Reproductive medicine is a branch of

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

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 (ARTs) which have allowed advances in overcoming human

infertility In biology, infertility is the inability of a male and female organism to Sexual reproduction, reproduce. It is usually not the natural state of a healthy organism that has reached sexual maturity, so children who have not undergone puberty, whi ...

, as well as being used in

agriculture Agriculture encompasses crop and livestock production, aquaculture, and forestry for food and non-food products. Agriculture was a key factor in the rise of sedentary human civilization, whereby farming of domesticated species created ...

and in

wildlife conservation Wildlife conservation refers to the practice of protecting wild species and their habitats in order to maintain healthy wildlife species or populations and to restore, protect or enhance natural ecosystems. Major threats to wildlife include habita ...

. 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 fertili ...

, as well as genome resource banking.

History

The study of reproductive medicine is thought to date back to

Aristotle Aristotle (; 384–322 BC) was an Ancient Greek philosophy, Ancient Greek philosopher and polymath. His writings cover a broad range of subjects spanning the natural sciences, philosophy, linguistics, economics, politics, psychology, a ...

, 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, the first baby to be conceived through IVF in 1978. Despite this, it was not until 1989 that it became a clinical discipline thanks to the work of Iain Chalmers in developing the

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 ...

and the Cochrane collection.

Scope

Reproductive medicine addresses issues of sexual education,

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 female, the testicles i ...

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 marit ...

birth control Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth control only be ...

, reproductive system disease (including

sexually transmitted infection A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is Transmission (medicine), spread by Human sexual activity, sexual activity, e ...

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 Mucous membrane, mucosal tissue from the endometrium, inner lining of the uterus through the vagina. The menstrual cycle is characterized ...

ovulation Ovulation is an important part of the menstrual cycle in female vertebrates where the egg cells are released from the ovaries as part of the ovarian cycle. In female humans ovulation typically occurs near the midpoint in the menstrual cycle and ...

pregnancy Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...

and

menopause Menopause, also known as the climacteric, is the time when Menstruation, menstrual periods permanently stop, marking the end of the Human reproduction, reproductive stage for the female human. It typically occurs between the ages of 45 and 5 ...

, as well as gynecologic disorders that affect fertility. The field cooperates with and overlaps mainly with reproductive endocrinology and infertility, sexual medicine and

andrology Andrology (from , ''anēr'', genitive , ''andros'' 'man' and , ''-logy, -logia'') is a name for the medicine, medical specialty that deals with male health, particularly relating to the problems of the male reproductive system and urology, urologi ...

, but also to some degree with

gynecology Gynaecology or gynecology (see American and British English spelling differences) is the area of medicine concerned with conditions affecting the Female reproductive system, female reproductive system. It is often paired with the field of obste ...

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 su ...

urology Urology (from Ancient Greek, Greek wikt:οὖρον, οὖρον ''ouron'' "urine" and ''wiktionary:-logia, -logia'' "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of t ...

, genitourinary medicine, medical

endocrinology Endocrinology (from ''endocrine system, endocrine'' + ''wikt:-logy#Suffix, -ology'') is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions known as hormones. It is also concerned with the ...

, pediatric endocrinology,

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 Augustinians, Augustinian ...

, and

psychiatry Psychiatry is the medical specialty devoted to the diagnosis, treatment, and prevention of deleterious mental disorder, mental conditions. These include matters related to cognition, perceptions, Mood (psychology), mood, emotion, and behavior. ...

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 (RTIs) are infections that affect the reproductive tract. There are three types of RTIs: endogenous RTIs, iatrogenic RTIs and

s. 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 an infection 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 urina ...

. 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,

anal sex Anal sex or anal intercourse principally means the insertion and pelvic thrusting, thrusting of the Erection, erect human penis, penis into a person's Human anus, anus, or anus and rectum, for sexual pleasure.Sepages 270–271for anal sex inform ...

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). Cunnilingus is oral sex performed on the vu ...

