In vitro fertilization covers the aided fertilization process, in contrast with in vivo fertilization which is the normal uterine occuring fertilization process.
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In vitro is from the Latin "in glass" meaning in essence a test tube as apposed to in vivo (in life or a living body). Note that even in vivo fertilization can also now be assisted through some fertility drug treatments. Both processes have the same biological outcome, fusion of male and female gametes to form a diploid zygote.
In all countries using Assisted Reproductive Technologies (ART), pregnancy rates vary for the different methods of treatment and also between individual IVF or GIFT units. In Australia best clinical pregnancy rate (per 100 oocyte retrieval cycles) by most successful 25% of all clinics increased from 24.9% (1998) to 34.4% (2001) (NPSU data - ART 2002 report) (More? ART - Australia and New Zealand).
These Australian results can be compared with the European Society of Human Reproduction and Embryology annual data ESHRE Data
Page Links: Introduction | Some Recent Findings | Reading | 18 Ways to Make a Baby | Embryo Culture Milestones | Human Embryo Blastocyst Formation | Success Rates | Success Rate Detection | Oldest IVF Mother | IVF Costs (USA) | ART - Australia and New Zealand | ART - USA | ART - European | ART - UK | ART - Sweden | WWW Links |
3rd IVI International Congress to be held in Madrid, May 14-16, 2009 addresses cutting edge topics of the continuously evolving field of human reproduction.
Hoozemans DA, Schats R, Lambalk NB, Homburg R, Hompes PG. Serial uterine artery Doppler velocity parameters and human uterine receptivity in IVF/ICSI cycles. Ultrasound Obstet Gynecol. 2008 Feb 4;
"In an unselected group of patients undergoing in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and embryo transfer, serial Doppler ultrasound examination of the uterine artery does not discriminate between cycles resulting in ongoing pregnany, miscarriage and no pregnancy."
Baby born from frozen embryo (ABC News 27 Feb 2007)
"In what's thought to be a world first, a baby has been born in Melbourne using a woman's frozen egg and a donor's frozen sperm which created an embryo that was also frozen, then thawed and implanted into the mother"
"JOHN MCBAIN: Oh egg freezing is very difficult. Embryo freezing itself is very well established. We would probably have about 55 per cent of all the babies born from our program, and that's about 1,400 a year, come from frozen embryos. So, that's very well established technology. But even with these embryos, only 70 per cent of the embryos survive the freezing and thawing. With eggs, it's closer to 40 to 50 per cent, and then you have to have the number which don't fertilise following that, and then you have to have those which end up being frozen, possibly not surviving the embryo freezing stage too, and that's a reason we don't promote it."
European Society for Human Reproduction and Embryology (ESHRE) 2001 data shows that more than 2% of babies born in some European countries are now the result of assisted reproductive technology (ART), though there is a wide range of country to country IVF success rates (0.2% in Latvia to 3.9% in Denmark). Nyboe Andersen A, Erb K. Register data on Assisted Reproductive Technology (ART) in Europe including a detailed description of ART in Denmark. Int J Androl. 2006 Feb;29(1):12-6. | BMJ Mar 18 Proportion after IVF varies 20-fold (More? ESHRE Reports)
Online Books
HSTAT In Vitro Fertilization As A Medical Treatment For Male or Female Infertility
The Cell Molecular Medicine: In Vitro Fertilization
Molecular Biology of the Cell Fertilization
Reviews
Van Voorhis BJ. Clinical practice. In vitro fertilization. N Engl J Med. 2007 Jan 25;356(4):379-86. "a case vignette highlighting a common clinical problem"
1. Natural sex
2. Artificial insemination -- of mother with father's sperm
3. Artificial insemination -- of mother with donor sperm
4. Artificial insemination -- with egg and sperm donors, using surrogate
mother
5. In vitro fertilization (IVF) -- using egg and sperm of parents
6. IVF -- with Intra-Cytoplasmic Sperm Injection (ICSI)
7. IVF -- with frozen embryos
8. IVF -- with Preimplantation Genetic Diagnosis (PGD)
9. IVF -- with egg donor
10. IVF -- with sperm donor
11. IVF -- with egg and sperm donor
12. IVF -- with surrogate using parents' egg and sperm
13. IVF -- with surrogate and egg donor
14. IVF -- with surrogate and sperm donor
15. IVF -- with surrogate using her egg, sperm from baby's father
16. IVF -- with surrogate using egg and sperm donors*
17. Cytoplasmic transfer**
18. Nuclear transfer and cloning
source: PBS Nova
1949 8 cell mouse embryo -> blastocyst (in saline and egg yolk)
1956 8 cell mouse embryo -> blastocyst (first embryo culture medium)
1957 2 cell mouse embryo -> blastocyst
1958 8 cell mouse embryo -> blastocyst, then transferred to pregnant recipient
1960's development of culture requirements for mouse mebryos
1965 2 cell mouse embryo -> blastocyst, then transferred into pseudopregnant recipient
1968 zygotes from mouse -> blastocysts
1968,70 2 & 4 cell rabbit embryos -> blastocyst in serum supplemented medium
1970,71 1 & 2 cell rabbit embryos -> blastocyst in defined medium
1970,81 Culture of in vitro fertilized human embryo -> 16 cells -> blastula
1998 Cloning of adult sheep "dolly"
2004 Cloning of human blastocysts
Modified from Bavister, B.D., Human Reproduction Update, 1:91-148 (1995)
The table below shows changes in vitro blastocyst development in week 1.
