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  Vol 432 No 7013 pp37-57

4 November 2004

  outlook

Outlook: Fertility

PETER ALDHOUS AND NATALIE DEWITT

"All couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education and means to do so." Few would disagree with this statement, agreed by world leaders at the United Nations' International Conference on Population and Development in Cairo, a decade ago.

The arrival of a child is a life-changing event — one that we would all like to control, and plan for. Alas, it often doesn't work out that way. Infertility curses many couples, whereas lives are turned upside down every day by reproductive 'accidents'. That's especially true in the developing world, where access to contraception is limited. But even in the United States about half of all pregnancies are unplanned.

Meeting the UN conference's goal will not be easy. Religious and moral agendas often complicate the picture, arguing — unrealistically — that unwanted pregnancies are best avoided through sexual abstinence. Economic and social factors weigh heavily: the trend in many rich countries to delay reproduction until later in life helps to explain why many couples then have trouble conceiving. But reproductive empowerment will require a vigorous research agenda, which provides the backdrop to this Outlook.

Mention the science of human reproduction, and thoughts turn to in vitro fertilization and similar technologies. In this area, science fact often seems to blur into science fiction. For a glimpse of what might lie ahead, a leading exponent of that genre has devised a brochure for a reproductive services company operating 75 years from now.

Other articles look at the nearer term. One of the most exciting — and controversial — frontiers of fertility is the removal of the menopause. Here, the science is moving fast. So too in other areas, such as how imprinting — the differential expression of genes, depending on whether they come from the mother or the father — controls fetal nutrition.

But many of the field's frontiers are shrouded in ignorance — and, in some cases, blighted by inaction. Is our biological fertility declining? If so, is environmental pollution to blame? And why are millions of people, even in the developed world, using contraceptive methods that are unreliable and fail to deploy the latest findings in molecular biology?

Our authors don't claim to have all the answers. But we hope that this Outlook will frame the questions from which a brighter reproductive future can emerge.

  Outlook: Fertility
  Fertility 37
PETER ALDHOUS AND NATALIE DEWITT
doi:10.1038/432037a
Full text | PDF (199k)
  The fertility riddle 38
DECLAN BUTLER
Across the developed world, birth rates are plummeting. Is this just a social phenomenon, or is our biological fertility also declining? We don't yet know, and that is worrying, says Declan Butler.
doi:10.1038/432038a
Full text | PDF (297k)
  Age is no barrier...  40
KENDALL POWELL
Advances in reproductive medicine hint that female fertility might be extended into late middle age and beyond. But will the methods be safe? And is society ready for this demographic shift? Kendall Powell investigates.
doi:10.1038/432040a
Full text | PDF (792k)
  Waiting for the second coming  43
JEROME F. STRAUSS III AND MICHAEL KAFRISSEN
Contraceptive research is seriously in need of revitalization.
doi:10.1038/432043a
Full text | PDF (253k)
  Fertility 2079  46
GREG BEAR
Greg Bear glimpses the future of human reproduction.
doi:10.1038/432046a
PDF (774k)
  Seeds of concern  48
R. JOHN AITKEN, PETER KOOPMAN & SHEENA E. M. LEWIS
During the past few decades, worries about environmental threats to human health have centred on the possible induction of cancers. Now risks to the male germ line, both real and potential, are also causing disquiet.
doi:10.1038/432048a
Full text | PDF (609k)
  Resourceful imprinting 53
MIGUEL CONST´┐ŻNCIA, GAVIN KELSEY & WOLF REIK
A child's genes are not all equal: in some cases, the copy from either the mother or the father is turned off. This affects the child's ability to acquire resources in the womb, after birth, and perhaps throughout life.
doi:10.1038/432053a
Full text | PDF (381k)
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