Reproductive medicine is a branch of

medicine Medicine is the science and Praxis (process), practice of caring for a patient, managing the diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, and Health promotion ...

concerning the male and female

reproductive system The reproductive system of an organism, also known as the genital system, is the biological system made up of all the anatomical organs involved in sexual reproduction. Many non-living substances such as fluids, hormones, and pheromones are al ...

s. 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 of

artificial reproductive techniques Artificiality (the state of being artificial or manmade) is the state of being the product of intentional human manufacture, rather than occurring naturally through processes not involving or requiring human activity. Connotations Artificiality ...

(ARTs) which have allowed advances in overcoming human

infertility Infertility is the inability of a person, animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species (mostly haplodiploid insects). It is the normal st ...

, as well as being used in

agriculture Agriculture or farming is the practice of cultivating plants and livestock. Agriculture was the key development in the rise of sedentary human civilization, whereby farming of domesticated species created food surpluses that enabled peop ...

and in

wildlife conservation Wildlife conservation refers to the practice of protecting wild species In biology, a species is the basic unit of Taxonomy (biology), classification and a taxonomic rank of an organism, as well as a unit of biodiversity. A species is often ...

. Some examples of ARTs include IVF,

artificial insemination Artificial insemination is the deliberate introduction of sperm into a female's cervix or uterine cavity for the purpose of achieving a pregnancy through in vivo fertilization by means other than sexual intercourse. It is a fertility treatment ...

(AI) and

embryo transfer Embryo transfer refers to a step in the process of assisted reproduction in which embryos are placed into the uterus of a female with the intent to establish a pregnancy. This technique (which is often used in connection with in vitro fertilizat ...

, as well as

genome resource banking In the fields of molecular biology and genetics, a genome is all the genetic information of an organism. It consists of nucleotide sequences of DNA (or RNA in RNA viruses). The nuclear genome includes protein-coding genes and non-coding ...

History

The study of reproductive medicine is thought to date back to

Aristotle Aristotle (; grc-gre, Ἀριστοτέλης ''Aristotélēs'', ; 384–322 BC) was a Greek philosopher and polymath during the Classical Greece, Classical period in Ancient Greece. Taught by Plato, he was the founder of the Peripatet ...

, where he came up with the “ Haematogenous Reproduction Theory”. However, evidence-based reproductive medicine is traceable back to the 1970s. Since then, there have been many milestones for reproductive medicine, including the birth of

Louise Brown Louise Joy Brown (born 25 July 1978) is an English woman who was the first human to have been born after conception by ''in vitro'' fertilisation experiment (IVF). Her birth, following a procedure pioneered in Britain, has been lauded among "t ...

, the first baby to be conceived through IVF in 1978. Despite this, it wasn't until 1989 that it became a clinical discipline thanks to the work of

Iain Chalmers Sir Iain Geoffrey Chalmers (born 3 June 1943) is a British health services researcher, one of the founders of the Cochrane Collaboration,systematic review A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from published studies on t ...

and the Cochrane collection.

Scope

Reproductive medicine addresses issues of

sexual education Sex education, also known as sexual education, sexuality education or sex ed, is the instruction of issues relating to human sexuality, including emotional relations and responsibilities, human sexual anatomy, sexual activity, sexual reproduc ...

puberty Puberty is the process of physical changes through which a child's body matures into an adult body capable of sexual reproduction. It is initiated by hormonal signals from the brain to the gonads: the ovaries in a girl, the testes in a b ...

family planning Family planning is the consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which they wish to have them. Things that may play a role on family planning decisions include marita ...

, birth control,

reproductive system disease A reproductive system disease is any disease of the reproductive system. Types Infections Reproductive tract infection (RTI) are infections that affect the reproductive tract, which is part of the Reproductive System. For females, reproductive tra ...

(including

sexually transmitted disease Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are Transmission (medicine), spread by Human sexual activity, sexual activity, especi ...

s) and

sexual dysfunction Sexual dysfunction is difficulty experienced by an individual or partners during any stage of normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm. The World Health Organization defines sexual dysfunction ...

