An appreciation of modern ART.

ABSTRACT

As we have entered into the new millennium, it is difficult not to recognize ART as one of the most dynamic and rapidly emerging fields in all of medicine. What began as an experimental procedure in animals has developed into a multidisciplinary technology. A great debt is owed to the field of animal husbandry. In humans, implantation is inefficient and has been recognized as the rate-limiting step in reproduction. In vitro fertilization has allowed the observation of human gamete interaction in the laboratory. A milestone was reached when ART allowed couples with infertility to have success rates that exceeded those associated with normal human fecundity. Continued innovations are improving the rate of embryonic implantation. Blastocyst transfer will have a major role in the future of ART. It is common for the couple with infertility to battle their problem by increasing the frequency of intercourse because it is the only weapon at their disposal. So, too, did clinicians increase the number of embryos transferred to the uterus. New developments promise to challenge the long-held contention that successful IVF/embryo transfer is positively correlated with the number of oocytes retrieved or the number of embryos transferred. More accurate reporting will enable us to measure the impact of technologic improvements that improve implantation rates and decrease multiple gestations. The future holds the promise of some tangible goals. The development of in vitro maturation of immature oocytes could lead to an era in which oocytes are harvested without the need for controlled ovarian hyperstimulation. This would provide for the possibility of the banking of gametes. Women could preserve or store their fertility at a young age in a manner similar to that which has been possible for men for decades. They could avoid the increased risk for aneuploidy seen with the age of 35, and theoretically, they should have a lower risk for miscarriage. The future is near. One day, ART will be perfected so that a single embryo transfer will be the standard of care. Soon it will be possible to know all about the genetic makeup of that embryo and it will be routinely selected from its cohort by virtue of those genetic traits.