In-vitro fertilization

Most young couples trying for a baby will eventually conceive within 18 months and only one in seven couples in the UK remain subfertile after this period. In 80% of these subfertile women one or more causative factors are attributable; and some may be associated with significant co-morbidities. Even when no identifiable physical disease is revealed, the psychological impact on affected couples can be severe; and approximately 50% of subfertile couples will eventually undertake some form of assisted conception treatment. In-vitro fertilization (IVF) can be viewed both as a test of reproductive potential, allowing detailed assessment of oocytes, oocyte–sperm interaction and embryo quality, as well as an effective treatment for most forms of subfertility. The dramatic improvements in pregnancy rates seen with IVF treatment since its inception some 34 years ago have occurred due to close multidisciplinary collaboration and the practical application of scientific advances in embryology and pharmacology. There have been several important landmarks including: the use of drugs for superovulation and pituitary downregulation; the introduction of transvaginal ultrasound for monitoring of follicle growth and oocyte retrieval; developments in embryo culture; oocyte donation; and the introduction of intracytoplasmic sperm injection for the treatment of severe forms of male infertility. In the past decade, we have also witnessed the development of new technologies, including pre-implantation genetic diagnosis, the in-vitro culture of immature oocytes to viability, and the cryopreservation of oocytes, thereby widening the scope of clinical problems that can be addressed by IVF-associated technologies. Despite this progress, the majority of IVF cycles still do not produce a viable pregnancy. The psychological stresses imposed upon couples by assisted conception treatment need to be managed carefully and sympathetically. IVF practice continues to require support from appropriately trained and skilled counsellors.