill?
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06:04
Well, I believe that a male pill
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Ben, eu penso que a pílula masculina
06:06
will help reduce the stubbornly high
rates of unintended pregnancy and abortion
rates of unintended pregnancy and abortion
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axudaría a reducir as enormes taxas
de embarazos non desexados e de abortos,
de embarazos non desexados e de abortos,
e permitiríalles aos homes participar
en igualdade de condicións
en igualdade de condicións
06:12
and allow men to equally participate
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06:15
in contraception.
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na anticoncepción.
06:17
Thank you.
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Grazas.
(Aplausos)
06:18
(Applause)
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ABOUT THE SPEAKER
John Amory - Male reproductive health expertJohn Amory is leading research into novel options for male contraception, male infertility and hypergonadism.
Why you should listen
John Amory is is currently examining the potential of using inhibitors of testicular retinoic acid biosynthesis as reversible male contraceptives. He has published more than 130 peer-reviewed papers in the field of male reproduction and serves on the Advisory Board of the Male Contraception Initiative. He is currently Professor of Medicine and Section Head of General Internal Medicine at the University of Washington, where he works as an attending physician on the inpatient medicine wards and in the outpatient General Internal Medicine and Men's Health Clinics.
John Amory | Speaker | TED.com