Fertility is a very important for the human race. Historically rulers of countries have used all available means to guarantee family succession in the next generation of rulers. Our understanding of the reproductive tract anatomy started in the 1600’s, but it was not until the twentieth century that the endocrine control of the reproductive tract was elucidated. By the middle of the last century the world witnessed a collision between interest in procreation and the reality of world population explosion. The projections of global population growth and its potential impact on health and well being stimulated the study of reproductive biology and the control of fertility. The control of the population growth to maintain a healthy, educated, and happy family was in conflict with the long tradition and natural desire to procreate and form a large family. Soon the fertility factor created religious, ethical, political and economic controversy. It was clear to those who envisioned the population explosion that rapid development in our knowledge of reproduction was necessary in order to develop the means of controlling the population growth. The contraceptive pill was the first scientific answer to the problem of fertility control. The scientific knowledge created in this field of reproduction stimulated the study of infertility.
Obstetricians and Gynecologists up to this moment were unfamiliar with the hormonal regulation of male and female reproductive organs. The infertility cases were limited to anatomic pathologies in the female and perhaps the only routine test ordered was a vaginal cytology, endometrial histology, and semen analysis. Until the impact of biochemical and biological studies infertility was no more than another symptom in endocrine pathology. With biochemical studies of hormones (isolation, characterization, and biosynthesis), physiological studies and practical, inexpensive, accurate determinations of hormones in biological fluids, soon the Hypothalamic-Pituitary-Ovarian/Testes axis was established as a negative feedback control mechanism of the Reproductive Tract. It was established that (FSH and LH pituitary hormones) stimulate ovarian estradiol and progesterone production that result in the cyclic preparation of the endometrium and the maturation of the follicle. In men these same hormones stimulate the production of the sperm and testosterone. With the Hypothalamic-Pituitary-Ovarian/Testicular hormonal control of the reproductive tract and production of follicles and spermatozoids the two main players in the reproductive scenario the subspecialty Reproductive Endocrinology was born. Other endocrine glands and hormones play an important role in reproductive endocrinology: thyroid, adrenal cortex, pituitary (growth hormone, prolactin) and the endocrine pancreas. Because of the physiological importance of the hormones mentioned above and the identification of an ovulation as one of the main sources of endocrine pathology the first endocrine treatment was the use FSH/LH combination (Pergonal).
Reproductive Endocrinology has grown with our knowledge that other organ systems have an impact on fertility. Today a more appropriate name is Reproductive Medicine. Immunology, Coagulation and Genetics are some of the other factors that impact fertility. The most recent addition to the infertility field is the environmental/toxicology effects on reproduction.
The immune system, a complex defense system in charge of the protection of the body, is a life saving function. Its origin goes to the ancient Arabic and Chinese practice (A.D.1500) of inhalation of powder crust of small pox lesions in the treatment and prevention of the deadly disease. Lady Montague did not introduce this practice in the Western World until 1718. By the second half of the eighteenth century scientific advance was impacted by giants of medicine such as Jenner, Pasteur, Metchinikoff, Ehrlich and others who established basic concepts in immunology, vaccination, phagocytosis, allergic phenomena, and antibody formation.
By the end of the nineteenth century and beginning of the twentieth century immunochemical concepts were added to the field of immunology. The Complement system, Opsonin, Landsteiner introduce the ABO blood types concepts as well as Haptens same graft acceptance and Tumor rejection. In 1903 Ublenhuth first reported tissue specific antigen and in 1953 Medawar questioned why the fetus being a partially foreign object is not rejected. By 1956 Witebsky Hashimoto described hypothyroiditis as an autoimmune disease. The interacting antigen/antibody system (Ag/ Ab) is the foundation for the methodologies called RIA which are used for measuring hormones. RIA includes variants in the technology such as Elisa. Thanks to these simple, accurate, reproducible, and inexpensive measuring systems progress has been made possible in many branches of medicine, especially Endocrinology and Reproductive Endocrinology.