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Day 2 |
Day 3 |
Day 4 |
Day 5- Cavitated embryos |
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In-vitro system |
2-4 cells |
6-10 cells |
Compacting |
Early cavitating |
Late cavitating |
Early blastocyst |
Expanding blastocyst |
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Modified from Fong and Bongso, Human Reproduction 1999
In the early days (1980's) of IVF (or ART, which includes other techniques) success rates were very low, and drugs and tests carried out prior to IVF cycles were grueling. This is a good example where basic research has been informative to clinical practice.
(NPSU data) (More? ESHRE Reports)
There are a number of studies currently looking into new methods for detecting the success of assisted reproductive technology techniques. There are several studies showing teh lack of association of specific analytical techniques with final IVF outcome.
Links: Interleukin-10 and Interferon-gamma | Ultrasound of Uterine Artery | Progesterone
Interleukin-10 and Interferon-gamma Cerkiene Z, Eidukaite A, Usoniene A. Follicular Fluid Levels of Interleukin-10 and Interferon-gamma do not Predict Outcome of Assisted Reproductive Technologies. Am J Reprod Immunol. 2008 Feb;59(2):118-26.
"Conclusion Our study showed that IFN-gamma and IL-10 are not suitable markers in predicting outcome of assisted reproductive technologies."
Serial Doppler ultrasound of Uterine Artery Hoozemans DA, Schats R, Lambalk NB, Homburg R, Hompes PG. Serial uterine artery Doppler velocity parameters and human uterine receptivity in IVF/ICSI cycles. Ultrasound Obstet Gynecol. 2008 Feb 4;
"In an unselected group of patients undergoing in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and embryo transfer, serial Doppler ultrasound examination of the uterine artery does not discriminate between cycles resulting in ongoing pregnany, miscarriage and no pregnancy."
Progesterone Elevation on day of hCG Administration
Serial Doppler ultrasound of Uterine Artery Venetis CA, Kolibianakis EM, Papanikolaou E, Bontis J, Devroey P, Tarlatzis BC. Is progesterone elevation on the day of human chorionic gonadotrophin administration associated with the probability of pregnancy in in vitro fertilization? A systematic review and meta-analysis. Hum Reprod Update. 2007 Jul-Aug;13(4):343-55. Epub 2007 Apr 3. Review.
"...the best available evidence does not support an association between progesterone elevation on the day of hCG administration and the probability of clinical pregnancy in women undergoing ovarian stimulation with GnRH analogues and gonadotrophins for IVF.
There is still risk, ethical and genetic debate about very old women becoming pregnant by IVF.
India 2003 - A 65-year old Indian woman was the oldest in the world to give birth by IVF. (More? ABC News)
United Kingdom 2006 - A 62-year old woman has become the UK's oldest woman to give birth to a child. (More? IVF Net)
Australia 2008 - A 54-year old woman has become Australia's oldest woman pregnant by IVF (most Australian IVF clinics do not treat women over 50)
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2005 - 51,017 treatment cycles reported to ANZARD in Australia and New Zealand in 2005. Of these cycles, 91.1% were from Australian fertility centres and 8.9% from New Zealand’s centres. There is an increase of 13.7% of ART treatment cycles from 2004. (AIHW National Perinatal Statistics Unit Assisted Reproduction Technology in Australia and New Zealand 2005) |
Average age of women was 35.5 years (35.2 years in 2002). Women aged older than 40 years has increased from 14.3% in 2002 to 15.3% in 2005.