. In women, reproductive medicine also covers

menstruation Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of ...

ovulation Ovulation is the release of eggs from the ovaries. In women, this event occurs when the ovarian follicles rupture and release the secondary oocyte ovarian cells. After ovulation, during the luteal phase, the egg will be available to be fertilize ...

pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ...

and

menopause Menopause, also known as the climacteric, is the time in women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause usually occurs between the age of 47 and 54. Medical professionals often d ...

, as well as gynecologic disorders that affect fertility. The field cooperates with and overlaps mainly with

reproductive endocrinology and infertility Reproductive endocrinology and infertility (REI) is a surgical subspecialty of obstetrics and gynecology that trains physicians in reproductive medicine addressing hormonal functioning as it pertains to reproduction as well as the issue of infe ...

sexual medicine Sexual medicine or Psychosexual medicine as defined by Masters and Johnsons in their classic Textbook of Sexual Medicine, is “that branch of medicine that focuses on the evaluation and treatment of sexual disorders, which have a high prevalence ...

and

andrology Andrology (from grc, ἀνήρ, ''anēr'', genitive , ''andros'', "man"; and , '' -logia'') is a name for the medical specialty that deals with male health, particularly relating to the problems of the male reproductive system and urological p ...

, but also to some degree with

gynecology Gynaecology or gynecology (see spelling differences) is the area of medicine that involves the treatment of women's diseases, especially those of the reproductive organs. It is often paired with the field of obstetrics, forming the combined ar ...

obstetrics Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surg ...

urology Urology (from Greek οὖρον ''ouron'' "urine" and '' -logia'' "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive org ...

, genitourinary medicine, medical

endocrinology Endocrinology (from ''endocrine'' + '' -ology'') is a branch of biology Biology is the scientific study of life. It is a natural science with a broad scope but has several unifying themes that tie it together as a single, coherent field ...

pediatric endocrinology Pediatric endocrinology ( British: Paediatric) is a medical subspecialty dealing with disorders of the endocrine glands, such as variations of physical growth and sexual development in childhood, diabetes and many more. By age, pediatric endocrin ...

genetics Genetics is the study of genes, genetic variation, and heredity in organisms.Hartl D, Jones E (2005) It is an important branch in biology because heredity is vital to organisms' evolution. Gregor Mendel, a Moravian Augustinian friar worki ...

, and

psychiatry Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry. Initial p ...

Conditions

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.

Infectious Diseases

Reproductive Tract Infections A reproductive system disease is any disease of the reproductive system. Types Infections Reproductive tract infection (RTI) are infections that affect the reproductive tract, which is part of the Reproductive System. For females, reproductive tra ...

(RTIs) are infections that affect the

Reproductive Tract The reproductive system of an organism, also known as the genital system, is the biological system made up of all the anatomical organs involved in sexual reproduction. Many non-living substances such as fluids, hormones, and pheromones are ...

. There are three types of RTIs: Endogenous RTIs, Iatrogenic RTIs and

Sexually Transmitted Infections Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are spread by sexual activity, especially vaginal intercourse, anal sex, and ora ...

. Endogenous RTIs are caused by an overgrowth of bacteria which is normally present. An example of an endogenous RTI is

Bacterial Vaginosis Bacterial vaginosis (BV) is a disease of the vagina caused by excessive growth of bacteria. Common symptoms include increased vaginal discharge that often smells like fish. The discharge is usually white or gray in color. Burning with urinatio ...

. Iatrogenic RTIs are infections contracted as a result of a medical procedure. Sexually Transmitted Infections (STIs) are infections spread by sexual activity, usually by

vaginal intercourse Sexual intercourse (or coitus or copulation) is a sexual activity typically involving the insertion and thrusting of the penis into the vagina for sexual pleasure or reproduction.Sexual intercourse most commonly means penile–vaginal penetrat ...

anal sex Anal sex or anal intercourse is generally the insertion and thrusting of the erect penis into a person's anus, or anus and rectum, for sexual pleasure.Sepages 270–271for anal sex information, anpage 118for information about the clitoris. O ...

oral sex Oral sex, sometimes referred to as oral intercourse, is sexual activity involving the stimulation of the genitalia of a person by another person using the mouth (including the lips, tongue, or teeth) and the throat. Cunnilingus is oral sex p ...

