In vitro fertilisation

In vitro fertilisation (IVF) is a process of fertilisation in which an egg is combined with sperm in vitro ("in glass"). The process involves monitoring and stimulating the ovulatory process, then removing an ovum or ova (egg or eggs) from the ovaries and enabling sperm to fertilise them in a culture medium in a laboratory. After a fertilised egg (zygote) undergoes embryo culture for 2–6 days, it is transferred by catheter into the uterus, with the intention of establishing a successful pregnancy. IVF is a type of assisted reproductive technology (ART) used to treat infertility, enable gestational surrogacy, and, in combination with pre-implantation genetic testing, avoid the transmission of abnormal genetic conditions. When a fertilised egg from egg and sperm donors implants in the uterus of a genetically unrelated surrogate, the resulting child is also genetically unrelated to the surrogate. Some countries have banned or otherwise regulated the availability of IVF treatment, giving rise to fertility tourism. Financial cost and age may also restrict the availability of IVF as a means of carrying a healthy pregnancy to term. In July 1978, Louise Brown was the first child successfully born after her mother received IVF treatment. Brown was born as a result of natural-cycle IVF, where no stimulation was made. The procedure took place at Dr Kershaw's Cottage Hospital in Royton, Oldham, England. Robert Edwards, surviving member of the development team, was awarded the Nobel Prize in Physiology or Medicine in 2010. When assisted by egg donation and IVF, many women who have reached menopause, have infertile partners, or have idiopathic female-fertility issues, can still become pregnant. After the IVF treatment, some couples get pregnant without any fertility treatments. In 2023, it was estimated that twelve million children had been born worldwide using IVF and other assisted reproduction techniques. A 2019 study that evaluated the use of 10 adjuncts with IVF (screening hysteroscopy, DHEA, testosterone, GH, aspirin, heparin, antioxidants, seminal plasma, and PRP) suggested that (except for hysteroscopy) these adjuncts should be avoided until there is more evidence to show that they are safe and effective.

Terminology The Latin term in vitro, meaning "in glass", is used because early biological experiments involving cultivation of tissues outside the living organism were carried out in glass containers, such as beakers, test tubes, or Petri dishes. The modern scientific term "in vitro" refers to any biological procedure that is performed outside the organism in which it would normally have occurred, to distinguish it from an in vivo procedure (such as in vivo fertilisation), where the tissue remains inside the living organism in which it is normally found. A colloquial term for babies conceived as the result of IVF, "test tube babies", refers to the tube-shaped containers of glass or plastic resin, called test tubes, that are commonly used in chemistry and biology labs. However, IVF is usually performed in Petri dishes, which are both wider and shallower and often used to cultivate cultures. IVF is a form of assisted reproductive technology.

History

The first successful birth of a child after IVF treatment, Louise Brown, occurred in 1978. Louise Brown was born as a result of natural cycle IVF, where no stimulation was made. The procedure took place at Dr Kershaw's Cottage Hospital (now Dr Kershaw's Hospice) in Royton, Oldham, England. Robert G. Edwards, the physiologist who co-developed the treatment, was awarded the Nobel Prize in Physiology or Medicine in 2010. His co-workers, Patrick Steptoe and Jean Purdy, were not eligible for consideration as the Nobel Prize is not awarded posthumously. The second successful birth of a 'test tube baby' occurred in India on 3 October 1978, just 70 days after Louise Brown was born. The girl, named Durga, was conceived in vitro using a method developed independently by Subhash Mukhopadhyay, a physician and researcher from Hazaribag. Mukhopadhyay had been performing experiments on his own with primitive instruments and a household refrigerator. However, state authorities prevented him from presenting his work at scientific conferences, and it was many years before Mukhopadhyay's contribution was acknowledged in works dealing with the subject. Adriana Iliescu held the record as the oldest woman to give birth using IVF and a donor egg, when she gave birth in 2004 at the age of 66, a record passed in 2006. After the IVF treatment, some couples can get pregnant without any fertility treatments. In 2018, it was estimated that eight million children had been born worldwide using IVF and other assisted reproduction techniques.

Medical uses

Indications

IVF may be used to overcome female infertility when it is due to problems with the fallopian tubes, making in vivo fertilisation difficult. It can also assist in male infertility, in those cases where there is a defect in sperm quality; in such situations, intracytoplasmic sperm injection (ICSI) may be used, where a sperm cell is injected directly into the egg cell. This is used when sperm have difficulty penetrating the egg. ICSI is also used when sperm numbers are very low. When indicated, ICSI has been found to increase the success rates of IVF. According to the UK's National Institute for Health and Care Excellence (NICE) guidelines, IVF treatment is appropriate in cases of unexplained infertility for people who have not conceived after 2 years of regular unprotected sexual intercourse. In people with anovulation, it may be an alternative after 7–12 attempted cycles of ovulation induction, since the latter is expensive and easier to control.

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