The Joint Annual Scientific Meetings of the Endocrine Society of Australia and the Society for Reproductive Biology 2018

Significant Advances in ART – under the “The clinical picture" (#16)

Rob Norman 1
  1. School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, SA, Australia

IVF is part of the reproductive revolution that became visible in the 1960’s with the introduction of the oral contraceptive pill. This was followed by legalised termination of pregnancy, the use of donor sperm and attempts to facilitate improved fertility for couples where tubal blockage had prevented them from having children. The first clinical pregnancy was reported in Melbourne in 1973 but was an ectopic pregnancy. A second failed pregnancy was reported in the United Kingdom several years later, but with the birth of Louise Brown in 1978, the processes for IVF in humans became researched much more. Initially, natural cycles were used but subsequently the introduction of Clomiphene Citrate and Gonadotropins made a major impact on the efficiency of the process by enabling embryologists to obtain more eggs. Multiple pregnancies were common and unpredictable but were a side effect of the need to put back several embryos to obtain good quality pregnancy rates. In time, single embryo transfer became the norm in Australia, ICSI was incorporated for poor quality or absent sperm and genetic testing of embryos for chromosomal abnormalities became wide spread. There are many challenges remaining in IVF, including the woman in advanced reproductive age who produces poor quality eggs, unexplained implantation failure, recurrent unexplained miscarriage and ongoing questions about the health of children conceived from assisted reproductive technology. While 4% of all babies born in Australia come from IVF pregnancies, this is likely to increase with an aging population, more acceptance of assisted reproductive technology by the general public and by more competition in the market place for pricing. Clinic guidelines are required to enable that only the patients who really need it will get IVF, quality management processes for clinicians and scientific staff need to improve and much more research needs to be done into the causes of infertility and the personalisation of treatment, so that pregnancy rates can continue to increase. Australia was at the forefront in the early days of assisted reproductive technology and then significantly lost its place, largely due to commercialisation of the industry and the retreat of researchers and universities from the arena. It is hoped that in the next decade more funding for research and the contribution of clinical scientists will grow.