. Many STIs are curable; however, some STIs such as

HIV The human immunodeficiency viruses (HIV) are two species of '' Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immu ...

are incurable. STIs can be

bacterial Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among ...

, viral or

fungal A fungus ( : fungi or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms. These organisms are classified as a kingdom, separately from ...

and affect both men and women. Some examples of STIs are listed below: * Bacterial STIs **

Chlamydia Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium '' Chlamydia trachomatis''. Most people who are infected have no symptoms. When symptoms do appear they may occur only several w ...

Gonorrhoea Gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium ''Neisseria gonorrhoeae''. Infection may involve the genitals, mouth, or rectum. Infected men may experience pain or burning with u ...

** Syphilis * Viral STIs **

Herpes Herpes simplex is a viral infection caused by the herpes simplex virus. Infections are categorized based on the part of the body infected. Oral herpes involves the face or mouth. It may result in small blisters in groups often called cold ...

Human Papilloma Virus (HPV) Human papillomavirus infection (HPV infection) is caused by a DNA virus from the '' Papillomaviridae'' family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and r ...

** Human Immunodeficiency Virus (HIV)

Cancer

Many parts of the Reproductive system can be affected by

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal bl ...

. Below are some examples of Reproductive cancers:

Reproductive Cancers affecting Women

Breast cancer Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or ...

Ovarian cancer Ovarian cancer is a cancerous tumor of an ovary. It may originate from the ovary itself or more commonly from communicating nearby structures such as fallopian tubes or the inner lining of the abdomen. The ovary is made up of three different ...

Uterine cancer Uterine cancer, also known as womb cancer, includes two types of cancer that develop from the tissues of the uterus. Endometrial cancer forms from the lining of the uterus, and uterine sarcoma forms from the muscles or support tissue of the ute ...

Cervical cancer Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal ...

Reproductive Cancers affecting Men

Prostate cancer Prostate cancer is cancer of the prostate. Prostate cancer is the second most common cancerous tumor worldwide and is the fifth leading cause of cancer-related mortality among men. The prostate is a gland in the male reproductive system that su ...

Penile cancer Penile cancer is cancer that develops in the skin or tissues of the penis. Symptoms may include abnormal growth, an ulcer or sore on the skin of the penis, and bleeding or foul smelling discharge. Risk factors include phimosis (inability to retra ...

Testicular cancer Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system. Symptoms may include a lump in the testicle, or swelling or pain in the scrotum. Treatment may result in infertility. Risk factors include an ...

Male Breast cancer Male breast cancer (MBC) is a cancer in males that originates in their breasts. Males account for less than 1% of new breast cancers with about 20,000 new cases being diagnosed worldwide every year. Its incidence rates in males vs. females are, ...

Benign prostatic hypertrophy Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss o ...

Conditions affecting Fertility

A significant part of Reproductive Medicine involves promoting fertility in both men and women.

Causes of Infertility or Subfertility in Women

* Ovulatory dysfunction **

Polycystic ovary syndrome Polycystic ovary syndrome, or PCOS, is the most common endocrine disorder in women of reproductive age. The syndrome is named after the characteristic cysts which may form on the ovaries, though it is important to note that this is a sign and n ...

(PCOS) ** Hypogonadotrophic hypogonadism ** Hypergonadotrophic hypogonadism * Tubular dysfunction **

Pelvic inflammatory disease Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be no ...

Endometriosis Endometriosis is a disease of the female reproductive system in which cells similar to those in the endometrium, the layer of tissue that normally covers the inside of the uterus, grow outside the uterus. Most often this is on the ovaries, ...

