The impact of in vitro fertilization on the practice of gynecology and obstetrics.

Contemporary programs of in vitro fertilization (IVF) approach a pregnancy rate per cycle which is comparable to the pregnancy rate per month of exposure in normal reproduction. IVF has changed the approach to several pelvic conditions. Because multiple concepti are usually transferred in a program of IVF, and since 40% of implanted sites were found to vanish, it is necessary to be exceedingly careful in applying the usual clinical criteria for completion of an abortion for fear that the surgical interference will terminate a residual viable site. Because of the potential for rupture at the cornu during pregnancy, IVF has led to a reevaluation of the technique of salpingectomy. The indications for various types of tubal surgery must be reconsidered so that patients may be offered IVF if the expectancy from tubal surgery is inferior to that from IVF. This is especially true for repetitive tubal surgery, in which the subsequent pregnancy rate seems to be only about 5%, except in special circumstances. The retention of the tube in patients with ectopic pregnancy should be reevaluated in the light of contemporary figures of the expectancy of pregnancy after such an operation compared with the expectancy of pregnancy in patients who have had bilateral salpingectomies in programs of IVF. Some patients with endometriosis who have failed other types of therapy have become pregnant with IVF. In view of a satisfactory pregnancy rate with IVF in patients in the age group 35-39, it is possible that IVF should be offered as a primary therapy for patients in this age bracket with mild or moderate endometriosis.(ABSTRACT TRUNCATED AT 250 WORDS)