As early as 1500 BC, history records women using a variety of drugs, devices and manoeuvres in an attempt to prevent pregnancy after intercourse has taken place. It was not until the 1960s however that scientific efforts were made to develop effective postcoital contraception (PCC). Whilst it had been known for over thirty years that a variety of compounds would inhibit implantation and embryonic development and interrupt pregnancy in the rabbit and the rat, experiments with primates had been less successful. In 1966 however, Morris and Van Wagenen reported the prevention of pregnancy in 28 macaque monkeys treated with oestradiol, diethylstilboestrol or a synthetic compound (ORF 3858), administered after mating. In the same paper – and confessing that they embarked upon human experimentation ‘with some trepidation’ – the authors reported that 50 mg diethylstilboestrol (DES) given for four to six days appeared to be effective in preventing pregnancy after intercourse had taken place in an undisclosed number of women who were the victims of rape.

Fully mature oocytes are the rarest cells in the body. A premenopausal woman produces only one during each menstrual cycle and that survives for just a single day. Ovarian productivity is parsimonious in order that the ovulation rate matches the optimal capacity of the uterus for carrying conceptuses to full-term. But, in this new era of assisted reproductive medicine, there are many applications for which spare oocytes are needed (Table 1), and it is desirable to obtain more cells than are routinely available during superstimulated cycles. Since the great majority of ovarian oocytes undergo atresia (> 99.9%), the possibility of tapping the store of immature oocytes before they degenerate and maturing them in vitro is very attractive.

The diagnosis of inherited disease in affected embryos before implantation is now possible using in vitro fertilization (IVF), embryo biopsy and DNA analysis. This enables pregnancies to be established with unaffected embryos following transfer to the uterus avoiding the possibility of terminating a pregnancy diagnosed as affected later in gestation. Pregnancies have been established with female embryos in women carrying X-linked recessive genetic defects affecting boys by identifying the sex of embryos either by DNA amplification of Y-specific sequences or by dual fluorescent in situ hybridization (FISH) with X- and Y-specific probes to interphase nuclei. The predominant ΔF508 deletion causing cystic fibrosis (CF) has also been detected by DNA amplification from single cells and the first pregnancy and birth of a child successfully screened for a single gene defect achieved. The prospects for applying preimplantation diagnosis to other chromosomal and single gene defects are reviewed.

Several conclusions can be drawn from a review of the formation, function and regression of the corpus luteum. Ovulation and luteinization encompass degenerative and growth changes. Inflammatory conditions associated with ovulation lead to the breakdown of the follicle wall and the membrana granulosa, along with initial damage to theca and granulosa cells. The early corpus luteum is, therefore, a tissue in stress. Thus, one view of the corpus luteum is that it, like the phoenix, rises from the inflammatory ashes of the postovulatory follicle to exist briefly and to be consumed by a similar process at regression. The luteinization process is associated with parenchymal cell hypertrophy and matrix remodelling, which appear to be regulated by IGFs and androgens, and with angiogenesis, which is induced mostly by bFGF. High levels of functional activity of the corpus luteum are regulated by control at the level of the LH receptor, whose activation leads to the translocation of cholesterol into the cell and mitochondria for conversion to steroids. Functional luteal regression can be considered as another inflammatory-like condition with apparent activation of the immune system, along with cytokine, reactive oxygen, and eicosanoid production. Structural luteolysis is subsequently invoked that leads to matrix dissolution and cellular degeneration. It is perhaps not surprising that the invocation of immune activation, which causes the production of DNA-damaging reactive oxygen species and cytotoxic cytokines each cycle, may increase the risk of pathologies. One example may be ovarian cancer which appears to be associated with the use of fertility-enhancing drugs and associated with the number of ovulations in a woman's lifetime.

Lasers have now been used laparoscopically in infertility surgery for over a decase. Use of the CO2 laser at laparoscopy began independently in France, Israel and North America. Investigators have subsequently reported use of the argon, Nd-YAG, and the KTP lasers for laparoscopic laser surgery. All of these surgical lasers are now widely available and have been used clinically for many laparoscopic procedures. This review will examine the laparoscopic use of both infrared and visible laser light energy in the treatment of infertility and endometriosis.

Hysteroscopy was first reported by Pantaleoni in 1869. He used a 12 mm diameter straight tube that was inserted into the uterine cavity with a concave mirror to reflect light into the uterus. Today, there are two main types of endoscopes in use: (1) the rigid endoscopie panoramic hysteroscope and (2) the flexible hysteroscope.

Uterine fibroids are estimated to affect up to 25% of women of reproductive age and are a common cause of morbidity, being associated with menstrual dysfunction, iron deficiency anaemia, pregnancy wastage and subfertility. Their pathogenesis remains unknown but their association with ovarian function and oestrogen production is undisputed and supported by their occurrence only after puberty and the shrinkage observed after the menopause. This oestrogen dependency has recently been exploited therapeutically through investigation of the use of agents that induce a hypo-oestrogenic state, the gonadotrophin-releasing hormone (GnRH) or luteinizing hormone-releasing hormone (LHRH) analogues.

Since the discovery of the structure and function of steroids over 60 years ago, it has long been recognized that synthetic antagonists of the natural hormones would have potential therapeutic uses. Antagonists of mineralocorticoids, androgens and oestrogens, for example spironolactine, cyproterone, flutamide and tamoxifen, have already found a place in the management of hormone dependent conditions. In 1982, chemists at Roussel UCLAF announced that they had synthesized mifepristone (RU486) 17β-hydroxy-11(p-(dimethylamino)phenyl)-17-(1-propynyl) estra-411, 9-dien-3-one) a derivative of norethindrone which had potent antiprogestogenic as well as antiglucocorticoid activity. Although it was immediately realised that this compound would potentially have wide clinical application, its development in the last 10 years has been dominated by its abortifacient action. In the original clinical report by Herrman and colleagues it was shown that bleeding occurred when it was given to female volunteers in the second half of the menstrual cycle. In addition, complete abortion occurred in eight of 11 women who took the drug in the early weeks of pregnancy. These findings, which demonstrated that mifepristone could be used as the basis of a medical method of inducing abortion, were immediately made the focus of groups opposed to abortion on moral grounds. Experience over the last 10 years has confirmed the promise of these early studies and mifepristone, in combination with a suitable prostaglandin, is now licensed in France, UK and Sweden for use as a medical method of inducing abortion in early pregnancy.

Micromanipulation technology entered the forum of human conception in vitro in the late 1980s. It was erroneously perceived as a new technology – a purely mechanical approach to bypass failures of conception in vitro, the aetiology of which were unknown. In fact, it is the modification of technology developed since the beginning of this century, and its logical utilization for conception in vitro, preconception (polar body) biopsy and preimplantation (blastomere and trophectoderm) biopsy in the realm of human infertility and genetic disorders.

The aim of this article is to review our knowledge of the status of human relaxin in reproductive medicine.

Relaxin has a particular interest for obstetricians and gynaecologists for its potential to ripen the uterine cervix in order to promote effective labour. Despite research activity over approximately sixty years in the relaxin field since the original observation of Hisaw, there is still a considerable gap in our understanding of the role of relaxin in reproductive medicine. As pointed out by Sherwood in a comprehensive review of the relaxin literature, the accumulation of knowledge concerning the hormone is in its infancy.

Following the isolation, and subsequent synthesis of the decapeptide gonadotrophin-releasing hormone (GnRH) in the laboratories of Schally and Guillemin in 1971, a more physiological treatment for hypogonadotrophic women became available. It was not, however, until 1980 that a successful, pulsatile mode of administration was established.