ABOUT THE SPEAKER
John Amory - Male reproductive health expert
John 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.

More profile about the speaker
John Amory | Speaker | TED.com
TEDMED 2017

John Amory: How a male contraceptive pill could work

約翰.艾莫瑞: 男性避孕藥丸如何能奏效?

Filmed:
1,124,721 views

男科醫師約翰.艾莫瑞正在開發創新的男性避孕方法,讓男性有新的選擇,為預防意外懷孕盡一份心力。他詳細說明了這項發展中的科學——以及為什麼世界需要男性避孕藥丸。
- Male reproductive health expert
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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當我跟別人說,
00:14
that I'm trying to develop發展
a contraceptive避孕的 pill for men男人,
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我正試著研發男性用避孕藥時,
00:18
the response響應 usually平時 varies變化
along沿 gender性別 lines.
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他們的反應通常會因性別而異。
00:23
Women婦女 say something like,
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女性會說:
00:25
"Fantastic奇妙. It's about time. When?"
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「好極了!也該是時候了。
何時會完成?」
00:28
(Laughter笑聲)
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(笑聲)
00:29
Men男人 have one of two responses回复.
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男性則有兩種反應。
00:31
They either love the idea理念,
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他們要嘛會喜歡這個點子,
00:34
or they look at me a little warily翼翼
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不然就是有點謹慎地看著我,
00:36
and wonder奇蹟 what exactly究竟
I have in store商店 for their testicles睾丸.
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納悶我想對他們的睪丸做什麼?
00:39
(Laughter笑聲)
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(笑聲)
00:42
So why does the world世界 need a male pill?
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所以,為什麼世界
需要男性避孕藥丸?
00:47
Well, what if I told you
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嗯,如果我跟你說,
00:49
that of the six million百萬 pregnancies懷孕
annually每年 in the United聯合的 States狀態,
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美國每年六百萬個懷孕案例當中,
00:53
three million百萬 of them are unintended意外?
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有三百萬個都是不小心
發生的,你怎麼想?
00:56
That's half.
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那佔了一半。
00:57
That's a really surprising奇怪 number.
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這個數字很驚人。
01:00
And those three million百萬
unintended意外 pregnancies懷孕
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而那三百萬個不小心懷孕的案例
01:02
account帳戶 for the vast廣大 majority多數
of the more than one million百萬 abortions人工流產
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是美國每年超過一百萬個
墮胎案例的主要原因。
01:06
annually每年 performed執行 in the United聯合的 States狀態.
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01:09
Happily令人高興的是, the rate of unintended意外 pregnancy懷孕
has fallen墮落 in the last few少數 years年份
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值得高興的是,最近幾年,
不小心懷孕的比率
01:13
by about 10 percent百分.
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下降了約 10%。
01:15
This is because more women婦女
are using運用 effective有效, long-acting長效,
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這是因為有更多女性
會使用有效、長效
01:18
reversible可逆 forms形式 of contraception避孕.
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且可逆式的避孕方式。
01:21
But we still have a long way to go.
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但我們還有很長的路要走。
01:25
One approach途徑 that's finally最後
becoming變得 a real真實 possibility可能性
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有一個快要實現的方法
01:28
is better contraceptive避孕的 options選項 for men男人.
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就是提供男性更好的避孕工具。
01:32
Think about it.
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試想看看。
01:33
We have over a dozen methods方法
of contraception避孕 for women婦女:
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我們有十多種給女性的避孕方法:
藥物、貼布、子宮內避孕器、
注射、海棉、避孕環等等。
01:37
pills, patches補丁, IUDsIUDs,
shots鏡頭, sponges海綿, rings戒指, etc等等.
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01:44
For men男人, we've我們已經 had the same相同 two options選項
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對男性而言,
超過一百年來,都只有兩種選擇:
01:48
for more than a hundred years年份:
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01:49
condoms避孕套 and vasectomy輸精管結紮術.
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保險套和輸精管切除術。
01:52
Despite儘管 having only two options選項,
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儘管只有兩種選擇,
01:54
both of which哪一個 have significant重大 drawbacks缺點,
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兩者都有明顯的缺點,
01:57
men男人 currently目前 account帳戶
for 30 percent百分 of all contraceptive避孕的 use,
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目前所有避孕工具的使用中,
有 30% 是由男方來做避孕,
02:02
with 10 percent百分 of couples情侶
relying依托 on vasectomy輸精管結紮術
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其中 10% 用輸精管切除術,
02:04
and 20 percent百分 of couples情侶 using運用 condoms避孕套.
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20% 使用保險套。
02:08
Why are 20 percent百分 of couples情侶
relying依托 on condoms避孕套 for contraception避孕