** Previous sterilisation ** Previous surgery * Cervical or Uterine dysfunction ** Congenital abnormalities ** Fibroids **

Asherman's syndrome Asherman's syndrome (AS) is an acquired uterine condition that occurs when scar tissue (adhesion (medicine), adhesions) forms inside the uterus and/or the cervix. It is characterized by variable scarring inside the uterine cavity, where in many ca ...

* Hormonal issues **

Hypothyroidism Hypothyroidism (also called ''underactive thyroid'', ''low thyroid'' or ''hypothyreosis'') is a disorder of the endocrine system in which the thyroid gland does not produce enough thyroid hormone. It can cause a number of symptoms, such as ...

Hyperthyroidism Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormones by the thyroid gland. Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidis ...

Cushing's syndrome Cushing's syndrome is a collection of signs and symptoms due to prolonged exposure to glucocorticoids such as cortisol. Signs and symptoms may include high blood pressure, abdominal obesity but with thin arms and legs, reddish stretch marks ...

Congenital adrenal hyperplasia Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders characterized by impaired cortisol synthesis. It results from the deficiency of one of the five enzymes required for the synthesis of cortisol in the adrenal cortex. ...

Causes of Infertility or Subfertility in Men

* Problems with Sperm Number or Function **

Cryptorchidism Cryptorchidism, also known as undescended testis, is the failure of one or both testes to descend into the scrotum. The word is from Greek () 'hidden' and () 'testicle'. It is the most common birth defect of the male genital tract. About 3% of ...

** Y chromosome micro-deletions **

Varicocele varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum. This plexus of veins drains blood from the testicles back to the heart. The vessels originate in the abdomen and course down through the inguinal canal as pa ...

** Hypogonadotrophic hypogonadism ** Hypergonadotrophic hypogonadism * Tubular dysfunction ** Congenital abnormalities ** Prior sexually transmitted infections **

Vasectomy Vasectomy, or vasoligation, is an elective surgical procedure for male Sterilization (medicine), sterilization or permanent contraception. During the procedure, the male vas deferens, vasa deferentia are cut and tied or sealed so as to prevent sp ...

* Problems with Sperm Delivery **

Premature ejaculation Premature ejaculation (PE) occurs when a man expels semen (and most likely experiences orgasm) soon after beginning sexual activity, and with minimal penile stimulation. It has also been called ''early ejaculation'', ''rapid ejaculation'', '' ...

** Damage to the reproductive organs **

Retrograde ejaculation Retrograde ejaculation occurs when semen which would be ejaculated via the urethra is redirected to the urinary bladder. Normally, the sphincter of the bladder contracts before ejaculation, sealing the bladder which besides inhibiting the relea ...

** Certain genetic diseases

Disorders of Sex Development

Congenital Abnormalities

Congenital Abnormalities of the Female Reproductive system

* Cervical abnormalities ** Cervical agenesis ** Cervical duplication * Hymen abnormalities **

Imperforate hymen An imperforate hymen is a congenital disorder where a hymen without an opening completely obstructs the vagina. It is caused by a failure of the hymen to perforate during fetal development. It is most often diagnosed in adolescent girls when men ...

Microperforate hymen The hymen is a thin piece of mucosal tissue that surrounds or partially covers the external vaginal opening. It forms part of the vulva, or external genitalia, and is similar in structure to the vagina. In children, a common appearance of the h ...

** Septate hymen * Uterine abnormalities **

Duplicate uterus Duplication, duplicate, and duplicator may refer to: Biology and genetics * Gene duplication, a process which can result in free mutation * Chromosomal duplication, which can cause Bloom and Rett syndrome * Polyploidy, a phenomenon also known ...

** Unicornate uterus **

Septate uterus A uterine septum is a form of a Congenital disorder, congenital uterine malformation, malformation where the uterus, uterine cavity is partitioned by a longitudinal septum; the outside of the uterus has a normal typical shape. The wedge-like parti ...

