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8 - In-vitro fertilization: indications, stimulation and clinical techniques

Published online by Cambridge University Press:  06 July 2010

Gabor T. Kovacs
Affiliation:
Monash University, Victoria
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Summary

Edwards and Steptoe first described the technique for in-vitro fertilization (IVF) and embryo transfer (ET) in 1976 and the subsequent births of two normal babies in 1978 (Steptoe and Edwards, 1978). Since then, the success rate of the system has been improved (to 30%) by the use of fertility drugs to provide more oocytes and prematuration to mature the oocytes before fertilization (Trounson et al., 1981). The techniques are now used in 53 countries throughout the world. In 1993, the results of 492 units from all over the world were collected from national surveys and registers. Since 1985, more than 53,635 women had been treated and 34,316 babies had been born from 224,473 treatment cycles, following more than 160,518 transfer cycles. Only about 65–75% of all resulting pregnancies attained live births. The remainder ended with spontaneous abortions (26%), or ectopic pregnancies (5.54%). The multiple pregnancy rate (22%) was higher than the normal population and contributed to higher rates of preterm deliveries and perinatal mortality. No increased incidence of chromosomal alterations and malformations were noted during the years (2.25%).

Since the birth of the first IVF baby, tremendous developments have occurred regarding the indications for assisted reproductive technology (ART). For example, the dramatic development concerning male infertility which initially was considered to involve a small fraction of patients benefiting from IVF, now, with the development of intracytoplasmic sperm injection (ICSI), involves up to 35% of started cycles.

Type
Chapter
Information
The Subfertility Handbook
A Clinician's Guide
, pp. 88 - 108
Publisher: Cambridge University Press
Print publication year: 1997

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