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為什麼明明保險套的
一年失效率超過 15%,
02:13
when condoms避孕套 have a one-year一年
failure失敗 rate of over 15 percent百分?
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卻有 20% 的伴侶選擇靠它來避孕?
02:17
It's because many許多 women婦女
can't either safely安然 take
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那是因為,許多女性
無法安全地採用
02:21
currently目前 available可得到 female contraceptives避孕藥,
for reasons原因 such這樣 as blood血液 clots血塊,
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現今的女性避孕工具,
理由包括血栓,
02:24
or they can't tolerate容忍 the side effects效果.
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或是她們無法忍受副作用。
02:28
So if we think a male contraceptive避孕的
would be useful有用, the next下一個 question is:
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如果我們認為男性的避孕工具
會很有用,下一個問題就是:
02:32
How do we go about developing發展 one?
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我們要如何著手開發它?
02:35
Well, there's two general一般 approaches方法.
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嗯,有兩種常用的方法。
02:37
The first approach途徑 is to try and interfere干擾
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第一種是嘗試阻擾
02:39
with the way the sperm精子
swim游泳 towards or bind捆綁 to the egg.
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精子游向卵子或和卵子結合。
02:44
This approach途徑 turns out
to be really difficult,
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結果發現這種方法很困難,
02:47
because it's hard to get enough足夠 medication藥物治療
in the small volume of the ejaculate射出
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因為一次射精的量很小,
使其很難達到足夠的藥物劑量
02:51
and have it still work inside
the female reproductive生殖 tract管道.
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在女性的產道中能持續發揮功效。
02:55
This is why there's been a lot more work
doneDONE on the second第二 approach途徑,
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這就是為什麼比較多人
致力於第二種方法,
02:59
which哪一個 is turning車削 off
sperm精子 production生產 entirely完全.
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就是完全關閉精子的生產。
03:03
This is also challenging具有挑戰性的.
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這也很有挑戰性。
03:05
Why? Turns out
that men男人 make a lot of sperm精子.
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為什麼?結果發現
男性會製造很多精子。
03:09
(Laughter笑聲)
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(笑聲)
03:10
Men男人 make a thousand sperm精子 every一切 second第二
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男性每秒鐘會製造一千個精子,
03:15
and to have an effective有效 contraceptive避孕的,
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若要達到避孕的效果,
03:17
you need to get that level水平
of sperm精子 production生產
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必須要把精子產量降低
03:19
down to one percent百分 of its normal正常 value.
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到正常值的 1%。
03:23
The good news新聞 is, this is possible可能,
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好消息是,這的確有可能辦到,
03:26
almost幾乎.
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幾乎有可能。
03:27
The most studied研究 approach途徑 has been to use
hormones激素 to suppress壓制 sperm精子 production生產.
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最多人研究的方法,
是用荷爾蒙來抑制精子的製造。
03:33
Testosterone睾酮 and progesterone黃體激素,
when administered管理 together一起,
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如果同時施用睪丸素和黃體酮,
03:37
will suppress壓制 the signals信號 from the brain
to the testes睾丸 to make sperm精子,
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就能夠抑制從大腦發送到睪丸
要求製造精子的訊號,
03:41
and in about 90 percent百分 of men男人,
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在大約 90% 的男性身上,
03:43
sperm精子 production生產 after
three to four months個月 will stop.
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三到四個月後精子製造就會停止。
03:47
Unfortunately不幸, 10 percent百分 of men男人
don't respond響應 to these hormonal激素 regimens方案
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不幸的是,10% 的男性
對這類荷爾蒙方案沒有反應,
03:51
for reasons原因 that aren't understood了解.
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目前原因還不明。
03:54
For the last several一些 years年份,
my colleagues同事 and I
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過去數年間,我同事和我
03:57
have been taking服用 a different不同 approach途徑
to male contraceptive避孕的 development發展,
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採用了一個不同的方法
來開發男性避孕工具,
04:00
one that doesn't involve涉及
the administration行政 of hormones激素.
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我們的方法不需要用到荷爾蒙。
04:04
Specifically特別, we are looking to block
the function功能 of vitamin維他命 A in the testes睾丸.
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明確來說,我們想做的是
阻擋睪丸中維生素 A 的功能。
04:09
Why? Well, for over 90 years年份
it's been known已知
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為什麼?過去九十年間
我們一直都知道
04:12
that you need vitamin維他命 A to make sperm精子.
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需要維生素 A 才能製造精子。
04:15
Animals動物 who are deprived剝奪
of vitamin維他命 A in their diet飲食
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動物的飲食若去除維生素 A,
04:19
stop making製造 sperm精子
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牠們就會停止製造精子,
