The medical subfield of reproductive medicine has existed since the 1980s and is concerned with the study, diagnosis, and treatment of fertility. In vitro and in vitro fertilization are among the most important orientations of reproductive medicine procedures. In the field of research, reproductive medicine is additionally concerned with the analysis of social and ethical consequences.
What is reproductive medicine?
Reproductive medicine is concerned with the study, diagnosis, and treatment of reproductive processes. Reproductive medicine deals with the research, diagnostics and treatment of processes of reproduction. In this respect, the main focus of the medical specialty is on fertility disorders. The term reproduction in this context is understood as the generation of new, but largely similar individuals. Reproductive medicine is broadly related to the subfields of urology, gynecology, genetics and andrology. Andrology is understood by physicians as the study of male reproductive ability. Thus, in the broadest sense, andrology corresponds to gynecology for men. The andrological pioneer Carl Schirren established the first reproductive medicine center in Germany in 1983. One of the most important areas of reproductive medicine opened up in the 1980s. At that time, Steptoe and Edwards developed in vitro fertilization. This artificial insemination gave birth to the country’s first “test-tube baby” in Germany during the 1980s. Since then, artificial insemination procedures have been constantly refined and developed. The framework of reproductive medicine is largely determined by German law and bioethics. Ethical and legal disputes have always arisen in connection with artificial insemination. It is precisely these controversial issues that reproductive medicine must permanently clarify in terms of medical law and bioethics.
Treatments and therapies
Reproductive medicine is primarily concerned with in vivo and in vitro fertilization. The spectrum of treatments ranges from therapy for certain fertility disorders to inducing assisted pregnancies in cases of infertility. Both in vivo and in vitro fertilization belong to the subfield of so-called assisted reproduction. The focus of this assisted reproduction is the generation of a pregnancy through various medical techniques. These techniques include hormonal treatments as well as surgical or minimally invasive procedures. In vivo fertilization methods fertilize the egg in the womb. In vitro fertilization methods, on the other hand, refer to artificial fertilization in a test tube. In the field of research, reproductive medicine is particularly concerned with the further development of in vitro and in vivo fertilization methods. Diagnostic methods for diagnosing infertility are also constantly being developed in the research field. Apart from this, research in reproductive medicine is investigating innovative contraceptive methods, such as hormonal contraception. In addition, the analysis of environmental influences related to general fertility is an important field of research in the specialty. The social and ethical implications of new reproductive medical procedures are also recorded and analyzed in the research area of reproductive medicine. This concerns, for example, the question of the extent to which the planning of offspring according to selected characteristics, which is already possible to a limited extent today, is ethically responsible. Reproductive medicine is also concerned with stem cell research in the broadest sense. For example, embryonic stem cells are largely obtained from in vitro fertilization. In this area, reproductive medicine is bound by the legal requirements for stem cell research. In the field of fertilization, compliance with the Embryo Protection Act is one of the most important framework conditions in the development of new therapeutic and fertilization procedures.
Diagnosis and research methods
Usually, a couple or an individual visits a reproductive physician mainly in the context of a failure to conceive. The medical history is a component of reproductive medicine that should not be underestimated.In most cases, the physician already anamnetically develops an idea of the possible causes of impaired fertility. Fertility tests also fall within the treatment spectrum of the specialty. In men, such tests usually correspond to a sperm function test. Masturbation can be used to obtain the sperm. However, minimally invasive procedures are also conceivable. The function of the sperm obtained and analyzed in this way is documented in a spermiogram. This spermiogram primarily provides information on the density, speed and general health of the sperm. The reproductive physician may examine the woman’s fertility via hormone tests. In addition, laparoscopies, uterine endoscopies and ultrasound examinations or observation of the menstrual cycle are also conceivable diagnostic procedures. The most important methods in the therapeutic field of reproductive medicine are intrauterine insemination, intracytoplasmic sperm injection and testicular sperm extraction. In addition, microsurgical epididymal sperm aspiration and in vitro maturation are now also of great importance in reproductive medicine therapy. In intrauterine insemination, sperm are introduced directly into the woman’s uterus. This procedure is particularly suitable when the flow velocity of the sperm is impaired. Intracytoplasmic sperm injection goes one step further. Here, the male sperm is injected into the cytoplasm of the female egg. To obtain sperm, testicular biopsy is used in testicular sperm extraction. However, for in vitro procedures, sperm can also be obtained from the epididymis via microsurgical epididymal sperm aspiration. In vitro maturation involves women with certain fertility disorders. In this procedure, the reproductive physician removes immature eggs from the woman’s ovaries. The retrieved eggs are artificially post-matured in a test tube until they are fertile. Many reproductive medicine procedures are predominantly hormonally controlled and are therefore accompanied by hormone therapy. The fulfillment of a previously unfulfilled desire for a child is thus the main area of all reproductive therapy measures.