* Vaginal abnormalities ** Transverse vaginal septum ** Vertical vaginal septum **

Vaginal agenesis Vaginal atresia is a condition in which the vagina is abnormally closed or absent. The main causes can either be complete vaginal hypoplasia, or a vaginal obstruction, often caused by an imperforate hymen or, less commonly, a transverse vaginal ...

** Mayer-Rokitansky-Küster-Hauser syndrome * Vulvar abnormalities **

Labial hypoplasia The term ''labial'' originates from '' Labium'' (Latin for "lip"), and is the adjective that describes anything of or related to lips, such as lip-like structures. Thus, it may refer to: * the lips ** In linguistics, a labial consonant ** In zoolo ...

Labial hypertrophy The term ''labial'' originates from '' Labium'' (Latin for "lip"), and is the adjective that describes anything of or related to lips, such as lip-like structures. Thus, it may refer to: * the lips ** In linguistics, a labial consonant ** In zool ...

Congenital Abnormalities of the Male Reproductive system

Hypospadias Hypospadias is a common variation in fetal development of the penis in which the urethra does not open from its usual location in the head of the penis. It is the second-most common birth abnormality of the male reproductive system, affecting abo ...

Epispadias An epispadias is a rare type of malformation in which the urethra ends, in males, in an opening on the upper aspect of the penis, and in females when the urethra develops too far anteriorly. It occurs in around 1 in 120,000 male and 1 in 500,000 ...

Endocrine Disorders

Disorders due to hormone excess

* Polycystic ovarian syndrome (PCOS) *

Granulosa cell tumour Granulosa cell tumours are tumours that arise from granulosa cells. They are estrogen secreting tumours and present as large, complex, ovarian masses. These tumours are part of the sex cord-gonadal stromal tumour or non-epithelial group of tumour ...

Leydig cell tumour Leydig cell tumour, also Leydig cell tumor (US spelling), (testicular) interstitial cell tumour and (testicular) interstitial cell tumor (US spelling), is a member of the sex cord-stromal tumour group of ovarian and testicular cancers. It arises ...

Teratoma A teratoma is a tumor made up of several different types of tissue, such as hair, muscle, teeth, or bone. Teratomata typically form in the ovary, testicle, or coccyx. Symptoms Symptoms may be minimal if the tumor is small. A testicular tera ...

Disorders due to hormone deficiency

Hypogonadism Hypogonadism means diminished functional activity of the gonads—the testes or the ovaries—that may result in diminished production of sex hormones. Low androgen (e.g., testosterone) levels are referred to as hypoandrogenism and low est ...

Turner's syndrome Turner syndrome (TS), also known as 45,X, or 45,X0, is a genetic condition in which a female is partially or completely missing an X chromosome. Signs and symptoms vary among those affected. Often, a short and webbed neck, low-set ears, low hairl ...

Klinefelter's syndrome Klinefelter syndrome (KS), also known as 47,XXY, is an aneuploid genetic condition where a male has an additional copy of the X chromosome. The primary features are infertility and small, poorly functioning testicles. Usually, symptoms are sub ...

Disorders due to hormone hypersensitivity

Idiopathic hirsutism Hirsutism is excessive body hair on parts of the body where hair is normally absent or minimal. The word is from early 17th century: from Latin ''hirsutus'' meaning "hairy". It usually refers to a "male" pattern of hair growth in a female that ...

Disorders due to hormone resistance

Androgen insensitivity syndrome Androgen insensitivity syndrome (AIS) is a difference in sex development involving hormonal resistance due to androgen receptor dysfunction. It affects 1 in 20,000 to 64,000 XY (karyotype, karyotypically male) births. The condition results in the ...

* 5a-reductase deficiency

Non-functioning endocrine tumours

Ovarian cyst An ovarian cyst is a fluid-filled sac within the ovary. Often they cause no symptoms. Occasionally they may produce bloating, lower abdominal pain, or lower back pain. The majority of cysts are harmless. If the cyst either breaks open or causes ...

s *

Carcinoma Carcinoma is a malignancy that develops from epithelial cells. Specifically, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that arises from cells originating in the endodermal, mesoderma ...

