In vitro fertilisation, or IVF, has helped millions of women all over the world enjoy the experience of pregnancy despite health conditions making it impossible for them to conceive. Despite its somewhat low success rate and very high expense, for many couples, IVF is no less than a miracle. Surprisingly, the history of IVF began more than a century before it was successfully achieved in a human.
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According to Dr. Barry Bavister, a large number of experiments involving in vitro fertilisation started in 1878. Walter Heape successfully transferred embryos between rabbits in the 1890s, long before the applications to human fertility were even suggested. Bavister writes that the 1951 discovery of sperm capacitation, or the final step in sperm's maturation, was central to the development of IVF. In 1959, researchers showed that rabbit eggs fertilised in vitro, or outside the human body, could develop into normal rabbit babies. Similar studies in 1963 and 1964 proved the same for hamster gametes.
Edwards and Steptoe
According to the Wisconsin Fertility Institute, Robert Edwards, a physiologist, and Patrick Steptoe, a gynecologist, pioneered IVF in humans in Britain in the 1970s. Throughout the 1960s, Edwards had experimented with bits of human ovaries removed in surgery and had achieved the first fertilisation of a human egg outside the body in 1967. At the same time, Steptoe was working to develop the new surgical technique of laparoscopy, surgery involving a small incision and a camera to see inside the body. The two men began to collaborate in 1971.
The First Successful IVF Treatment
In early attempts, Edwards and Steptoe retrieved eggs from the ovaries of volunteers by laparoscopy and focused on improving the timing of egg retrieval and in vitro culture conditions, according to WFI. In 1976, they achieved pregnancy in a patient, but, unfortunately, it was an ectopic pregnancy (it developed in the Fallopian tube) and had to be terminated. Then, in 1977, Edwards and Steptoe successfully implanted a fertilised egg in Lesley Brown, and the world's first "test tube baby," Louise Brown, was born on July 25, 1978.
WFI reports that, initially, Edwards and Steptoe used a method known as "natural IVF," meaning that the patients were not given any fertility medication. Instead, mothers were monitored closely to predict ovulation, and a laparoscopy was done whenever ovulation seemed imminent. As ovulation is an imprecise phenomenon, prediction was difficult, and they often failed to obtain a mature egg. In 1980, Australian doctors tried stimulating their patients' ovaries with medication to produce more than one egg, and they enjoyed a higher success rate using this method, known as "stimulated IVF." Eventually, Edwards and Steptoe adopted this approach, and most modern doctors also use it.
Improvements in the 1980s
In the 1980s, researchers made improvements to IVF treatment, including better embryology culturing techniques, refinements in fertility drug protocols and the ability to retrieve eggs with a vaginal ultrasound probe instead of laparoscopy. Because of these improvements, IVF success rates increased, reaching 20 to 25 per cent per attempt for women under 40 by 1990, according to WFI.
WFI describes additional improvements to IVF in the 1990s, including better treatment protocols for women over 40 and the development of intracytoplasmic sperm injection, a treatment that allows a single sperm to be injected into an egg and achieve fertilisation. For women over 34, a technique called assisted hatching and the ability to grow embryos longer in the lab, for up to five days before they are transplanted into the uterus, have helped improve the odds of successful pregnancy. Also, the development of IVF using donated eggs has helped even women with ovulation problems achieve pregnancy.
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