It starts with an age-old question: If a human being pulls out earlier ejaculating, can a adult female still go pregnant?

In bedrooms, basements and the backs of cars worldwide, millions of sexually active humans make choices (or regret them) based on what should be foundational fertility noesis. Most trusted sources say the answer is yeah—information technology is unlikely just possible that pregnancy will occur, then don't run a risk it.

Dig deeper, though, and it quickly becomes unclear exactly where the risk is coming from. Instead of evidence-based education, you'll meet some of the nigh durable misconceptions in sexual and reproductive wellness. When researchers analyzed a year's worth of questions that were submitted to an emergency contraception Web site, they found that nigh half of the questions that involved sexual acts "express fear nigh the pregnancy adventure posed past pre-ejaculatory fluid."

Preejaculate—which pretty much everyone calls precum—is the lubricative secretion that is emitted, involuntarily, from the Cowper'south gland in the penis during sexual arousal. Its task is to create a hospitable ride for sperm that ultimately pass through the urethra during ejaculation. Merely whether yous query the Net or an andrology skillful nigh the fertilizing ability of that egg-white goo, you're likely to go an reply to a different question—that is, a announcement that pulling out is a terrible class of birth control.

"When we're talking well-nigh what's in preejaculate, that'south not really the signal," said Michael Eisenberg, director of male reproductive medicine and surgery at Stanford University Schoolhouse of Medicine, after I'd asked him the fertilizing-power question in various ways. "We know that pulling out is not effective at preventing pregnancy."

The pullout method—alternatively known as "withdrawing" or "pull and pray" and formally christened in Latin every bit "coitus interruptus"—is an ancient form of contraception. The Talmud refers to it as "threshing inside and winnowing outside." Globally, it is still i of the almost unremarkably used forms of birth command, especially in regions without access to mod methods. When performed perfectly every fourth dimension, it actually has a failure rate that isn't much higher than that of condoms: 4 percent versus two per centum, respectively. That means almost four out of 100 women who rely on the pullout method exclusively volition become significant during 1 yr of utilise.

Only real life is rarely perfect. Some males cannot reliably perceive the imminence of ejaculation and withdraw likewise late. Others might emit semen intermittently or over a long period of fourth dimension instead of equally a single event, according to a 1970 family-planning manual. A lot of men don't realize that the highest concentration of sperm occurs in the first spurt of semen—which can be especially problematic if getting drunk slows down their reaction time. Notwithstanding others don't pull out in time because their pleasance takes precedence over a woman'due south health and well-being. For reasons such as these, the "typical utilize" failure rate of coitus interruptus jumps to between 20 and 30 percentage.

People in the reproductive-wellness field largely dismiss the pullout method because they don't believe men have the power and willpower to withdraw at the correct time, every time. Meanwhile there is a shocking lack of research on whether or not feasible sperm are actually present in preejaculate.

The best way to synthesize the answers I nerveless from physicians, peer-reviewed journals and educational institutions is this: Preejaculate itself does non contain sperm—or perchance it does occasionally, but perhaps it gets contaminated with sperm that has "leaked" from elsewhere. Plus, there'southward leftover sperm from previous ejaculation. And anyway, Eisenberg says, we should assume that preejaculate "unremarkably has some sperm, which can pb to [contraception] failure."

It is obvious to blame inadequate sex education for our collective confusion. But ironically, write the authors of a 2009 Contraception paper, "the notion that pre-ejaculatory fluid tin can cause pregnancy ... seems to take been introduced by the medical profession itself."

Dispelling a Myth?

