In-vitro fertilisation

Infertility is not an identifiable physical disease yet its psychological impact on affected couples can be severe. One in seven couples in the UK suffers from subfertility. Of these, approximately half will end up undertaking some form of assisted conception treatment. In-vitro fertilisation (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 30 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 seen 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.