Assisted reproductive technology (ART)
- Definition. Direct handling and manipulation of oocytes and sperm to facilitate optimal fertilization and maximize the probability of achieving pregnancy. However, IVF is usually performed in Petri dishes.
- Classification. IVF is the paradigm of ART procedures. Other examples include gamete or zygote intrafallopian transfer, but these techniques are rarely used.
- Frequency. The first baby conceived by IVF was delivered in 1978. Since that historic birth, ART has undergone rapid growth. There are >125,000 IVF cycle initiated in the USA annually.
- Goal. To maximize the chance of a successful pregnancy while minimizing the risk of multiple gestations.
In vitro fertilization
Patient selection
- IVF was originally developed for tubal factor infertility. It is now widely utilized for several infertility conditions that have not been successfully treated with other modalities.
- Female age is usually most predictive of IVF success. Most IVF programs limit IVF treatment to women aged up to 43.9 years. Although the menopause has set a natural barrier to further conception, IVF has allowed women to be pregnant in their 50s and 60s using donor egg IVF.
- A serum follicle-stimulating hormone (FSH) level >10 mIU/mL and/or estradiol >80 pg/mL on day 3 of the menstrual cycle is usually indicative of diminished ovarian reserve and suboptimal responsiveness to ovarian stimulation.
- IVF with donor oocytes may be recommended for women with significantly diminished ovarian reserve regardless of age, and for those who have premature ovarian insufficiency or been traditionally considered sterile (eg, Turner syndrome, ovarian dysgenesis).