Where did the fertile prowess of preejaculate originate? Mayhap it was in 1931, when Abraham Stone—a dr. and colleague of Planned Parenthood founder Margaret Sanger—wondered how information technology was even possible for the withdrawal method to fail: Sperm are fabricated in the testicles and don't route through the Cowper'south gland on their way out. Stone asked some buddies with microscopes to examine their preejaculate for sperm. Among the 24 samples from eighteen men, simply iv contained many or a few sperm. In a 1938 volume, Applied Birth-Control Methods, Stone wrote that these figures were insignificant. Regardless, a "myth" that a handful of sperm in preejaculate makes coitus interruptus unreliable took off, and it was "copied uncritically from ane textbook another," according to the 1994 edition of the book Fertility Control.

This myth was popularized by the classic 1966 textbook Man Sexual Response, by William H. Masters and Virginia East. Johnson, according to the Contraception paper. These pioneering sex researchers "warned of the possibility of pregnancy from withdrawal due to the presence of sperm in secretions of the Cowper's gland"—a statement that "was manifestly not evidence-based but subsequently repeated," the authors write.

The Contraception paper'due south authors also speculate on why sperm seem to accept "extraordinary dominance" in the eyes of the public. In textbooks and the media, sperm are "often anthropomorphized as masculine, forceful, competitive, and single-mindedly determined to fertilize the egg against all obstacles," they write. Indeed, the memorable 1989 educational pic The Making of Me features cartoon sperm "men" in a literal race for a sexualized egg "woman," gear up to a soundtrack that includes Richard Wagner's "Ride of the Valkyries." Additionally, girls often learn to be terrified of sperm still aren't taught how their own body works: A recent survey of 1,000 American women of reproductive age plant that fourscore percent of them were not able to correctly reply how many days of each cycle they are fertile.

Since Stone'due south experiment, there has been little incentive to research coitus interruptus at all, partly considering unlike condoms or intrauterine devices (IUDs), there's no contraceptive production to sell. While the pregnancy risk of preejaculate has only been investigated a handful of times, the results claiming pop assumptions and heighten new questions.

Here's what the literature tells us: In the early 1990s, a study examined the preejaculate of HIV-positive men to determine if the virus was nowadays. (It was.) An ancillary but "more significant" finding described in Contraceptive Technology Update was that "most pre ejaculate samples did not contain any sperm and those that did had simply small clumps of a very small amount of sperm which seemed to be immobile." If a larger study confirmed the results, the commodity said, it "may dispel the myth that pre ejaculate fluid contains sperm."

Only tiny studies have taken identify since. In a 2003 experiment with 12 Israeli men who gave at least two samples of preejaculate each, scientists examined the secretions under a microscope and institute that none of them contained sperm. Another small written report likewise establish no sperm.

Several years ago, researchers in England and the U.S. gear up out to more rigorously investigate the fertilizing potential of preejaculate, noting that "no report has found motile sperm in the pre-ejaculate." Their paper, published in Human Fertility in 2011, analyzed forty samples of preejaculate from 27 volunteers. 10 of the volunteers (37 percent) produced samples that included "a reasonable proportion" of motile sperm.

Because some of the men gave samples on multiple separate occasions, an intriguing blueprint emerged: sperm was present in either all of an private's samples or in none of them. "It would appear from our study," the authors wrote, "that some men repeatedly leak sperm in their pre-ejaculatory fluid while others practise not."

They therefore concluded, "it is tempting to speculate that the use of withdrawal as a ways of contraception might be more successful in some men because they are less likely to release sperm with their pre-ejaculate."

Then, in 2016, a larger study of 42 salubrious Thai men reported that "actively mobile sperm" were found in only 16.7 percent of the subjects. Unfortunately, the researchers did not collect preejaculate samples on multiple occasions.

To make sense of these conflicting data, I called John Amory, a dr. and professor at the University of Washington, who is known for his research on male infertility and novel forms of contraception. I asked him near the plausibility of this "two groups" concept: the thought that men might either ever have sperm in their preejaculate or never have it.

Amory responded with surprise. "See, I didn't even know that," he said well-nigh the studies. "Nosotros were taught [in medical preparation] that sperm were left over from the last ejaculate." This is a popular theory. Planned Parenthood similarly says that preejaculate "may selection upward sperm from a previous ejaculation as it passes through a human being'south urethra." Wikipedia promotes a familiar fix: simply urinate before intercourse, the logic goes, and you'll affluent out lingering sperm.

