Next steps

There is no sign that the growth in uptake of ART is slowing. Clinics are opening across the world and national regulatory systems are struggling to keep up with the increasing complexities of treatments, and with cross-border travel to allow couples to access a test or treat­ment that they desire which is not permitted in their own country.

As the technology improves, giving couples a high chance of preg­nancy from IVF provided that the female partner is not too old, more attention is being paid to safety for both mother and child. Child safety is maximized after SET for avoidance of premature birth and cerebral palsy in multiples. SET is widely practised in Scandinavia and Australia, less so in the United Kingdom, and seldom in the United States and in the developing world. Increasingly, ‘segmentation’ of the clinic with ovarian stimulation and egg collection being followed by elective ‘freeze all’ of blastocysts with later transfer in a separate cycle. This almost completely removes the risk of severe OHSS while maintaining good pregnancy rates, provided that the embryo labora­tory is capable of delivering high-quality cryopreservation.

Increasing attention is also being paid to quality management and use of Standard Operating Procedures to minimize risk of error in IVF practice. Laboratories now work in a ‘clean room’ environ­ment with high-grade air quality and minimal exposure of embryos to volatile organic compounds. Such approaches have allowed very large practices, performing in excess of 20,000 IVF cycles per year, to work efficiently in parts of Europe, Japan, and China.

IVF has come a long way since the first faltering steps of the pion­eers in the 1970s and 1980s. Perhaps the greatest challenge is for IVF to remain a part of established medical practice instead of becoming a mere money-spinner for large corporate companies. Having a family is one of the most important steps that women and men take in their lives and those who need help to achieve this goal should not be overburdened financially by commercial entities that view IVF purely as a commodity.