, and rarely manual sex. Many STIs are curable; however, some STIs such as HIV are incurable. STIs can be bacterial, viral or

fungal A fungus (: fungi , , , or ; 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 one of the tradit ...

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

Syphilis Syphilis () is a sexually transmitted infection caused by the bacterium ''Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms depend on the stage it presents: primary, secondary, latent syphilis, latent or tertiary. The prim ...

* Viral STIs ** Herpes ** Human Papilloma Virus (HPV) ** Human Immunodeficiency Virus (HIV)

Cancer

Many parts of the Reproductive system can be affected by

cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

. Below are some examples of Reproductive cancers:

Reproductive cancers affecting women

Breast cancer Breast cancer is a cancer that develops from breast tissue. Signs of breast cancer may include a Breast lump, lump in the breast, a change in breast shape, dimpling of the skin, Milk-rejection sign, milk rejection, fluid coming from the nipp ...

* Ovarian cancer * Uterine cancer * Cervical cancer

Reproductive cancers affecting men

Prostate cancer Prostate cancer is the neoplasm, uncontrolled growth of cells in the prostate, a gland in the male reproductive system below the bladder. Abnormal growth of the prostate tissue is usually detected through Screening (medicine), screening tests, ...

Penile cancer Penile cancer, or penile carcinoma, is a 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 phimo ...

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 c ...

* Male breast cancer *

Benign prostatic hyperplasia 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, urinary retention, inability t ...

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 polycystic ovarian syndrome, (PCOS) is the most common endocrine disorder in women of reproductive age. The name is a misnomer, as not all women with this condition develop cysts on their ovaries. The name origin ...

(PCOS) ** Hypergonadotropic hypogonadism ** Hypogonadotropic hypogonadism * Tubular dysfunction ** Pelvic inflammatory disease **

Endometriosis Endometriosis is a disease in which Tissue (biology), tissue similar to the endometrium, the lining of the uterus, grows in other places in the body, outside the uterus. It occurs in women and a limited number of other female mammals. Endomet ...

** Previous sterilisation ** Previous surgery * Cervical or uterine dysfunction ** Congenital abnormalities ** Fibroids ** Asherman's syndrome * Hormonal issues ** Hypothyroidism **

Hyperthyroidism Hyperthyroidism is a endocrine disease in which the thyroid gland produces excessive amounts of thyroid hormones. Thyrotoxicosis is a condition that occurs due to elevated levels of thyroid hormones of any cause and therefore includes hyperth ...

** Cushing's syndrome **

Congenital adrenal hyperplasia Congenital adrenal hyperplasia (CAH) is a group of Genetic disorder#Autosomal recessive, autosomal recessive disorders characterized by impaired cortisol synthesis. It results from the deficiency of one of the five enzymes required for the Biosy ...

Causes of infertility or subfertility in men

* Problems with sperm number or function ** Cryptorchidism ** Y chromosome micro-deletions **

Varicocele A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum; in a woman, it is an abnormal painful swelling to the List of related male and female reproductive organs, embryologically identical pampiniform venous plexu ...

** Hypogonadotropic hypogonadism ** Hypergonadotropic hypogonadism * Tubular dysfunction ** Congenital abnormalities ** Prior

s **

Vasectomy Vasectomy is an elective surgical procedure that results in male sterilization, often as a means of permanent contraception. During the procedure, the male vasa deferentia are cut and tied or sealed so as to prevent sperm from entering into ...

* Problems with sperm delivery **

Premature ejaculation Premature ejaculation (PE) is a male sexual dysfunction that occurs when a male Ejaculation, expels semen (and most likely experiences orgasm) soon after beginning sexual activity, and with minimal penile stimulation. It has also been called ''e ...