Since ANZARD was established in 2002 there has been a significant increase in the number of embryos transfer cycles where women received single-embryo transfers (SET). SET cycles accounted for 48.3% of embryos transfer cycles in 2005, compared to 28.4% in 2002. The increase of SET cycles resulted more singleton deliveries. The proportion of singleton deliveries was 85.9% in 2005, the highest proportion ever reported.
Babies born to women who had a single-embryo transfer had better outcomes compared to babies born to women who had a double-embryo transfer (DET). In 2005, there were 3,681 SET babies and 5,589 DET babies. In SET babies, 96.1% were singletons, compared to 61.6% singletons in DET babies. SET babies had a lower proportion of preterm babies (11.7%), compared to 30.6% in DET babies. Similarly, 8.0% of SET liveborn babies were low birthweight, compared to 25.0% in DET liveborn babies.
Perinatal mortality rate is a measure of perinatal outcomes. In 2005, for all babies born following ART treatment, the perinatal mortality rate was 14.7 deaths per 1,000 births, a 23.8% decrease from 19.3 deaths per 1,000 births in 2004. The perinatal mortality rate was the lowest among singletons born following SET (7.3 deaths per 1,000 births) in 2005.
(AIHW National Perinatal Statistics Unit Assisted Reproduction Technology in Australia and New Zealand 2005)
2004 - 41,904 IVF treatment cycles were started in Australia 92.6% (38,823) and New Zealand 7.4% (3,081). (More? NPSU Assisted Reproduction Technology Reports)
In Vitro Fertilization - ABC News Baby born from frozen embryo
"In what's thought to be a world first, a baby has been born in Melbourne using a woman's frozen egg and a donor's frozen sperm which created an embryo that was also frozen, then thawed and implanted into the mother"
"JOHN MCBAIN: Oh egg freezing is very difficult. Embryo freezing itself is very well established. We would probably have about 55 per cent of all the babies born from our program, and that's about 1,400 a year, come from frozen embryos. So, that's very well established technology. But even with these embryos, only 70 per cent of the embryos survive the freezing and thawing. With eggs, it's closer to 40 to 50 per cent, and then you have to have the number which don't fertilise following that, and then you have to have those which end up being frozen, possibly not surviving the embryo freezing stage too, and that's a reason we don't promote it."
Reports annually (in the journal Human Reproduction) on the European results of assisted reproductive techniques. Listed below are some statistical information gathered from reporting clinics for the current 2001 report. ESHRE Report 2001
The UK Human Fertilisation and Embryology Authority (HFEA) was established in August 1991 following the passing of the Human Fertilisation and Embryology Act 1990 (HFE Act).
The HFEA's principal tasks are to:
HFEA also provide a downloadable patient booklet: Your Guide to Infertility and website information on Patients' Guide to Donor Insemination (DI)
Sweden had its first child born after in vitro fertilisation 20 years ago. A recent paper in BMJ looks at the change in multiple birthrates since a change in the early 1990s, to reduce the number of embryos transferred in the clinic from three to two.
"The rate of multiple births after in vitro fertilisation increased to a maximum of 29% in 1991 but fell to 18.5% by 2001, resulting in a 70% reduction of preterm births"
Temporal trends in multiple births after in vitro fertilisation in Sweden, 1982-2001: a register study Bengt Kallen, Orvar Finnstrom, Karl Gosta Nygren, Petra Otterblad Olausson
Note that the dynamic nature of the internet may mean that some of the above links may no longer function. If the link no longer works search the web with the above link name.
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From the first successful IVF carried out in the UK in 1978 by Steptoe PC, et al. this technique continues to grow worldwide with new medical technologies.
In Australia during 2005 1596 IVF babies were born. In the same year in Australia and New Zealand 51,017 treatment cycles were reported, an increase of 13.7% of ART treatment cycles from 2004. (More? ART - Australia and New Zealand)
(AIHW NPSU ART in Australia and New Zealand 2005)
Please email Dr Mark Hill if you wish to make a comment about this current project.
