Reproductive medicine: Difference between revisions

The study of reproductive medicine is thought to date back to [[Aristotle]], where he came up with the “[[Haematogenous Reproduction Theory]]”.<ref>{{Cite journal|last=Kremer|first=J.|date=2003-12-20|title=[The haematogenous reproduction theory of Aristotle]|url=https://www.ncbi.nlm.nih.gov/pubmed/14735853|journal=Nederlands Tijdschrift Voorvoor Geneeskunde|volume=147|issue=51|pages=2529–2535|issn=0028-2162|pmid=14735853}}</ref>. However, evidence-based reproductive medicine is traceable back to the 1970's1970s.<ref name=":000">{{Cite journal|last=Johnson|first=Martin H.|date=March 2013|title=The early history of evidence-based reproductive medicine|url=https://www.ncbi.nlm.nih.gov/pubmed/23273757|journal=Reproductive Biomedicine Online|volume=26|issue=3|pages=201–209|doi=10.1016/j.rbmo.2012.11.010|issn=1472-6491|pmid=23273757|viadoi-access=free}}</ref> 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.<ref>{{Cite journal|last=Clarke|first=Gary N.|date=July 2006|title=A.R.T. and history, 1678-1978|url=https://www.ncbi.nlm.nih.gov/pubmed/16606642|journal=Human Reproduction (Oxford, England)|volume=21|issue=7|pages=1645–1650|doi=10.1093/humrep/del067|issn=0268-1161|pmid=16606642|via=}}</ref> Despite this, it wasn’twas not until 1989 that it became a clinical discipline thanks to the work of [[Iain Chalmers]] in developing the [[systematic review]] and the [[Cochrane (organisation)|Cochrane]] collection.<ref name=":000" />

Reproductive medicine addresses issues of [[sexual education]], [[puberty]], [[family planning]], [[birth control]], [[infertility]], [[reproductive system disease]] (including [[sexually transmitted diseaseinfection]]s) and [[sexual dysfunction]].<ref>{{cite web|title=KKIVF Centre|url=http://www.kkh.com.sg/Services/Women/KKIVFCentre/Pages/Home.aspx|website=KK Women's and Children's Hospital|publisher=SingHealth|accessdateaccess-date=4 December 2015}}</ref> In women, reproductive medicine also covers [[menstruation]], [[ovulation]], [[pregnancy]] and [[menopause]], as well as gynecologic disorders that affect fertility.<ref>{{cite web|title=Fertility and Reproductive Medicine|url=https://wuphysicians.wustl.edu/medical-services/specialties/obstetrics-and-gynecology/fertility-and-reproductive-medicine|website=Washington University Physicians|publisher=Barnes-Jewish Hospital and St. Louis Children's Hospital|accessdateaccess-date=4 December 2015}}</ref>

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’swoman's general health, sexual history and relevant family history. <ref>{{Cite web|url=https://www.nice.org.uk/cks-uk-only|title=Initial assessment of infertility|last=|first=|date=|website=NICE|url-status=live|archive-url=|archive-date=|access-date=2019-09-25}}</ref> A physical examination will also take place to identify abnormalities such as [[hirsutism]], [[Abdominalabdominal mass|abdominal masses,]]es, [[infection]], [[Cyst|cystscyst]]s or [[Fibroidwikt:fibroid|fibroidsfibroid]]s. A [[Bloodblood test|blood tes]]<nowiki/>t 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 [[Medical ultrasound|pelvic ultrasounds]] can also be used to assess the internal anatomy. <ref name=":0">{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/female-infertility/diagnosis-treatment/drc-20354313|title=Female infertility - Diagnosis and treatment - Mayo Clinic|website=www.mayoclinic.org|access-date=2019-09-25}}</ref>

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. <ref>{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/male-infertility/diagnosis-treatment/drc-20374780|title=Male infertility - Diagnosis and treatment - Mayo Clinic|website=www.mayoclinic.org|access-date=2019-09-25}}</ref>

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|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. <ref name=":0" /> Treatment is also required for sexually transmitted infections (STIs). These can take the form of [[Antibiotic|antibioticsantibiotic]]s for bacterial infections such as [[chlamydia]] <ref>{{Cite web|url=https://medlineplus.gov/chlamydiainfections.html|title=Chlamydia Infections|website=medlineplus.gov|access-date=2019-09-25}}</ref> or [[Management of HIV/AIDS|highly active anti-retroviral therapy]] (HAART) for the [[HIV|HIV virus]]. <ref>{{Cite web|url=https://apps.who.int/iris/bitstream/handle/10665/44379/9789241599764_eng.pdf;jsessionid=6ED0B04C85A28234594078856095D605?sequence=1|title=Antiretroviral therapy for HIV infection in adults and adolescents|website=WHO}}</ref>

The [[anamnesis (medicine)|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, hethey oroften she oftendo doesn'tnot start talking about such an issue without the physician initiating the subject by a specific question about sexual or [[reproductive health]].<ref name=Quilliam2011/> 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.<ref name=Quilliam2011/> 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.<ref name=Quilliam2011>'[http://www.medscape.com/viewarticle/743689_3 The Cringe Report]' By Susan Quilliam. Posted: 06/28/2011; J Fam Plann Reprod Health Care. 2011;37(2):110-112.</ref>

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.<ref>{{Cite web|url=https://www.nice.org.uk/guidance/cg156/chapter/Recommendations#access-criteria-for-ivf|title=Recommendations {{!}} Fertility problems: assessment and treatment {{!}} Guidance {{!}} NICE|website=www.nice.org.uk|date=20 February 2013 |access-date=2019-09-25}}</ref>. While NICE recommends NHS [[Clinicalclinical commissioning group|clinical commissioning groups]]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<ref>{{Cite web|url=https://www.nhs.uk/conditions/ivf/availability/|title=IVF - Availability|date=2017-10-20|website=nhs.uk|language=en|access-date=2019-09-25}}</ref>

There are many groups around the world which oppose to ARTs, including [[Religious response to assisted reproductive technology|religious groups]] and pro-life charities such as [[Life (UK organisation)|LIFE]].