RESUMO
Several aspects of the program of in vitro fertilization (IVF), or, as it is called in Norfolk, the program for the Vital Initiation of Pregnancy (VIP), have been or are in the process of publication. However, because there has been no overall account, it seems appropriate to give a brief report of a general nature covering the period from the beginning of the effort in late February 1980 through December 31, 1981. Although minor changes were constantly made in the protocol, there were two major revisions. Therefore, a discussion of the program during three distinct periods, i.e., 1980, 1981-Phase I, and 1981-Phase II, is necessary. During 1980 and 1981 all patients had either no fallopian tubes or irreparable tubes.
PIP: The general procedures utilized in the 2 major phases of the Norfolk in vitro fertilization program in 1981 are described. When the program began, it was believed desirable to exploit the natural menstrual cycle instead of a stimulated controlled cycle, to aspirate the single dominant follicle at the last possible moment prior to expected ovulation, since it was believed impossible to further mature an oocyte in vitro; to utilize a reliable method to predict the hour of ovulation; to utilize a proven aspiration technique; to take extreme measures to maintain a special environment for the oocyte; and to provide means of inseminating the egg with the least possible delay. The results for 1980 were disappointing; from 41 laparoscopies only 19 fertilizable ova were obtained, and no pregnancies resulted from in vitro and in vivo attempts. For phase I beginning in 1981, a protocol was adopted calling for stimulated controlled ovulation using human menopausal gonadotropin (hMG). Exogenous human chorionic gonadotropin (hCG) was used to substitute for the midcycle luteinizing hormone (LH) surge. Laparoscopy for follicular aspiration was scheduled 36-38 hours after hCG administration. The use of a realtime sector ultrasonograph to monitor follicular growth became routine, quality control in the laboratory was tightened, and supplementary maturation in vitro of oocytes prior to insemination was initiated. In Phase I, 48 fertilizable eggs were obtained in 26 of 31 cycles; cleavage was obtained in eggs from 12 cycles, and 2 pregnancies occurred. In 1981-Phase II, several changes in procedures were made. Serum E2 values became available on a daily basis, so that hMG injections could be controlled. There were further improvements in laboratory quality control, such as measures to insure a toxin-free water supply. It became possible to incubate morphologically immature oocytes which subsequently accepted fertilization. In 1981 Phase II, fertilizable eggs were obtained in 22 of 24 laparoscopic cycles, eggs were fertilized from 21 of the 22 cycles, transfers were made in 19 cycles, and there were 5 pregnancies. The importance of transferring more than 1 conceptus became evident from the 31 cycles with transfers: the pregnancy rate was 13% with transfer of a single conceptus, 31% with 2, and 50% with 3.