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(October 2004)
Mark P. Trolice, M.D., FACOG, FACS
Board Certified, Reproductive Endocrinology And Infertility
Director, Fertility C.A.R.E.
Milton McNichol, MD, FACOG, FACS
Board Certified, Reproductive Endocrinology And Infertility
The History Of IVF
IVF Today
The GIFT Procedure
The ZIFT Procedure
(Part Two) In-Vitro Fertilization: Then and Now
The History of IVF
Today, In-vitro Fertilization (IVF) is practically a household word. But not so long ago it was a mysterious procedure that produced what were then known only as "test-tube" babies. On a Tuesday evening in July 1978, Louise Brown, the world's first human IVF baby was born in Manchester, England. For Drs. Patrick Steptoe and Robert Edwards, this achievement marked the culmination of twelve years of painstaking research and was a giant step forward into a brave new world with seemingly limitless potential of solving the reproductive disorders of couples with formerly diagnosed untreatable infertility.
The initial IVF successes were primarily in Europe because the political, legislative and religious climate in the United States made reproductive research untenable. However, IVF soon gained widespread acceptance by the general public that eventually ushered in an era making it possible to provide hope for many couples previously childless.
IVF Today
Since 1978 there has been a remarkable increase in available reproductive solutions as evidenced by the veritable alphabet soup of acronyms describing currently available treatment options. These include IVF, GIFT, ZIFT, TET, ICSI, MESA, TESE and PGD. Collectively these procedures are known as 'assisted reproductive technologies' or ART.
Unlike the simpler intrauterine insemination (IUI) where sperm are introduced into the uterus and fertilization occurs in the fallopian tube, ART involves the removal and/or manipulation of both male and female gametes outside the body and in a laboratory.
Transvaginal oocyte retrieval IVF is the most commonly performed procedure of all the currently available ART options. Each year approximately 20,000 babies are born using IVF. Injectable gonadotropins are used by the female to induce development of multiple mature follicles, each with an oocyte. Ovarian follicular development is closely monitored by ultrasound and serial estradiol determinations.
When follicular maturity is achieved, all available oocytes are retrieved transvaginally in a simple procedure under intravenous sedation in an office setting.
In the embryology laboratory, mature oocytes are inseminated with variable numbers of motile sperm (usually 50,000 to 100,000 per oocyte) to effect fertilization.
Once fertilization has occurred, the early stages of embryonic development are allowed to proceed in the laboratory for three to five days after which the most advanced embryos are transferred back to the uterus. Supernumerary embryos may be cryopreserved for subsequent use in a frozen embryo transfer (FET) cycle.
Read more about IVF and Fertility C.A.R.E's IVF program.
The GIFT Procedure
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GIFT or gamete intra fallopian transfer represents one of the earliest and innovative modifications of the original IVF procedure and accounts for less than 3% of all ART performed annually.
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In GIFT, oocytes are retrieved by laparoscopy and inserted into the ampulla of each fallopian tube simultaneously with 50,000 to 100,000 spermatozoa. Fertilization and embryonic development occur in vivo and excess embryos are fertilized in vitro as in IVF for potential cryopreservation.
Normal fallopian tubes and adequate numbers of progressively motile sperm are absolute prerequisites for GIFT. The biggest drawback to GIFT is the need for general anesthesia and laparoscopic surgery. With recent advances in IVF media culture conditions success rates are equivalent with IVF and GIFT in appropriately selected patients.
The ZIFT Procedure
ZIFT or zygote intra fallopian transfer was an early attempt to capitalize on the strengths of IVF and GIFT. After oocyte retrieval, fertilization is effected as in IVF or ICSI. One or two selected two-cell embryos are then transferred to the ampulla of the fallopian tube by laparoscopy.
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ZIFT is also known as tubal embryo transfer (TET) and currently accounts for less than 1% of all ART procedures performed annually.
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Since the birth of Louise Brown 26 years ago, many remarkable strides have been made in the clinical application of ART. Although initially developed exclusively for the treatment of tubal factor infertility, current indications for IVF include unexplained infertility, endometriosis, ovulatory dysfunction, male factor, recurrent miscarriage and autoimmune reproductive failure.
While many horizons remain to be conquered, skillful application of these technologies have resulted in the birth of more than 200,000 babies since 1981 and will remain the most potent treatment in the care of fertility patients.
Read Part Two of this article to learn about the major advances of IVF today and future applications.
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