** 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, inhibiting urination and preventing a reflux of semen ...

** 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 ** Microperforate hymen ** Septate hymen * Uterine abnormalities ** Duplicate uterus ** Unicornate uterus ** Septate uterus * Vaginal abnormalities ** Transverse vaginal septum ** Vertical vaginal septum ** Vaginal agenesis ** Mayer-Rokitansky-Küster-Hauser syndrome * Vulvar abnormalities ** Labial hypoplasia ** Labial hypertrophy

Congenital abnormalities of the male reproductive system

* Cryptorchidism *

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

Epispadias Epispadias is a birth defect in which the urethra fails to fully develop, resulting in urine leaving the body from an abnormal site. In males, this may be an opening on the upper aspect of the penis, and in females when the urethra develops too ...

Endocrine Disorders

Disorders due to hormone excess

* Polycystic ovarian syndrome (PCOS) * Granulosa cell tumour * Leydig cell tumour *

Teratoma A teratoma is a neoplasia, tumor made up of several types of biological tissue, tissue, such as hair, muscle, Human tooth, teeth, or bone. Teratomata typically form in the tailbone (where it is known as a sacrococcygeal teratoma), ovary, or test ...

Disorders due to hormone deficiency

Hypogonadism Hypogonadism means diminished functional activity of the human gonad, gonads—the testicles or the ovary, ovaries—that may result in diminished biosynthesis, production of sex hormones. Low androgen (e.g., testosterone) levels are referred t ...

* Turner's syndrome * Klinefelter's syndrome

Disorders due to hormone hypersensitivity

* Idiopathic hirsutism

Disorders due to hormone resistance

Androgen insensitivity syndrome Androgen insensitivity syndrome (AIS) is a condition involving the inability to respond to androgens, typically due to androgen receptor dysfunction. It affects 1 in 20,000 to 64,000 XY (karyotype, karyotypically male) births. The condition result ...

* 5a-reductase deficiency

Non-functioning endocrine tumours

* Ovarian cysts * Carcinoma * 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 Malignancy, malignant neoplasm and is one of the most treatable and curable cancers, with a survival rate above 95% if di ...

Secondary endocrine disorders (originating in the pituitary gland)

* Pituitary gonadotrophinoma * Hypopituitarism * Kallmann's syndrome

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 a set of information the physicians collect over medical interviews. It involves the patient, and ev ...

(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, abdominal masses,

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

, cysts or fibroids. A

blood test A blood test is a medical laboratory, 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 ...

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 a bodily fluid that contains spermatozoon, spermatozoa which is secreted by the male gonads (sexual glands) and other sexual organs of male or hermaphrodite, hermaphroditic animals. In humans and placen ...

samples also take place to assess the volume, motility and number of

sperm Sperm (: sperm or sperms) is the male reproductive Cell (biology), cell, or gamete, in anisogamous forms of sexual reproduction (forms in which there is a larger, female reproductive cell and a smaller, male one). Animals produce motile 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), and cryopreservation of ga ...

(ART) such as in-vitro fertilisation (IVF) or fertility 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. 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 or highly active anti-retroviral therapy (HAART) for the HIV virus.

Education and training

Before starting a career in reproductive medicine, individuals must first obtain an undergraduate degree. The next step is medical school, where they earn a

Doctor of Medicine A Doctor of Medicine (abbreviated MD, from the Latin language, Latin ) is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the ''MD'' denotes a professional degree of ph ...

(MD) or

Doctor of Osteopathic Medicine Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become li ...

(DO) degree. Specialists in reproductive medicine usually undergo medical residency training in

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

followed by medical fellowship training in reproductive 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. After completing medical fellowship, physicians can obtain board certification and must maintain

continuing medical education Continuing medical education (CME) is continuing education (CE) that helps those in the medical field maintain competence and learn about new and developing areas of their field. These activities may take place as live events, written publications ...

(CME). 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 the American Society for Reproductive Medicine (ASRM) and European Society of Human Reproduction and Embryology (ESHRE).

Anamnesis

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

reproductive health Sexual and reproductive health (SRH) is a field of research, health care, and social activism that explores the health of an individual's Human reproductive system, reproductive system and sexual well-being during all stages of their life. Se ...

. 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 (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 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 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, 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