The Evolution of in Vitro Fertilization: Integration of Pharmacology, Technology, and Clinical Care

Abstract

For the couple having trouble achieving pregnancy, the options and opportunities for assistance have never been brighter. Options such as controlled ovarian hyperstimulation, in vitro fertilization, and intracytoplasmic sperm injection have been developed over the past five decades and provide hope for couples that previously would have been considered infertile. In vitro fertilization and intracytoplasmic sperm injection represent a coalescence of advances in physiology, endocrinology, pharmacology, technology, and clinical care. In vitro fertilization has assisted well over one million couples in their efforts to start or build a family, and the demand for such services continues to increase. The purpose of this manuscript is to review the pharmacological advances that made controlled ovarian hyperstimulation, and therefore in vitro fertilization and intracytoplasmic sperm injection, possible. We will discuss the early stages of gonadotropin use to stimulate ovarian production of multiple mature eggs, the advances in recombinant technology that allowed purified hormone for therapy, and the use of other hormones to regulate the menstrual cycle such that the likelihood of successful oocyte retrieval and embryo implantation is optimized. Finally, we will review current areas that require particular attention if we are to provide more opportunity for infertile couples.Controlled ovarian hyperstimulation (COH), in vitro fertilization (IVF), and intracytoplasmic sperm injection have become the standard of care for many couples with infertility. The combination of pharmacologic and surgical manipulation of the menstrual cycle is the key to improving pregnancy rates. The history and evolution of COH, IVF, and intracytoplasmic sperm injection has been rapidly developing and continues to change at an ever increasing pace (Fig. 1). As we learn more about the molecular basis of cellular communication and signaling, pharmacologic treatments with greater efficacy can be developed. Improvements in embryo culture techniques and embryo cryopreservation will similarly enhance outcomes. The purpose of this review is to summarize the history and development of the pharmacology that has made COH and IVF successful.In a typical menstrual cycle, there is the formation of a single dominant follicle, from which ovulation of a single oocyte occurs each month. For the fertile couple, this menstrual cycle has a 20% chance of resulting in a pregnancy; however, for infertile couples, the chance of pregnancy with one oocyte can be well under 5% per cycle. Over the past 50 years, pharmacologic agents have been developed to increase the likelihood of pregnancy by increasing the number of eggs released and available for fertilization.To clarify the obstacles to fertility that have been overcome as well as the challenges that remain, we will review the physiology of the menstrual cycle, major historical developments, and the therapeutic evolution and current use of medications used during controlled ovarian hyperstimulation and in vitro...

Cultural competence in fertility care for lesbian, gay, bisexual, transgender, and queer people: a systematic review of patient and provider perspectives

“…F ertility care has rapidly evolved over the past decade, now offering assisted reproductive technology (ART) for millions of patients worldwide who have difficulties in conceiving or accessing pregnancy (1,2). In particular, medical advances have improved accessibility for same-sex couples and gendernonconforming patients.…”

Subfertility overview

“…Doctor John Hunter performed artificial insemination in a couple where the husband had hypospadias. 91,92 Between 1878 and 1953, many attempts were made to fertilize mammalian eggs in vitro. IUI is still widely used today.…”

In Vitro Fertilization

“…Knowledgeable manipulation of menstrual cycle through injectable drugs have made it possible to increase the number of mature oocytes and thus enhance the chances of becoming pregnant through IVF. 2 Number of oocytes capable of fertilization leading to a successful and healthy pregnancy determines the capacity of the ovaries which is named as the ovarian reserve. It is a natural gift and is influenced by the age of the female.…”