Reproductive medicine is a branch ofmedicine concerning the male and femalereproductive systems. It encompasses a variety of reproductive conditions, their prevention and assessment, as well as their subsequent treatment and prognosis.
Reproductive medicine has allowed the development ofartificial reproductive techniques (ARTs) which have allowed advances in overcoming humaninfertility, as well as being used inagriculture and inwildlife conservation. Some examples of ARTs includeIVF,artificial insemination (AI) andembryo transfer, as well asgenome resource banking.
The study of reproductive medicine is thought to date back toAristotle, where he came up with the “Haematogenous Reproduction Theory”.[1] However, evidence-based reproductive medicine is traceable back to the 1970s.[2] Since then, there have been many milestones for reproductive medicine, including the birth ofLouise Brown, the first baby to be conceived through IVF in 1978.[3] Despite this, it was not until 1989 that it became a clinical discipline thanks to the work ofIain Chalmers in developing thesystematic review and theCochrane collection.[2]
Reproductive medicine addresses issues ofsexual education,puberty,family planning,birth control,infertility,reproductive system disease (includingsexually transmitted infections) andsexual dysfunction.[4] In women, reproductive medicine also coversmenstruation,ovulation,pregnancy andmenopause, as well as gynecologic disorders that affect fertility.[5]
The field cooperates with and overlaps mainly withreproductive endocrinology and infertility,sexual medicine andandrology, but also to some degree withgynecology,obstetrics,urology,genitourinary medicine, medicalendocrinology,pediatric endocrinology,genetics, andpsychiatry.
Reproductive medicine deals with prevention, diagnosis and management of the following conditions. This section will give examples of a number of common conditions affecting the human reproductive system.
Reproductive tract infections (RTIs) are infections that affect thereproductive tract. There are three types of RTIs:endogenous RTIs,iatrogenic RTIs andsexually transmitted infections.[6] Endogenous RTIs are caused by an overgrowth of bacteria which is normally present. An example of an endogenous RTI isbacterial vaginosis.
Iatrogenic RTIs are infections contracted as a result of a medical procedure.
Sexually transmitted infections (STIs) are infections spread by sexual activity, usually byvaginal intercourse,anal sex,oral sex, and rarelymanual sex. Many STIs are curable; however, some STIs such asHIV are incurable. STIs can bebacterial,viral orfungal and affect both men and women. Some examples of STIs are listed below:[7]
Many parts of the Reproductive system can be affected bycancer. Below are some examples of Reproductive cancers:
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A significant part of reproductive medicine involves promoting fertility in both men and women.
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Assessment and treatment of reproductive conditions is a key area of reproductive medicine.
Female assessment starts with a fullmedical history (anamnesis) which provides details of the woman's general health, sexual history and relevant family history.[12] A physical examination will also take place to identify abnormalities such ashirsutism,abdominal masses,infection,cysts orfibroids. Ablood test can inform the clinician of the endocrine status of the patient.Progesterone levels are measured to check forovulation, and other ovulatory hormones can also be measured. Imaging techniques such aspelvic ultrasounds can also be used to assess the internal anatomy.[13]
Male assessment also starts with a history and physical examination to look for any visible abnormalities. Investigations ofsemen samples also take place to assess the volume, motility and number ofsperm, as well as identifying infections.[14]
Once the investigations are complete, treatment of identified conditions can occur. For fertility issues, this may involveassisted reproductive technology (ART) such asin-vitro fertilisation (IVF) orfertility medication. There are surgical methods that can be used as treatment however these are now performed less frequently due to the increasing success of the less invasive techniques.[13] Treatment is also required for sexually transmitted infections (STIs). These can take the form ofantibiotics for bacterial infections such aschlamydia[15] orhighly active anti-retroviral therapy (HAART) for theHIV virus.[16]
Before starting a career in reproductive medicine, individuals must first obtain an undergraduate degree. The next step is medical school, where they earn aDoctor of Medicine (MD) orDoctor of Osteopathic Medicine (DO) degree. Specialists in reproductive medicine usually undergomedical residency training inobstetrics and gynecology followed bymedical fellowship training inreproductive endocrinology and infertility. An alternative path to practicing reproductive medicine after medical school involves a medical residency in urology, followed by a medical fellowship in male infertility. The education and training required to practice reproductive medicine is typically 15-16 years in duration.[17][18][19] After completing medical fellowship, physicians can obtain board certification and must maintaincontinuing medical education (CME).[20] CME is necessary in reproductive medicine as advancements in technology and treatment options require ongoing learning and skill development.
For reproductive medicine specialists in contraception, other methods of training are possible. Specialists tend to be organized in specialty organizations such as theAmerican Society for Reproductive Medicine (ASRM) andEuropean Society of Human Reproduction and Embryology (ESHRE).
Theanamnesis or medical history taking of issues related to reproductive orsexual medicine may be inhibited by a person's reluctance to disclose intimate or uncomfortable information. Even if such an issue is on the person's mind, they often do not start talking about such an issue without the physician initiating the subject by a specific question about sexual orreproductive health.[21] Some familiarity with the doctor generally makes it easier for person to talk about intimate issues such as sexual subjects, but for some people, a very high degree of familiarity may make the person reluctant to reveal such intimate issues.[21] When visiting a health provider about sexual issues, having both partners of a couple present is often necessary, and is typically a good thing, but may also prevent the disclosure of certain subjects, and, according to one report, increases the stress level.[21]
There are many ethical and legal issues surrounding reproductive medicine. In the UK theHuman Fertilisation and Embryology Authority (HEFA) regulates many aspects of reproductive medicine in the UK, includingIVF,Artificial Insemination, storage of reproductive tissue and research in this field. HEFA was established due to theHuman Fertilisation and Embryology Act (1990). This act was reviewed and theHuman Fertilisation and Embryology Act (2008) was passed through parliament as an update to the 1990 act.
For therapies such as IVF, many countries have strict guidelines. In the UK, referrals are only given to women under 40 who have either undergone 12 cycles of artificial insemination, or have tried and failed to conceive for 2 years.[22] While NICE recommends NHSclinical commissioning groups (CCGs) to provide 3 NHS funded cycles of IVF, many only offer 1 cycle, with some only offering IVF in exceptional circumstances on the NHS. If an individual does not meet the criteria or has gone through the maximum number of NHS-funded cycles, the individual will have to pay for private treatment[23]
Many reproductive technologies are seen to have ethical problems, including IVF,mitochondrial replacement therapy,germline modification,preimplantation genetic diagnosis.
There are many groups around the world which oppose to ARTs, includingreligious groups and pro-life charities such as LIFE.
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