Though the acidity of urine does impairment sperm, I could not discover any evidence to prove that this strategy is solid. In fact, researchers in the 2011 Human Fertility paper wrote that the volunteers giving samples had, of course, gone to the bathroom several times since their concluding ejaculation. Therefore, every fourth dimension the authors observed sperm in preejaculate, the contagion "must have taken identify immediately prior to ejaculation." Clearly, there are consequences to misunderstanding this facet of male fertility.

"Fertility Is a Squad Sport"

Because we know and so little well-nigh sperm in preejaculate, the failure rate of pulling out is really more of an "educated gauge" and a topic of controversy among experts in the field. The reality is that lots of people in the U.Due south. use this method to avoid pregnancy. Then, exercise males approach withdrawal as a serious form of contraception and accept responsibility for learning how to maximize its efficacy? While plenty of men feel confident discussing the minutia of abortion and female reproductive parts they tend to be quite ignorant of their own fertility.

Greg Sommer discovered just how few males understand their contribution to pregnancy when he launched an at-home sperm-testing kit chosen Trak. In 2017, he brought his product to the Consumer Electronics Prove in Las Vegas. "We had a demo kit at our booth, and I tin can't tell you how many guys came up and said, 'So, what, I pee in the cup?'"Sommer recalls. "And nosotros had to tell them, 'No, at that place'south no sperm in your urine.'"

Sperm sensation got a boost in 2017, when a meta-assay showed that sperm counts of men from the U.S., Europe, Australia and New Zealand had dropped past more fifty percentage in less than 40 years. "Men are responsible for nearly half of infertility cases but take fashion besides long to get a semen analysis when they are non conceiving naturally," Sommer says. The study was widely framed as a potential crunch in male fertility, sparking some men to consider their sperm functionality more deeply—or only consider it at all.

Whereas women have long shouldered the burden of both preventing pregnancy (with drugs) and causing pregnancy (with assisted-reproduction technologies such as egg freezing), "there is a growing agreement that fertility is a team sport," Eisenberg says. "We need to understand more well-nigh the male person side."

Recent population surveys have shown that many men practise desire more birth-control options. Without contraception methods beyond condoms, vasectomy and withdrawal, some guys are already doing "all sorts of crazy and potentially dangerous things to brand themselves less fertile to avoid pregnancy," Sommer says.

In give-and-take forums on Trak'south infertility teaching Web site at www.dontcookyourballs.com Sommer found that some men "are biohacking themselves" by using prescription steroid creams to intentionally squash sperm count. Others sit in a hot tub every day. I guy wrote about his "hacked-up underwear heater-type device with a piddling battery pack," Sommer says. "Don't underestimate men's bulldoze and inventiveness when it comes to having a better sexual practice life"—pregnant men will indeed make efforts and take risks to have sex activity without condoms.

The Center for Male person Contraceptive Inquiry & Development fifty-fifty exploits this incentive to solicit volunteers for clinical drug trials. One image on the center's Instagram business relationship features a boxer with a punching pocketbook. "Done with condoms? Join the fight for male nascency control," it reads, followed by the hashtag #LoveWithoutTheGlove. Information technology seems to exist working: A major clinical trial for a hormonal gel began late last year.

Information technology sounds woefully apropos that scientists and entrepreneurs are convincing guys to acquire virtually reproductive responsibility past appealing to their sexual pleasure—particularly at a time when some U.S. lawmakers want to investigate the "misdeed" of miscarriages and classify treatment for ectopic pregnancy equally an "ballgame."

