Reproduktionsmedizin - gestern, heute, morgen und übermorgen

This review article contains a historical outline of the developments in reproductive medicine in the last decades, presents the current state of reproductive medicine and provides a view into the future. Until the end of the 1970s women with bilateral fallopian tube blockages could not be helped in fulfilling the desire to have children. Until the early 1990s it was not possible to offer reproductive medical aid to couples with male subfertility. Usually, three embryos were introduced into the uterus. The pregnancy rate was no more than 20% in the early years of assisted reproduction. As ovulation was triggered exclusively by human chorionic gonadotropin (HCG), there was a risk of ovarian hyperstimulation. Nowadays, many women with infertility and, in some cases, men with azoospermia can be helped with reproductive medical treatment. In most cases only one embryo is placed in the uterus. The pregnancy rate per transfer is around 31%. Severe hyperstimulation occurs in less than 1% of all treatments. Around 10 million people worldwide now owe their lives to assisted reproductive technologies (ART). Despite all the advances in this field, little is still known about the fundamentals of embryology and reproduction. Failure of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment is still more likely than successful treatment. Because of the relatively low success rate of ART, more and more additional examinations and treatments (so-called add-ons) have been developed in recent years. These are intended to increase the chances of success and thus the pregnancy rate; however, further development of these technologies will be necessary in the future. Further prospective randomized controlled trials with hard outcome parameters, such as a continuous pregnancy rate with the birth of a healthy child, are still required.