Reproductive and developmental toxicology has existed, in some form, at least since the Middle Ages when women commonly used naturally derived abortifacients for birth control. Percival Pott was the first to observe that environmental exposures could detrimentally affect the male reproductive system. He noticed that chimney sweeps exposed to soot developed testicular cancer and infertility at unusually young ages. The formal investigation of male-mediated effects on offspring (germline mutagenesis) began with the pioneering studies of Muller, Hertwig, Snell, Brenneke, and others, who established X-rays as the first identified agent capable of inducing hereditary changes in mice. They showed that litters sired by irradiated males contained fewer pups than controls. Because sperm motility and density were not affected, but chromosome abnormalities were found in fertilized eggs, they concluded that irradiated sperm were the source of the abnormal chromosomes. Since that discovery, the mutagenic effects of radiation on the male germline have been studied extensively (see below). Later, Auerbach & Robson and Bock & Jackson were the first to demonstrate that exposing mice to chemicals decreases their fertility and induces chromosomal abnormalities and other mutations in the male germline. The subsequent five decades of work on chemical mutagens has resulted in a detailed biochemical and genetic characterization of chemical mutagenesis in the male germline and male-mediated developmental problems in laboratory animals (see below).

Female-dependent methods of contraception have been the subject of considerable scientific advance since the introduction of the combined contraceptive pill, offering effective and male-independent contraception, but there is an emerging emphasis that men should be more involved in family planning. The supremacy of modern, female methods in the developed world obscures the fact that one-third of all couples worldwide rely on a male-dependent method of contraception, mostly the condom or withdrawal, methods that have been used since antiquity. Potential methods of male contraception include withdrawal of the gonadotrophic support to the testis, interference with spermatogenesis within the seminiferous tubules, or with post-testicular functions. Effects on maturation within the epididymis can be induced by chloro-6-deoxy sugars or plant-derived glycosides. Although advances in assisted conception, particularly associated with intracytoplasmic sperm injection (ICSI), have demonstrated the functional competence of the nucleus and centriole of testicular spermatozoa and other less mature forms, it has been suggested that normal passage through the male reproductive tract is necessary for conventional conception. Advances in both testicular and post-testicular methods of contraception have been hampered by toxicity and remain in preclinical testing, reflecting the limited extent of (and thus the need for) scientific knowledge in this area. While progress in these areas is fully acknowledged, the pretesticular hormonal approach is currently at a considerably more advanced stage of development with prospects for a real product becoming increasingly likely on a realistic time-scale. This review will therefore confine itself to this, the hormonal approach.

The original title that I was given when asked to write this article was “Recent advances in endometrial resection”. Whilst there have been a number of recent important publications regarding the results and place of endometrial resection, there have been no advances in the technique itself. There have however been a number of recent advances in other methods of endometrial ablation. I therefore changed the title so as to encompass all the advances in this area and I use the term endometrial ablation to cover all methods of resecting or destroying the endometrium.

Diabetes mellitus is the most common chronic disease in the industrialized world. In North America and Europe the prevalence in adults is 7–8% and it is estimated that there are more than 100 million cases worldwide. With the increasing prevalence of non-insulin-dependent diabetes mellitus (NIDDM) this figure continues to rise. The World Health Organization predicts that the number of patients with diabetes will rise from 130 million to over 300 million over the next 25 years. Diabetes affects 1 in 30 people living in England and Wales and accounts for more than £2 billion of hospital costs annually. The number of diabetic patients in the UK is predicted to double to 3 million by the year 2010.