Yet more options and knowledge for preventing pregnancy are good things for anybody. After all, nearly half of all pregnancies in the U.S. are unintended, and the lack of admission to birth control and wellness care providers is not the only problem. Nearly 40 percent of women are not satisfied with the birth-control method they are currently using, according to the Guttmacher Plant. When people dislike their contraception for whatever reason—including health side effects from the pill or the tactile compromises of condoms—they are less probable to utilize information technology correctly and consistently.

One day, if the pharmaceutical industry decides to opposite course and fund the development of innovative nativity command, we could become genetic tests and other technologies to assistance people of both sexes figure out what kind of contraception might work best for our individual physiologies and ways of life. In addition to hormones and IUDs, researchers could investigate "proteins, enzymes and genes involved in the reproductive procedure that could be targeted to forestall pregnancy in both women and men—and potentially do so in more than precise ways," wrote announcer Maya Dusenbery in the May outcome of Scientific American.

With a personalized-medicine approach, imagine if birth control could be catered to the specific needs and priorities of an individual. In some cases, the task of preventing pregnancy could exist truly shared betwixt a couple. "What if the male person partner is willing to take on some of the risks and side effects to lower the risks and side effects of his female partner?" Amory says. "No one has actually talked about the idea of reframing risk paradigms."

Until this equitable hereafter arrives, understanding the fertilizing potential of an individual's preejaculate could give some men another style to participate in the responsibility of contraception. Let'south say that males do fall into two groups, as the Homo Fertility report speculates. What if a man—my beau, for example—could undergo a preejaculate sperm evaluation?

If and then, my boyfriend and I might scientifically resolve the terminal variable in our nativity-command efficacy. We apply coitus interruptus1 during my fertile window, the weeklong bridge during which his sperm tin potentially fertilize my egg. (An egg is just viable for fertilization for up to 24 hours per menstrual cycle, and sperm tin survive in the female body for up to five days.) I determine this window using a technique chosen the symptothermal method, a means of fugitive pregnancy that involves meticulously tracking changes in cervical fluid and basal-trunk temperature in order to predict, so confirm, when ovulation occurs.2

We devised this contraception strategy based on our personal risk-benefit assay and combined physiologies—and it has worked for us so far. But I'd prefer to empirically validate the absence (or problematic presence) of sperm in my boyfriend's preejaculate. Frustrated by the paltry research, I decided to conduct an experiment myself.

For Scientific discipline!

The Trak exam, while approved past the Nutrient and Drug Administration, is not designed for testing preejaculate. Nor is it intended to be used as form of pregnancy prevention. But according to Sommer, it is sensitive enough to pick up on sperm concentration as low as one million per milliliter (Yard/mL). While that sounds like a lot, "the chance of pregnancy is extremely low," Amory says. "In fertility settings, we take care of a lot of men with those counts who never conceive spontaneously." The Globe Health Organisation has determined that suppressing sperm counts to this threshold appears to decrease the chances of formulation to less than i percent per year.

I ordered a Trak fertility kit and recruited one study participant: subsequently assuring my fellow that his genetic material wouldn't exist sent off to a lab and end upward in a database (Trak isn't connected to the Internet), he gave me his informed consent.

Commencement, we did a control test to get a sense of his sperm baseline. After 48 hours of forbearance (the minimum length of time for proper semen analysis, co-ordinate to the WHO), he proffered a five-milliliter ejaculation sample. Per the instructions, we let it sit down for 30 minutes to liquefy, gave information technology a good swirl, so deposited a pipette's worth of fluid into a test prop. That went into the Trak "engine," an adorably sized, bombardment-powered centrifuge.

My boyfriend stared downward the engine until information technology beeped to betoken its finish, recalling the way women glare at pregnancy tests while awaiting the results. A white column in the prop reached to a higher place the 55 M/mL mark, signaling that his sperm concentration fabricated information technology into the "optimal" range for conception. Afterwards another 48 hours of abnegation from ejaculation ("for consequent science," I insisted), it was time to test his preejaculate.

