Reproduction is a mandate of nature. The continuity of species demands promulgation. However, as humans have attempted to control nature, reproduction has evolved into an option. But, preventing conception is quite often easier than reproduction on demand. Indeed, 12 months of intercourse without contraception and without conception is defined as infertility. Although infertility has plagued humans throughout history, its face has changed throughout by economics of large families, women's role in the workplace, smaller families born later in life and effective contraception. Advanced technology has aided the diagnosis of infertility and revolutionized the treatment. This chapter reviews the history, diagnosis and therapy of infertility.
Sara was perhaps the earliest documented infertile woman. At age 90, after many years of marriage to Abraham, Sara's first born was conceived only after God's intervention (The Bible, Genesis 17:17-21:2). Fertility gods pepper hieroglyphic inscriptions on Egyptian temples. The ancient Egyptian god Seth was god of thunder and storms as well as the desert. Though married to Nephthys, Seth never fathered children, hence his association with the barren desert and infertility. In ancient Rome, infertility was an acceptable reason for a man to request divorce. Even English royalty was pressured to bear their kings' heirs to the thrones, pressure so daunting that it often resulted in pseudocyesis (1,2).
Modern gynecologists wrote about infertility in the mid 20th century as a descriptive state induced by a certain personality type of the woman (3,4). As more data become known of the physical causes of infertility, the depression and anxiety thought to be a cause of infertility evolved into an effect of the disease.
The next significant advance in the diagnosis of infertility was laparoscopy. Laparoscopy enabled tubal factor infertility and endometriosis to be diagnosed in women without major abdominal surgery. It would be much later when surgical intervention was actually introduced through the laparoscope, but, nonetheless, diagnosis became more aggressive.
The first therapeutic breakthrough was probably the introduction of clomiphene citrate in the 1960s for ovulation induction in anovulatory women (5). This was followed by gonadotropin injections.
Most recently, the birth of Louise Brown in July of 1978, the world's first child conceived after in vitro fertilization, altered the approach to therapy one again. Because of its technologic glamour, IVF was highlighted by the media in the last quarter of the 20th century as the Mecca of infertility therapy and the prime example of interfering with the intimacy of reproduction. The biologic fidelity of gametes from the married couple resulting in the wife's gestation and delivery of their child was broken. Gestational parent, gamete donors, and surrogate mothers became the topic of heated ethical and legal battles.