A SHORT HISTORY AND BACKGROUND TO IN VITRO FERTILIZATION, INTRACYTOPLASMIC SPERM INJECTION AND ASSOCIATED TECHNIQUES

On 25 July in 1978, Louise Joy Brown, the world's first baby to be born as a result of in vitro fertilization (IVF), heralded a breakthrough in the alleviation of infertility. Over a million babies have now been born as a result of IVF. However, this relatively simple technique of placing eggs into medium containing thousands of sperm is of benefit only to those patients with the ability to produce large numbers of highly motile, normally shaped spermatozoa. Cases involving sperm disorders, however, are less likely to possess an adequate number of functional spermatozoa, with normal cleavage of any fertilized eggs also being less likely to occur.

Initially, most patients with male-factor infertility were treated empirically (e.g. using anti-oestrogens, gonadotrophins, androgens and antibiotics) in an attempt to optimize their semen profile, but without any great proven success. Modifications in preparation (e.g. discontinuous density gradient centrifugation purification and metabolic stimulation with phosphodiesterase inhibitors) and insemination procedures (e.g. high insemination concentration and short-duration inseminations) improve the fertilizing potential of spermatozoa but only in those amenable to such treatment (e.g. those with more than 500 000 progressively motile sperm). Hence, those with severe male-factor infertility have had to wait until the last decade of the twentieth century, during which time the application of micromanipulation technology and surgical sperm-recovery techniques have allowed us to offer hope to these patients.