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Human reproduction: current status
Rev Assoc Med B ras 2015; 61(6):1-6 557
REVIEW ARTICLE
Human reproduction: current status
Carlos Roberto Izzo1*, Pedro Augusto Araújo Monteleone2, Paulo C. Serafini3
1Assistant, PhD, Division of Gynecology, Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
2Administrative Coordinator of the Human Reproduction Center, Department of Obstetrics and Gynecology, FMUSP, São Paulo, SP, Brazil
3Associate Professor, Habilitation (BR: Livre Docência), Department of Obstetrics and Gynecology, FMUSP, São Paulo, SP, Brazil
Summary
Study conducted by the Division
of Gynecology, Department of Obstetrics
and Gynecology, Hospital das Clínicas,
Faculdade de Medicina, Universidade de
São Paulo, São Paulo, SP, Brazil
Article received: 10/20/2015
Accepted for publication: 10/23/2015
*Correspondence:
Address: Al. Gabriel Monteiro da Silva, 602,
Jd. Paulistano
Postal code: 01442-002
São Paulo, SP – Brazil
Conflict of interest: none
The concern about the maintenance of the human species has existed since the
earliest civilizations. Progress in the diagnosis and treatment of infertility has led
to the development of assisted reproductive techniques (ART) which, along with
the evolution of genetics and molecular biology studies, have contributed in a con-
crete way to the management of infertile couples. Classic in vitro fertilization was
initially developed 35 years ago for the treatment of women with tubal blockage,
however, it remains inaccessible to a significant proportion of infertile couples
around the world. This can be explained by the lack of specialized clinics in some
countries and by the high cost of the procedures. Efforts have been employed to
increase the number of treatment cycles for assisted reproduction, as for example,
the creation of low-cost programs. Even today, infertility remains a problem of
global proportions, affecting millions of couples. The estimate of the incidence of
infertility is uncertain, mainly because of the criteria used for its definition. This
article aims to review the most important aspects, succinctly, regarding the inci-
dence, etiology, and treatment options available to infertile couples.
Keywords: infertility, techniques of assisted reproduction (ART), in vitro fertilization.
Introduction
Reproduction and maintenance of the human species are
concerns since the most ancient civilizations. Egyptians,
Greeks and Babylonians have linked the occurrence of in-
tercourse with the birth of a child and were concerned to
discuss the etiology and possible treatments for couples
who had no children. In ancient Rome, it was believed that
infertility was linked to sex at the wrong time during the
menstrual cycle and the best time recommended for con-
ception was that soon after the end of menstrual bleeding.
As of the sixteenth century, scientific observations
have resulted in outstanding contributions to the devel-
opment of medicine, especially studies in anatomy and
physiology. The role of endocrinology in infertility began
to unravel in the early nineteenth century. The hypotha-
lamic-hypophyseal-ovarian axis was described in the ear-
ly twentieth century.
The development of tubal surgery and endoscopy, over
the past century, has allowed progress in the assessment
and treatment of tubo-peritoneal diseases. All this improve-
ment in the diagnosis and treatment of infertility led to in
vitro fertilization and assisted reproduction techniques
which, together with genetic and molecular biology, have
become a real solution promise for infertile couples.1
Techniques of assisted reproduction (ART), such as
classic in vitro fertilization, were initially developed for
the treatment of women with tubal obstruction aged over
35 years, and remain inaccessible to a significant propor-
tion of infertile couples worldwide. The lack of special-
ized clinics in some countries and the high cost of proce-
dures, led to efforts to create low-cost treatment programs,
which often lead infertile couples to undergo treatment
cycles in services outside their country of origin.
Infertility, or the lack of conception, remains a prob-
lem of global proportions. This is true in the second de-
cade of the new millennium. Millions of people around
the world are diagnosed with infertility. It is difficult to es-
timate the total infertile population in the world, due to
the heterogeneity of the criteria used to define infertility,
to important differences in the estimation of infertility
based on large scale population studies versus epidemio-
logical studies, and the complete absence of the prevalence
of male infertility. 2,3 Three surveys on the overall preva-
lence of infertility published in the newmillennium (2004,
2007 and 2012) have very different results, between 48.5
million and 186 million.4-6 Secondary infertility or lack of
conception after a previous pregnancy is the most com-
mon form of female infertility around the world.