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The early history of IVF in Australia and its contribution to the world (1970-1990).

Although Edwards and Steptoe achieved the first IVF pregnancy and birth in 1978, the majority of pioneering developments in IVF during the eighties came from Australia. They included the world's first donor egg pregnancy, the first frozen embryo pregnancy and the first IVF multiple pregnancies. Australia also produced the first national guidelines for IVF practices, the first statute legislation protecting donor gamete pregnancies, and Victoria proclaimed the first statute legislation regarding control of IVF procedures. The reporting of the outcome of all IVF pregnancies began in 1980 as another world initiative.

Australia↗

A mixed bag: a perspective on the regulation of IVF in Australia.

Regulation of ART in Australia consists of a mixed bag of Federal and State legislation and a national regulatory authority involved in accreditation. Access to IVF technology is variable between states and much ethical debate surrounds issues such as "social sexing" and other access differences, as well as the fate of surplus embryos. Little public debate on restriction of multiple embryo transfer practices has occurred, most likely due to public ignorance of the associated health risks.

Australia↗

The likelihood of pregnancy with IVF and GIFT in Australia and New Zealand.

OBJECTIVE: To determine the likelihood of pregnancy for couples entering the New Reproductive Technology (NRT) programs in Australia and New Zealand, by combining the data from nearly all the practising units. DESIGN: All units practising in-vitro fertilisation (IVF) and/or gamete intrafallopian transfer (GIFT) were contacted and asked to provide data on patients treated and pregnancy rates. These figures were then combined to produce life tables to determine the likelihood of pregnancy with repeated attempts. SETTING: IVF/GIFT units in five States of Australia, the Australian Capital Territory and New Zealand. Eighteen of the 22 units provided data to be analysed. PATIENTS: Data were available for analysis on 18,089 cycles of IVF resulting in 3034 clinical pregnancies, and 6308 cycles of GIFT resulting in 1724 clinical pregnancies. MAIN OUTCOME MEASURES: This was either "clinical pregnancy" (the presence of products of conception on ultrasound examination), or "viable pregnancy" (a pregnancy developing to at least 20 weeks of gestation). RESULTS: After four attempts at IVF, half the couples achieved a pregnancy, whereas four attempts at GIFT resulted in two-thirds of the couples achieving pregnancy. CONCLUSION: Both IVF and GIFT are effective and successful options for infertile or subfertile couples. New Reproductive Technology should be readily available in every advanced clinic dealing with subfertile couples in the 1990s.

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The early days of IVF outside the UK.

In this article the history of IVF in geographical regions outside the UK are traced by pioneers of that time. Following the birth of Louise Brown in 1978, live births after IVF occurred in Australia in 1980, in the USA in 1981 and in Sweden and France in 1982. Following the first IVF birth in Australia, the Government of Victoria established a review of IVF research and practice which led to the proclamation of the Infertility (Medical Procedures) Act 1984, the first legislation to regulate IVF and its associated human embryo research. Despite such restriction, IVF doctors and scientists from Victoria, especially those under the leadership of Carl Wood, Alan Trounson and Ian Johnston continued to initiate new treatments for infertility and new methods for delivering this treatment. In the USA IVF research began on animals as early as the 1930s, when Pincus and Enzmann at Harvard were involved in attempts at IVF in the rabbit. In the 1940s, John Rock attempted human IVF with 138 human oocytes without success. In 1965, Bob Edwards was with Georgeanna and Howard Jones at Johns Hopkins where attempts were made to fertilize oocytes in vitro. Clinical IVF began in earnest in the USA in 1980 with the first birth in 1981 achieved by the use of HMG--a first successful use with IVF. In France, two groups Frydman and Testart (Clamart) and Cohen, Mandelbaum and Plachot (Sevres) focused their research in particular directions. In 1981, the Clamart group developed a plasma assay for the initial rise in LH. The Sevres group developed a transport technique. Plachot produced a long series of cytogenetic analyses of oocytes and human embryos. Mandelbaum described the microstructures of the human oocyte. The start of IVF in France benefited from the help of animal researchers from the Institut National de la Recherche Agronomique. The first babies were born in Clamart in February 1982 and in Sèvres in June 1982. Important contributions to the development of IVF from the Nordic countries include techniques for ovarian stimulation, sonographic techniques for monitoring and vaginal oocyte retrieval and also unique possibilities for monitoring IVF safety. These developments, in combination with relatively permissive laws for the practice of reproductive medicine and relatively generous reimbursement policies, as well as a general public confidence in IVF, have led to an exceptionally high availability of IVF, within international comparison.

