30 Years of IVF: What Does the Future Hold?

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The publication of the first successful human birth after IVF-embryo transfer (IVF-ET) in 1978 revolutionized the infertility industry [1]. The original technique involved oocyte retrieval in a natural ovulatory cycle. The tools for retrieval and the culture medium for embryos were rather primitive compared with those used today, hence, initial pregnancy rates were low. In addition, despite careful monitoring, there were often times when the one egg could be released without being ‘caught’. This combination of factors resulted in low pregnancy rates [2,3]. The pervading thoughts at this time were that in a given cohort of antral follicles, some of the oocytes would be genetically normal whilst some would have meiosis errors, and it would be merely fortuitous if the follicle containing a genetically normal egg became dominant. Thus, stimulating multiple follicles with clomiphene citrate alone or with clomiphene and human menopausal gonadotropin, became the usual method for preparing oocyte retrieval [4]. An even greater recruitment of follicles could be achieved by the use of gonadotropin stimulation instead of clomiphene. This would not only allow more fresh embryos to be transfered, but also produce extra embryos that could be cryopreserved for future use [5]. Thus, one could try to maximize the success from one expensive oocyte harvest (cost of medications, monitoring, oocyte retrieval and anesthesia) by performing a much less expensive frozen-embryo transfer in case of failure to achieve a pregnancy with the fresh-embryo transfer [6]. Unfortunately, in approximately 20% of the cycles, the high serum estradiol levels generated by the expensive gonadotropins caused premature luteinization and, thus, cancellation of