Reproductive medicine is a branch of medicine concerning the male and female reproductive systems. It encompasses a variety of reproductive conditions, their prevention and assessment, as well as their subsequent treatment and prognosis.
The study of reproductive medicine is thought to date back to Aristotle, 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 of Louise 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 of Iain Chalmers in developing the systematic review and the Cochrane collection.[2]
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.
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, oral sex, and rarely manual sex. Many STIs are curable; however, some STIs such as HIV are incurable. STIs can be bacterial, viral or fungal and affect both men and women. Some examples of STIs are listed below:[7]
Assessment and treatment of reproductive conditions is a key area of reproductive medicine.
Female assessment starts with a full medical 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 as hirsutism, abdominal masses, infection, cysts or fibroids. A blood test can inform the clinician of the endocrine status of the patient. Progesterone levels are measured to check for ovulation, and other ovulatory hormones can also be measured. Imaging techniques such as pelvic 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 of semen samples also take place to assess the volume, motility and number of sperm, as well as identifying infections.[14]
Once the investigations are complete, treatment of identified conditions can occur. For fertility issues, this may involve assisted reproductive technology (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.[13] Treatment is also required for sexually transmitted infections (STIs). These can take the form of antibiotics for bacterial infections such as chlamydia[15] or highly active anti-retroviral therapy (HAART) for the HIV virus.[16]
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 (MD) or Doctor of Osteopathic Medicine (DO) degree. Specialists in reproductive medicine usually undergo medical residency training in obstetrics and gynecology 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.[17][18][19] After completing medical fellowship, physicians can obtain board certification and must maintain continuing medical education (CME).[20] CME is necessary in reproductive medicine as advancements in technology and treatment options require ongoing learning and skill development.
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.[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]
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 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[23]
There are many groups around the world which oppose to ARTs, including religious groups and pro-life charities such as LIFE.
References
^Kremer, J. (2003-12-20). "The haematogenous reproduction theory of Aristotle". Nederlands Tijdschrift voor Geneeskunde. 147 (51): 2529–2535. ISSN0028-2162. PMID14735853.
^"KKIVF Centre". KK Women's and Children's Hospital. SingHealth. Retrieved 4 December 2015.
^"Fertility and Reproductive Medicine". Washington University Physicians. Barnes-Jewish Hospital and St. Louis Children's Hospital. Retrieved 4 December 2015.
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