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Prospective randomized comparison of two embryo culture systems: P1 medium by Irvine Scientific and the Cook IVF Medium.

PURPOSE: To compare the efficacy of two commercially available in vitro fertilization (IVF) and embryo culture media systems: the glucose-free P1 Medium supplemented with 20% synthetic serum substitute (SSS) (Irvine Scientific), and the Cook IVF Medium (Cook, Australia). METHODS: A prospective randomized study. Medical center-based IVF Unit affiliated to the Faculty of Medicine of Tel Aviv University. IVF patients were randomly assigned to either P1 Medium supplemented with 20% SSS (182 patients, 196 cycles) or Cook Medium (167 patients, 179 cycles). RESULTS: Fertilization rates were similar with both media (52.3 +/- 26.1 and 53.8 +/- 27.6, respectively). Likewise, no difference was found in morphological characteristics and grading of cultured embryos. However, a significantly higher proportion of the embryos incubated in the P1 Medium reached the four-cell stage on day 2 or the 6-cell stage on day 3 postfertilization, compared to those incubated in Cook Medium (54.3% vs. 41.9%, p < 0.0001). Clinical pregnancy and delivery rates were improved when oocytes and embryos were cultured in P1 Medium. Finally, Implantation rate was significantly higher in the P1 Medium Group (9.9% vs. 6%, respectively). CONCLUSIONS: Our results suggest that the P1 Medium may be associated with a higher embryo cleavage rate and improved implantation rates compared to the Cook IVF Medium.

Culture Media↗

Births in Israel resulting from in-vitro fertilization/embryo transfer, 1982-1989: National Registry of the Israeli Association for Fertility Research.

Our objective was to describe the characteristics of pregnancies, deliveries and children at birth following in-vitro fertilization (IVF) and related technologies in Israel, from 1982 to 1989. A national survey with collaboration from all IVF units in the public hospitals was designed and data were collected on individual patients. Comparison of results was made with data from a national delivery census and from other national IVF registries. During the period covering this survey, 1149 deliveries resulted in 1475 newborns; 98% of deliveries occurred following conventional IVF and embryo transfer (IVF-ET), 2% after in-vivo fertilization and gamete intra-Fallopian transfer. Following IVF-ET, 23% of the pregnant women were hospitalized due to a complication of pregnancy and 47.3% of the deliveries were by Caesarean section (41% if multiple births are omitted). The male to female birth ratio was 1.07:1.0; 23.6% of the deliveries were multiple births, 28.6% of deliveries were pre-term and the median length of gestation decreased with multiple births. At delivery, 23.8% of newborns weighed less than 2500 g. The incidence of low birthweight newborns was significantly higher in multiple births. The ratio of perinatal mortality (22.8/1000), double the incidence found in a national census (13/1000), increased dramatically with multiple births (12.7, 24.5 and 75.8/1000 for singleton, twins and triplets respectively). The incidence of a major congenital malformation was 2.2%, no higher than in the general population. A survey of published national IVF registries from Australia and New Zealand, Great Britain, USA and France showed much similarity in all aspects of pregnancy outcome following IVF and related technologies.(ABSTRACT TRUNCATED AT 250 WORDS)

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