* Teratoma *

Seminoma A seminoma is a germ cell tumor of the testicle or, more rarely, the mediastinum or other extra-gonadal locations. It is a malignant neoplasm and is one of the most treatable and curable cancers, with a survival rate above 95% if discovered in e ...

Secondary Endocrine disorders (originating in the pituitary gland)

Pituitary gonadotrophinoma In vertebrate anatomy, the pituitary gland, or hypophysis, is an endocrine gland, about the size of a chickpea and weighing, on average, in humans. It is a protrusion off the bottom of the hypothalamus at the base of the brain. The h ...

Hypopituitarism Hypopituitarism is the decreased (''hypo'') secretion of one or more of the eight hormones normally produced by the pituitary gland at the base of the brain. If there is decreased secretion of one specific pituitary hormone, the condition is know ...

Kallmann's syndrome Kallmann syndrome (KS) is a genetic disorder that prevents a person from starting or fully completing puberty. Kallmann syndrome is a form of a group of conditions termed hypogonadotropic hypogonadism. To distinguish it from other forms of hypog ...

Assessment and treatment

Assessment and treatment of reproductive conditions is a key area of reproductive medicine. Female assessment starts with a full

medical history The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient is information gained by a physician by asking specific questions, either to the patient or to other pe ...

(anamnesis) which provides details of the woman's general health, sexual history and relevant family history. A physical examination will also take place to identify abnormalities such as

hirsutism Hirsutism is excessive body hair on parts of the body where hair is normally absent or minimal. The word is from early 17th century: from Latin ''hirsutus'' meaning "hairy". It usually refers to a "male" pattern of hair growth in a female that ...

abdominal mass An abdominal mass is any localized enlargement or swelling in the human abdomen. Depending on its location, the abdominal mass may be caused by an enlarged liver ( hepatomegaly), enlarged spleen ( splenomegaly), protruding kidney, a pancreatic ...

es,

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable d ...

cyst A cyst is a closed sac, having a distinct envelope and division compared with the nearby tissue. Hence, it is a cluster of cells that have grouped together to form a sac (like the manner in which water molecules group together to form a bubble ...

s or fibroids. A

blood test A blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a hypodermic needle, or via fingerprick. Multiple tests for specific blood components, such as a glucose test or a ch ...

can inform the clinician of the endocrine status of the patient.

Progesterone Progesterone (P4) is an endogenous steroid and progestogen sex hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species. It belongs to a group of steroid hormones called the progestogens and is the ma ...

levels are measured to check for

, and other ovulatory hormones can also be measured. Imaging techniques such as pelvic ultrasounds can also be used to assess the internal anatomy. Male assessment also starts with a history and physical examination to look for any visible abnormalities. Investigations of

semen Semen, also known as seminal fluid, is an organic bodily fluid created to contain spermatozoa. It is secreted by the gonads (sexual glands) and other sexual organs of male or hermaphroditic animals and can fertilize the female ovum. Semen ...

samples also take place to assess the volume, motility and number of sperm, as well as identifying infections. Once the investigations are complete, treatment of identified conditions can occur. For fertility issues, this may involve

assisted reproductive technology Assisted reproductive technology (ART) includes medical procedures used primarily to address infertility. This subject involves procedures such as in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), cryopreservation of gametes o ...

(ART) such as

in-vitro fertilisation In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro ("in glass"). The process involves monitoring and stimulating an individual's ovulatory process, removing an ovum or ova (egg or eggs) f ...

(IVF) or

fertility medication Fertility medications, also known as fertility drugs, are medications which enhance reproductive fertility. For women, fertility medication is used to stimulate follicle development of the ovary. There are very few fertility medication options av ...

