ABSTRACT
Since the birth of the first IVF baby over 25 years ago, dramatic developments have occurred in in vitro fertilization (IVF). IVF was initially designed to overcome the problem of tubal infertility, but is now widely held to represent the treatment of choice for unexplained infertility, male factor, endometriosis, and ovarian dysfunction resistant to ovulation induction.1,2 The introduction of intracytoplasmic sperm injection (ICSI) has rendered severe forms of male infertility amenable to treatment and further widened the scope of IVF.3 High-profile publicity given to the latest achievements with IVF has led to its perception as a panacea for all those having difficulty in conceiving a pregnancy. This has been reflected in the rapid expansion of indications for IVF and an estimated current annual number of IVF cycles worldwide approaching 500 000, resulting in one in 100 to one in 150 babies born in the Western world being conceived by IVF.4 The degree to which IVF merits this growth in application remains unclear, however, since prospective randomized trials comparing the effectiveness of IVF with simpler fertility treatments remain scarce.
