Appraisal of in vitro fertilization.

In-vitro fertilization and embryo transfer techniques are now used all over the world (53 countries). The results of 492 of all world units were collected from national surveys and registries of different countries. Since 1985, more than 53,635 women were treated and 34,316 babies were born by 224,473 treatment cycles, followed by more than 160,518 transfer cycles. Only about 65%-75% of all resulting pregnancies attained live births. The remainder ended with spontaneous abortions (26%), or ectopic pregnancies (5.54%). The multiple pregnancy rate (22%) was higher than the normal population and contributed to higher rates of preterm deliveries and perinatal mortality. No increased incidence of chromosomal aberrations and malformations were noted during the years (2.25%). Success rates did not improve significantly within the 5-year period surveyed, in most parts of the world. The indications for treatment were broadened during the years and the procedure became a final step for diagnosis and treatment of unexplained infertility. We conclude that IVF/ET is not an empirical treatment anymore and is a relatively safe procedure, although it should be used only when properly indicated. Male infertility and infertility of unexplained origin may be accepted indications for IVF/ET. More research and centralization of treatment in fewer but large units should be established in order to improve success rates and lower the cost per live birth child. Quality control by professional or public associations should be regulated.