History of in vitro fertilisation

There was a transient biochemical pregnancy reported by Australian Foxton School researchers in 1953. John Rock was the first to extract an intact fertilized egg.[1] In 1959, Min Chueh Chang at the Worcester Foundation, proved fertilisation in vitro was capable of proceeding to a birth of a live rabbit. Chang's discovery was seminal, as it clearly demonstrated that oocytes fertilised in vitro were capable of developing, if transferred into the uterus and thereby produce live young.[2]

The first pregnancy achieved through in vitro human fertilisation of a human oocyte was reported in The Lancet from the Monash University team of Carl Wood, John Leeton and Alan Trounson[3] in 1973, although it lasted only a few days and would today be called a biochemical pregnancy. Landrum Shettles attempted to perform an IVF in 1973, but his departmental chairman interdicted the procedure at the last moment.[4][5] There was also an ectopic pregnancy reported by Patrick Steptoe and Robert Edwards in 1976.

In 1977, Steptoe and Edwards successfully carried out a pioneering conception which resulted in the birth of the world's first baby to be conceived by IVF, Louise Brown on 25 July 1978, in Oldham General Hospital, Greater Manchester, UK.[6][7][8]

In October 1978, it was reported that Subash Mukhopadyay, a physician from Kolkata, India was performing experiments on his own with primitive instruments and a household refrigerator and this resulted in a test tube baby, later named as "Durga" (alias Kanupriya Agarwal) who was born on 3 October 1978.[9] However, state authorities prevented him from presenting his work at scientific conferences[10] and, in the absence of scientific evidence, his work is not recognised by the international scientific community. These days, however, Mukhopadhyay's contribution is acknowledged in works dealing with the subject.[11]

Steptoe and Edwards were responsible for the world's first confirmed boy conceived by IVF, Alastair Montgomery, born on 14 January 1979 in Glasgow. [12] A team led by Ian Johnston and Alex Lopata were responsible for Australia's first baby conceived by IVF, Candice Reed, born on 23 June 1980 in Melbourne.[13] It was the subsequent use of stimulated cycles with clomiphene citrate and the use of human chorionic gonadotrophin (hCG) to control and time oocyte maturation, thus controlling the time of collection, that converted IVF from a research tool to a clinical treatment.

This was followed by a total of 14 pregnancies resulting in nine births in 1981 with the Monash University team. Howard W. Jones and Georgeanna Seegar Jones[14] at the Eastern Virginia Medical School in Norfolk, Virginia, further improved stimulated cycles by incorporating the use of a follicle-stimulating hormone (uHMG). This then became known as controlled ovarian hyperstimulation (COH). Another step forward was the use of gonadotrophin-releasing hormone agonists (GnRHA), thus decreasing the need for monitoring by preventing premature ovulation, and more recently gonadotrophin-releasing hormone antagonists (GnRH Ant), which have a similar function. The additional use of the oral contraceptive pill has allowed the scheduling of IVF cycles, which has made the treatment far more convenient for both staff and patients.

The ability to freeze and subsequently thaw and transfer embryos has significantly improved the feasibility of IVF use.[15] The other very significant milestone in IVF was the development of the intracytoplasmic sperm injection (ICSI) of single sperms by Gianpiero D. Palermo et al.in Brussels (UZ Brussel), 1992.[16] This has enabled men with minimal sperm production to achieve pregnancies. ICSI is sometimes used in conjunction with sperm recovery, using a testicular fine needle or open testicular biopsy. Using this method, some men with Klinefelter's syndrome, and so would be otherwise infertile, have occasionally been able to achieve pregnancy.[15][17] Thus, IVF has become the final solution for most fertility problems, moving from tubal disease to male factor, idiopathic subfertility, endometriosis, advanced maternal age, and anovulation not responding to ovulation induction.

Robert Edwards was awarded the 2010 Nobel Prize in Physiology or Medicine "for the development of in vitro fertilization".[18] Steptoe and Jean Purdy were not eligible for consideration as the Nobel Prize is not awarded posthumously.[19] Carl Wood was dubbed "the father of IVF (in vitro fertilisation)" for having pioneered the use of frozen embryos.[20]

In the US, ART cycles started in 2006 resulted in 41,343 births (54,656 infants), which is slightly more than 1% of total US births.[21] In 2012 it was estimated that five million children had been born worldwide using IVF and other assisted reproduction techniques.[22]