"I think accurately testing but precum might exist a challenge," Sommer wrote when I informed him of my plans to employ his test for off-label endeavors. "Collecting a sample via masturbation might have different belch dynamics than during intercourse."

The hallowed pages of Scientific American are not the place to describe how nosotros collected a total milliliter of unadulterated preejaculate. I volition say that our methodology was informed by the scientific discipline of arousal, a commitment to rigorous inquiry standards and an abundance of humor.

Per the discussions of methodology in the academic studies, we knew it was critical to collect but preejaculate. The authors of the Thai paper wrote that written report volunteers might have smeared semen on the drove slides instead of preejaculate, which could mean the number of preejaculate samples that were found to contain sperm was artificially high. In other words, the subjects might have been sloppy, leading to false positives.

(Anecdotally, appealing to male person pride created a strong motivation for my volunteer to endure the xxx-ish minutes it took to retrieve plenty volume of pure preejaculate to run the Trak examination. "Wow, look at how much you're producing," I cheered nearly halfway through. Past comparison, the academic study subjects were likely masturbating, presumably alone, in a lab, and I humbly hypothesize that they may have gotten bored. The authors of the 2011 Human Fertility study fifty-fifty suggested that subjects might have knowingly handed over samples of ejaculate fluid because they were embarrassed they couldn't produce sufficient preejaculate.)

We ran the preejaculate test just as with my fellow's ejaculate: a full pipette of well-mixed fluid went into the prop, followed past a six-minute spin in the centrifuge. And so we peered into the measuring strip under brilliant light and couldn't observe fifty-fifty a speck of white. If there was sperm present, the concentration was likely beneath one million per milliliter, which ways my boyfriend's preejaculate sample could be considered infertile past WHO standards.

Though promising, one at-dwelling house test doesn't confirm anything. Nosotros would need to replicate this experiment several more times. Sperm count in semen changes over time and is afflicted past health factors, then perhaps the same is truthful for preejaculate. Because Trak is not intended for such diagnostics, it would be best to compare the results of our experiments with lab tests at a fertility clinic (if they'd even indulge such a request).

Larger questions grow: Even if there are sperm in preejaculate, tin can they swim? Are all of their parts intact? And if the sperm present in preejaculate aren't simply "left over" from the last ejaculation, then from where might they be "leaking," as the literature suggests?

Filling these knowledge gaps has the potential to fine-tune the math of pregnancy risk. Imagine if males were able to better gauge whether the pullout method is a useful tool in their contraception arsenal or, more critically, whether information technology is too risky even when the deed itself is performed correctly every time.

After all, contraceptive use in the real globe is more varied and coexisting than the behavioral patterns that decide "failure rates." Few people apply only one method in the same exact way every time they have sex activity. Recent surveys suggest that coitus interruptus is actually employed more frequently than previous research suggests and oftentimes in conjunction with other methods. If some men exercise consistently have viable sperm in their preejaculate, it might help explain the 4 percent failure rate of the withdrawal method despite "perfect" use. It would not be the start time the medical field was wrong to blame contraceptive failure on user fault instead of physiological variation.

At the least, researching the mechanisms of preejaculate and pregnancy risk could add evidence-based dash to sex didactics. Equally Amory told me after reviewing the studies on preejaculate, "I retrieve this is an example of when you drill downwards on a 'truth,' 1 finds it's not based on much."

1. We could use condoms during my "fertile window," but their failure rate over time is non significantly lower than coitus interruptus . Given the best available science and our personal considerations, we chose to be in command over preventing user fault rather than risk the uncertainty of product failure.

two. The symptothermal method should not exist dislocated with the rhythm method or similar counting techniques. With perfect use, information technology can be merely every bit effective as the pill at preventing pregnancy. While I nautical chart my data in a cycle-tracking app, I do not consult predictive algorithms to determine when I am fertile. Like all contraceptive methods, the symptothermal method is certainly non right for everyone. Information technology can, however, be used every bit an first-class educational tool for learning about fertility and reproductive health.