Historical Background on IVF
Robert Edwards, a Ph.D. physiologist, and Patrick Steptoe, a gynecologist, pioneered IVF in Great Britain during the 1970's. Edwards had spent the 1960's working with bits of human ovaries removed at surgery and had achieved the first fertilization of a human egg outside the body in 1967. During these same years Steptoe was helping to develop the new surgical technique of laparoscopy. By 1971 the two men had met and began to collaborate. Initially they retrieved eggs from the ovaries of volunteers by laparoscopy and focused on improving the timing of egg retrieval and in vitro culture conditions. By the mid seventies they felt ready to attempt pregnancy. Their initial pregnancy was unfortunately a tubal pregnancy (ectopic) in 1976. Then came true success and the first IVF baby, Louise Brown, was born in July 1978.
Steptoe and Edward's original group of patients had undergone natural IVF, meaning they were not given fertility drugs. Instead they were monitored closely and when ovulation appeared imminent, even if it was 3 o'clock in the morning, a laparoscopy was done and an attempt made to aspirate the single mature egg. As you might suspect they didn't always obtain the egg. Two Australian groups were only two years behind in achieving IVF pregnancies but they chose a different route. They stimulated their patients with fertility drugs in hopes of recovering more than one egg. As their initial success rates, about 5% per attempt, were higher than that of Steptoe and Edwards, all subsequent new IVF programs also used stimulated IVF. Eventually even Steptoe and Edwards adopted this approach as well.
The 1980's saw continued improvement in embryology culturing techniques, refinements in fertility drug protocols and the ability to retrieve eggs with a vaginal ultrasound probe instead of laparoscopy. As a result IVF success rates began to climb slowly but steadily, reaching at the end of the decade 20–25% per attempt for women under the age of 40.
The 1990's have seen numerous general refinements, such as improvements in treatment protocols for women 40 and older and the development of ICSI (Intracytoplasmic perm Injection), a revolutionary treatment for severe male factor problems. With ICSI a single sperm can be injected into an egg and thereby achieve fertilization. For women 35 and older a technique called assisted hatching and the ability to grow embryos longer (3 to 5 days before transfer) helped improve the odds. Also, the process of egg donation (IVF using eggs donated by a younger woman) was perfected which produced high pregnancy rates in previously hopeless situations. |