04:20
and restart重新開始 making製造 sperm精子 again
when the vitamin維他命 A is reintroduced重新.
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再度提供維生素 A 時,
才又會重新開始製造。
04:25
The vitamin維他命 A that we ingest攝取
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我們攝取的維生素 A
會由某些酶轉換成為
所謂的維生素 A 酸。
04:28
is converted轉換 by a family家庭 of enzymes
to something called retinoic甲酸 acid.
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在這些酶當中,
就只有一種酶存在於睪丸中。
04:33
One of these enzymes
is found發現 only in the testes睾丸.
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04:37
It's this enzyme
that we are attempting嘗試 to block.
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我們打算阻擋的就是這種酶。
04:40
The blockade封鎖 of this enzyme
should deprive剝奪 the testes睾丸 of retinoic甲酸 acid
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若能阻擋這種酶,就能讓
睪丸中不再有維生素 A 酸,
04:44
and stop sperm精子 production生產
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進而阻止精子產生,
04:46
without affecting影響 vitamin維他命 A's functions功能
elsewhere別處 in the body身體.
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且不會影響維生素 A
在身體其他地方的功能。
04:50
We're testing測試 this approach途徑 in animals動物
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此方法正在進行動物測試,
04:52
and hope希望 to move移動 to human人的 testing測試 soon不久.
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希望很快可以進入人體實驗階段。
04:57
Obviously明顯, the impact碰撞
of such這樣 a male contraceptive避孕的
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很顯然,這種男性避孕工具的影響
05:00
would go well beyond reproductive生殖 biology生物學.
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會遠遠超過生殖生物學的範圍。
05:03
It's interesting有趣 to speculate推測
about the effect影響 that it would have
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可以來推測看看
它對於男女之間的關係
05:06
on relationships關係 between之間 men男人 and women婦女.
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有什麼影響,應該很有趣。
05:09
One intriguing奇妙 possibility可能性
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挺有吸引力的一點
05:10
is that a man could monitor監控
his contraceptive避孕的 status狀態 over time.
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是男性可以隨時監控他的避孕狀態。
05:15
In the last several一些 years年份,
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在過去數年間,
05:17
two groups have introduced介紹
home sperm-testing精子檢測 devices設備
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有兩個團體都推出了
居家型精子測試機,
05:21
that are iPhone-based基於 iPhone 的
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以 iPhone 為基礎,
很容易使用。
05:23
and that are easy簡單 to use.
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05:25
A man could test測試 his sperm精子 count計數
and share分享 the result結果 with his partner夥伴.
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男性可以測出他的精子數量,
和他的另一半分享結果。
05:29
If the man's男人的 sperm精子 count計數 were zero,
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如果他的精子數量是零,
05:31
the man and his partner夥伴
would feel very comfortable自在
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他和他的另一半就可以非常放心地
05:34
relying依托 on his contraceptive避孕的.
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仰賴他的避孕工具。
05:37
A tool工具 like this,
coupled耦合 with a male contraceptive避孕的,
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像這樣的工具,
再搭配上男性避孕工具,
05:40
could greatly非常 increase增加 the role角色 for men男人
in preventing防止 unintended意外 pregnancy懷孕.
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就能讓男性在預防意外懷孕上
扮演更重要的角色。
05:46
The researchers研究人員 who are working加工
on male contraception避孕
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致力於男性避孕的研究者
05:49
are trying to create創建
a better future未來 for couples情侶,
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正在試圖為伴侶們
創造更美好的未來,
05:52
a future未來 where contraception避孕 is no longer
considered考慮 just "a woman's女人的 issue問題,"
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一個避孕不再只是
「女人的事」的未來,
05:57
rather an issue問題
for couples情侶 to decide決定 together一起.
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而是伴侶雙方要一起決定的議題。
06:01
So why does the world世界 need a male pill?
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所以,為什麼世界
需要男性避孕藥丸?
06:04
Well, I believe that a male pill
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我相信,男性避孕藥丸
06:06
will help reduce減少 the stubbornly固執地 high
rates利率 of unintended意外 pregnancy懷孕 and abortion流產
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能協助減少一直居高不下的
意外懷孕比率以及墮胎率,
06:12
and allow允許 men男人 to equally一樣 participate參加
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並讓男性有平等的機會參與
06:15
in contraception避孕.
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避孕工作。
06:17
Thank you.
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謝謝。
06:18
(Applause掌聲)
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(掌聲)
Translated by Lilian Chiu
Reviewed by SF Huang

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ABOUT THE SPEAKER
John Amory - Male reproductive health expert
John 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.

More profile about the speaker
John Amory | Speaker | TED.com