In Vitro Fertilization was developed in the United Kingdom by Doctors Patrick Steptoe and Robert Edwards. The first so-called "test-tube baby", Louise Brown, was born as a result of IVF on July 25, 1978.

The first successful In Vitro Fertilization treatment in the United Staes (producing Elizabeth Jordan Carr) occurred three years later,
in 1981. Since then, IVF has become a successful treatment for infertility, with more than 1% of all births now being conceived as a result of IVF.

Indications

Initially In Vitro Fertilization was developed to overcome infertility due to problems of the fallopian tube (such as blockages or scar tissue), but it has evolved into a successful treatment for almost all causes of infertility. With the introduction of intracytoplasmic sperm injection or ICSI (injecting a single sperm into the egg), virtually all causes of male infertility
can be overcome. IVF can be successful as long as healthy eggs and sperm can be obtained from couples.

Oocyte (egg) retrieval
When egg maturation is judged to be adequate by ultrasound and blood work, human chorionic gonadotropin (hCG) is
adminsitered by injection. hCG matures the eggs prior to removing them from the ovaries; thus, without this last
injection, all eggs retrieved would be immature and incapable of being fertilized. The eggs are retrieved from the patient
transvaginally. In this way, using ultrasound guidance, a needle is carefully introduced through the vaginal wall and into
the ovaries. Gentle suction is applied, and the fluid from each ovarian follicle is removed as is the egg as well.

This fluid (with the eggs) is transferred to the embryologist in the IVF CT laboratory, who then identifies theeggs and transfers them to incubators. The egg retrieval procedure takes about 15-20 minutes and is performed under local anesthesia and light sedation.

The In Vitro Fertilization CT, laboratory
In the IVF laboratory, the eggs are stripped of surrounding cells (which initially are there to support the growth of the egg) and prepared for fertilization. In the meantime, semen provided by the male partner is prepared for fertilization by removing inactive cells and seminal fluid, thus isolating healthy, motile (moving) sperm. The sperm and the egg are then incubated together (about 75,000 – 100,000 sperm are incubated with each egg) in the culture media (a very neutral solution similar to that found in thev fallopian tube) for approxiamtely 18 hours. Fertilization can then be ascertained by that time. In situations where the sperm count is too low to place thousands of sperm with the egg, a single sperm is injected directly into the egg by a technique called Intracytoplasmic Sperm Injection (ICSI). ICSI CT.

With ICSI, if there are ten eggs, then only a total of ten healthy sperm are needed to achieve fertilization.

Fertilized eggs are now termed embryos.

Oocyte is injected during ICSI		8-cell embryo for transfer
Blastocyst for transfer

Typically, embryos are transferred three days after retrieval (at the 6-8 cells stage). In some situations, embryos
are further incubated for two more days, resulting in embryos called blastocysts, containing over 200 cells. In cetain
instances, patients may benefit from transferring back blastocysts rather than embryos containing fewer cells.

Embryo transfer
The highest quality embryos are then transferred to the patient's uterus using a thin, soft catheter which is passed
through the cervix and into the uterus. This is performed by speculum exam. No anesthesia is needed at the time of
embryo transfer. Usually, two embryos are recommended for transfer, which maximizes the patient’s chances of conceiving without placing them at risk for higher order multiple pregnancy. In some instances (based on a patient’s
age and history), more than two embryos may be recommended for transfer. Immediately after the embryo transfer,
the patient will lie down for approximately 20 minutes before being discharged home.

Post-transfer
A pregnancy test is checked 14 day after the egg retrieval (14 days from when fertilization occurred, which corresponds
to 9-11 days after the embryo transfer). During this time period, patients take progesterone—a hormone that maintains
the uterine lining and helps to make it suitable for implantation – either by injection or by vaginal suppository. If a patient becomes pregnant, she continues progesterone supplementation through 8-10 weeks of pregnancy. Women undergoing In Vitro Fertilization CT must take some form of progesterone supplementation since both the medications during stimulation
and the egg retrieval procedure itself prevent her body from making adequate amounts of progesterone.
Pregnancy Pregnancy rates from IVF vary – they are dependent upon the patient’s age, reproducitve history, and diagnosis.

In general, younger patients have a higer rate of success from In Vitro Fertilization compared to older patients. Rates of success are
also determined by the quality of the eggs and sperm and resultant embryo quality observed. Once pregnancy is achieved, the chances of having a live birth is the same as that compared to a pregancy achieved in a spontaneous pregnancy.

Pregancies achieved from In Vitro Fertilization are not considered to be high-risk. Miscarriage rates are similar to that observed among patients who conceived without undergoing In Vitro Fertilization CT.