L'immunocontraception repose sur un principe simple en théorie : induire une immunisation réversible de l'organisme masculin ou féminin contre des antigènes impliqués dans les diffé-rentes étapes de la reproduction humaine.
Plusieurs cibles « théoriques » ont déjà été identi-fiées : les hormones du système gonadotrope hypothalamohypophysaire, les récepteurs aux gonadotrophines, les antigènes spermatiques et ovocytaires de surface et l'hormone chorionique gonadotrophique (hCG). De nombreux travaux ont été menés dans certaines espèces animales, avec une efficacité plus ou moins marquée selon
les cibles. Quelques essais de phases 1 et 2 ont déjà eu lieu dans l'espèce humaine avec des résultats mitigés, non superposables à ceux obtenus dans les espèces animales étudiées. Néanmoins, les cibles vaccinales les plus prometteuses à moyen terme restent la sous-unité β de l'hCG chez la femme et le récepteur de la FSH (follicle stimula-ting hormone) à la surface des cellules de Sertoli chez l'homme [69,70].
L'élaboration d'immunocontraceptifs est conf-rontée à trois problèmes majeurs qui sont la mise au point de méthodes à la fois efficaces et réver-sibles, la grande variabilité interindividuelle des réponses vaccinales et l'élaboration de schémas vaccinaux encore beaucoup trop complexes et astreignants. L'immunocontraception est donc une méthode d'avenir, mais pas encore celle d'un avenir proche !
C onclusion
Choisir la contraception la plus adaptée à chaque patiente est indispensable pour obtenir une bonne observance et donc une bonne efficacité du moyen contraceptif.
La contraception hormonale constitue une par-tie importante de la contraception féminine, avec la COP, la contraception microprogesta-tive, la contraception macroprogestative et enfin le SIU.
Dans l'avenir, nous attendons une diversifica-tion des voies d'administradiversifica-tion, des molécules disponibles et des schémas d'administration afin d'améliorer le confort et l'observance des patientes, ainsi que l'apparition progressive de la contraception hormonale masculine.
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