. 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. Treatment is also required for sexually transmitted infections (STIs). These can take the form of

antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy, ...

s for bacterial infections such as

chlamydia Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium '' Chlamydia trachomatis''. Most people who are infected have no symptoms. When symptoms do appear they may occur only several w ...

or highly active anti-retroviral therapy (HAART) for the

HIV virus The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immun ...

Education and training

Specialists in reproductive medicine usually undergo training in

obstetrics and gynecology Obstetrics and Gynaecology (also spelled as Obstetrics and Gynecology; abbreviated as Obs and Gynae, O&G, OB-GYN and OB/GYN) is the medical specialty that encompasses the two subspecialties of obstetrics (covering pregnancy, childbirth, an ...

followed by training in

, or in urology followed by training in

. For reproductive medicine specialists in contraception, other methods of training are possible. Specialists tend to be organized in specialty organizations such as the

American Society for Reproductive Medicine The American Society for Reproductive Medicine (ASRM) is a nonprofit, multidisciplinary organization for advancement of the science and practice of reproductive medicine. The society has its headquarters in Washington, D.C and its administrat ...

(ASRM) and

European Society of Human Reproduction and Embryology The European Society of Human Reproduction and Embryology (ESHRE) was founded in 1985 by Robert Edwards (University of Cambridge) and J. Cohen (Paris), who felt that the study and research in the field of reproduction needed to be encouraged and r ...

(ESHRE).

Anamnesis

The anamnesis or medical history taking of issues related to reproductive or

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, he or she often doesn't start talking about such an issue without the physician initiating the subject by a specific question about sexual or

reproductive health Sexual and reproductive health (SRH) is a field of research, healthcare, and social activism that explores the health of an individual's reproductive system and sexual wellbeing during all stages of their life. The term can also be further de ...

. 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. 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.The Cringe Report
By Susan Quilliam. Posted: 06/28/2011; J Fam Plann Reprod Health Care. 2011;37(2):110-112.

Ethical and medicolegal issues

There are many ethical and legal issues surrounding reproductive medicine. In the UK the

Human Fertilisation and Embryology Authority The Human Fertilisation and Embryology Authority (HFEA) is an executive non-departmental public body of the Department of Health and Social Care in the United Kingdom. It is a statutory body that regulates and inspects all clinics in the United ...

(HEFA) regulates many aspects of reproductive medicine in the UK, including IVF,

Artificial Insemination Artificial insemination is the deliberate introduction of sperm into a female's cervix or uterine cavity for the purpose of achieving a pregnancy through in vivo fertilization by means other than sexual intercourse. It is a fertility treatment ...

, storage of reproductive tissue and research in this field. HEFA was established due to the Human Fertilisation and Embryology Act (1990). This act was reviewed and the Human 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. While NICE recommends NHS

clinical commissioning group Clinical commissioning groups (CCGs) were NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Inte ...

s (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 Many reproductive technologies are seen to have ethical problems, including IVF, mitochondrial replacement therapy,

germline modification Assisted reproductive technology (ART) includes medical procedures used primarily to address infertility. This subject involves procedures such as in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), cryopreservation of gamete ...

preimplantation genetic diagnosis Preimplantation genetic diagnosis (PGD or PIGD) is the genetic profiling of embryos prior to implantation (as a form of embryo profiling), and sometimes even of oocytes prior to fertilization. PGD is considered in a similar fashion to prenatal ...

. There are many groups around the world which oppose to ARTs, including religious groups and pro-life charities such as LIFE.

References

Literature

* Lipshultz LI, Khera M, Atwal DT. Urology and the Primary Care Practitioner. Philadelphia: Elsevier, 2008. * Naomi Pfeffer: ''The Stork and the Syringe: A Political History of Reproductive Medicine'' (Feminist Perspectives) Polity Press 1993, * Speroff L, Glass RH, Kase NG. Clinical Gynecologic Endocrinology and Infertility. Fifth Edition. Williams and Wilkins, Baltimore MD, 1994 {{DEFAULTSORT:Reproductive Medicine Gynaecology Andrology Endocrinology Fertility medicine