Patrick Steptoe, a practicing gynaecologist at Oldam General Hospital who pioneered the use of laparoscopy in gynecology, partnered with Edwards, professor of human reproduction at the University of Cambridge, to make her human pregnancy a success with IVF. Their collaboration began in 1968 when Edwards attended a conference on laparoscopy at the Royal Society of Medicine in London. They first successfully fertilized and cell divided the oocytes in vitro (in a petri dish) with freshly extracted sperm, but were only able to successfully implant the fertilized egg into the female uterus in 1978. They manipulated hormone levels in the female until the eggs were fully mature, then laparoscopically extracted several eggs from the ovaries, an invasive technique that requires entry through the navel. Doctors fertilized the eggs in vitro and waited for the fertilized eggs to divide into eight cells before implanting them in the female uterus (until the mid-1970s, they had waited until the fertilized egg to divide into 100 cells before implantation). Improvements in embryo culture over the years have allowed us to extend in vitro culture of embryos to the blastocyst stage, allowing detailed morphological evaluation of embryos and better selection of embryos to be transferred. This was key to our ability to maximize IVF pregnancy rates while minimizing the number of embryos transferred, thereby minimizing the risk of multiple pregnancies. The expanded culture also allowed us to perform preimplantation genetic testing on embryos, a process best applied when the embryos in culture are sufficiently developed to maintain the elimination of multiple cells for genetic testing. In their early stages, embryos are made up of stem cells that can develop into any type of tissue in the body. Later generations of cells specialize: heart cells, muscles, neurons, etc.

Because of their versatility, CSES can be used to grow tissue for regenerative medicine. Efforts to treat diseases such as heart disease or Parkinson`s disease by injecting stem cells into the respective tissues are currently in human clinical trials. In the United States, these stem cell therapies were replaced by the decision of the George W. Bush administration in 2001 that prevented the fact that research with new HESC lines from IVF embryos could not be funded by the federal government. Such uses of embryos have been deemed unethical by Bush`s conservative Bioethics Advisory Board. In fact, more detailed genetic analyses of cells taken from embryos to look for genes associated with the disease have already been reported. This method, called preimplantation genetic diagnosis (PGD), is now authorized by the HFEA to look for about 400 serious diseases associated with individual genes (such as cystic fibrosis) so that embryos with genetic variants relevant to the disease are not implanted – the risk of passing the disease on to couples who know they carry the gene. But genetic testing technology is also fueling fears of designer babies chosen not to avoid disease, but because they have genes thought to be linked to desirable traits such as intelligence and athleticism. This practice is illegal in the UK, but there is no binding international legislation.

Two problems arose as a result of the injection of supraphysiological doses of gonadotropins. First, to improve a woman`s chances of getting pregnant with a fetus that would survive to the end, doctors began fertilizing several eggs and implanting several embryos. This practice sometimes results in women carrying twins and even higher multiples of fetuses, putting fetuses at risk of low birth weight and premature birth. Second, the most common and severe iatrogenic complication of ovarian stimulation is ovarian hyperstimulation syndrome (OHSS). SHO occurs when the ovaries are overstimulated and then triggered either with hCG injected to stimulate ovulation or by the endogenous increase in hCG that occurs when a woman becomes pregnant. OHSS is characterized by hemoconcentration of leaking vessels and third fluid spacing, resulting in ascites and electrolyte abnormalities. Symptoms range from mild abdominal stretching to renal failure and death as a result of thromboembolic phenomena or damage to the terminal organs. Despite extensive research, the exact pathogenesis of this syndrome remains uncertain, but it is noted that there is an increasing incidence with an increasing number of developing follicles and increased levels of estradiol formed by ovarian follicles. To address this problem, doctors began monitoring SOC in 1979 by mass-measuring serum estradiol levels and evaluating ovarian follicles transvaginally to better monitor risk factors.

Identifying patients at risk has allowed physicians to take preventative measures, such as appropriate medication adjustment and more frequent monitoring of symptoms.8–10 The United States has played and continues to play a distinctive and important role in the history of IVF and assisted reproductive technology around the world. American IVF emerged in the scientific context of contraception and fertility research, in the social context of a prosperous nation without universal health care, and in the political context of the abortion debate and its implications for federal and state funding and regulation. IVF had its first clinical success in the United States in 1981. Since then, IVF has been known in the United States for its procedures involving third, fourth and fifth gamete donors and surrogate mothers. The United States has also been one of the pioneers of the national and transnational use of IVF for lesbian, gay, bisexual, transgender (LGBT) parenting and a pioneer in the social revolution of egg freezing. American IVF is characterized by advocating for professionals and patients for things like honest reporting on success rates, recognizing the risks of delayed birth, and the need for insurance coverage. Some historical conflicts over the custody of IVF embryos and offspring, as well as media attention over access and pricing of gender-based, racialized and class-based assisted reproduction, have also spurred the development of IVF in the United States. The irony is that even though biology is linked to moral arguments, it shows our evolution as a series of random steps, none of which are obviously more “fundamental” than the others. Thus, the moral status of the embryo remains controversial.

The other very important step in IVF was the development of intracytoplasmic sperm injection (ICSI) from single sperm by Gianpiero D. Palermo and al.in Brussels (Brussels IP), 1992. [22] This allowed men with minimal sperm production to achieve pregnancies. ICSI is sometimes used in conjunction with sperm collection using a testicular fine needle or open testicular biopsy. Using this method, some men with Klinefelter syndrome who would otherwise be infertile were able to occasionally achieve pregnancy. [18] [23] Therefore, IVF has become the definitive solution to most fertility problems that develop from fallopian tube disease to male factor, idiopathic subfertility, endometriosis, advanced maternal age, and anovulation that does not respond to ovulation induction.