Title: In vitro fertilization's future looks bright.

POPLINE Document Number: 018151

Author(s):

Marrs R

Source citation:

Contemporary Ob/Gyn, 1982 Sep;20(3):135-41.

Abstract:

The 1st birth of a human "in vitro baby," in England in 1978 was followed by successful pregnancies in Australia, England, and the US. At this time, more than 100 women are pregnant after in vitro fertilization procedures, and there have been about 40 live births. Conventional methods to predict ovulation--basal body temperature graphs, cervical mucus changes, vaginal cytology, and serum hormone parameters--can predict only approximate time, and more precise methods of timing are essential to success. To ensure the recovery of mature oocytes, ovulatory function is monitored with real time ultrasound and rapid estrogen determinations. Real time is good for watching follicular changes on a daily basis. The 1st scan is performed with a real time sector scanner 1 day after the last clomiphene dose. At that time, the dominant follicle or follicles visualized should be at least 14 mm in diameter. If no follicle is adequately developed, therapy is extended 1-3 days, with the addition of hMG. Daily monitoring is continued until the follicle reaches 18 to 20 mm in diameter. At this point, blood samples are obtained twice daily and estradiol is measured by rapid radioimmunoassay. Once the preovulatory surge of estradiol appears 4000 IU of human chorionic gonadotropins (hCG) is given, and laparoscopy is performed precisely 36 hours later. This timing is essential because the eggs will be released spontaneously 38-40 hours after the hCG injection. Mature oocytes were obtained in 23 of 23 treatment cycles. This method, which combines ultrasound monitoring of the follicles' growth with the production of estradiol, ensures that the aspirated oocytes are mature and capable of fertilization. As long as luteinizing hormone (LH) levels are basal, the laparoscopy is performed. The male partner supplies a semen sample by masturbation approximately 5-7 hours after successful oocyte recovery. The sperm count and motility are estimated, and if these parameters are adequate, a 0.5 mL aliquot of the semen is washed in Ham's F-10 solution by a 2 wash technique. After removing the seminal plasma, the spermatozoa are incubated for an additional 40 minutes. Then 500,000 motile spermatozoa are added to each oocyte culture tube and incubated for 18 hours. The embryos are deposited by injecting 0.05 mL of Hepes buffer solution through a catheter. After 10 hours in Trendelenburg position, the patient leaves the hospital to remain at bedrest for the next 36 hours. Before 1981, overall pregnancy success ranged from 1% to 8% worldwide. Today the worldwide pregnancy statistics are between 17-20%. Before the rate of successful pregnancies can be increased further, several factors need to be improved.

Keywords:

Fertilization
Reproduction
Ovulation
Research and Development
Laparoscopy
Pregnancy
Laboratory Procedures
In Vitro
Technology
Economic Factors
Endoscopy
Physical Examinations and Diagnoses
Examinations and Diagnoses
Laboratory Examinations and Diagnoses
Clinical Research
Research Methodology