IVF (In Vitro Fertilization) and GIFT (Gamete Intra-Fallopian Transfer)

Excerpted from
How to Get Pregnant with the New Technology
By Sherman J. Silber, M.D., F.A.C.S.

On a Tuesday evening, July 25, 1978, at 11:47 P.M., the world's first human test-tube baby was born. Louise Brown was a beautiful, normal, five-pound, twelve-ounce girl with blond hair and blue eyes. Dr. Robert Edwards and Dr. Patrick Steptoe, in a little clinic near Manchester, England, were responsible for this giant step forward into the "brave new world." Dr. Edwards's first statement upon seeing the child was, "The last time I saw the baby it was just eight cells in a test tube. It was beautiful then and it is still beautiful now." The child's mother, Leslie Brown, and father, John Brown, had been married for nine years and were unable to have children. The problem was that the wife's tubes were so badly destroyed by scars and inflammation that surgery could not help her. Her ovaries and her uterus were normal, however, and all that was required was to take an egg from her ovary, mix it with her husband's sperm in a test tube, and then transfer the two-day-old embryo into her womb to grow for the next nine months into a full-term baby.

This achievement was the culmination of twelve years of painstaking research by the two doctors. Their experiments had begun many years before and involved an incredibly complicated variety of techniques which had to be tested over and over again in animals before being tried in humans. Determining the composition of the fluid in which the sperm and egg are to be bathed, the best time to remove and reimplant the egg, and monitoring the hormone levels of the mother prior to the retrieval of the egg all required years of patient effort. Their work was not funded by the medical hierarchy, and even after their first successful result, they were ridiculed because it was so difficult at first to make it happen again. Drs. Steptoe and Edwards courageously ushered in a new era that makes it possible today for virtually any couple to have a baby.

As with all other advances relating to reproduction, no matter what politicians, theologians, and medical critics may think, test-tube fertilization has been widely accepted by the public. Since 1985, modifications of the original IVF technique (including GIFT and ZIFT, and now ICSI) are producing pregnancy rates of 20 to 55 percent per cycle, and have revolutionized the treatment of infertility. IVF and GIFT today are the dominant form of therapy for childless couples.

The elegance and simplicity of the techniques for test-tube fertilization and GIFT do not require the bureaucracy of an enormous medical center. Research in this area was severely retarded in the United States because in 1975 federal support for research into in vitro fertilization was halted because of a fear that such research was not "ethical." Most of our early knowledge in this field in the United States had to be "imported" from Europe and Australia. Not only did our government refuse to recognize it, but even the first IVF clinic in America (Norfolk, Virginia) which was completely privately funded had to go through tremendous obstacles to get permission to get started. Political activists protested this tampering with nature. But infertile couples continued to support this developing field with no government research funding whatsoever. Now, because of privately funded improvements, this is the single-most successful treatment available for infertility today.

As I wrote in a series of predictions in How to Get Pregnant in 1981, all of which have now come true: "Now that we have already stepped over into that brave new world, think of the other possibilities. What if a woman has had a hysterectomy? She has no uterus at all, but does have normal ovaries and a fertile husband. It would now be possible to remove one of her eggs through the laparoscope, fertilize it in a culture dish with her husband's sperm, and then implant this new embryo into another woman, who could act as a 'surrogate' mother. Then when the baby is delivered nine months later, it could be turned over to the mother who originally provided the egg. From the opposite point of view, what if a woman had a perfectly normal uterus and a fertile husband, but her ovaries were incapable of producing eggs? An egg could be extracted from a donor through the laparoscope, fertilized with her husband's sperm, and then implanted into her own uterus." Now such treatment is commonplace. More importantly, for all types of infertility, not just the dramatic ones described above, the success rate is so good with the new technology that couples have less of an agonizing wait and are more likely than ever to achieve their dream.

What Is GIFT? ZIFT? IVF? ICSI?
How Do They Differ?

At first it might be confusing to hear all the different acronyms like IVF, GIFT, ZIFT, and ICSI, but in truth these are all just variations of the same technology. They are referred to as ART procedures, for "assisted reproductive technology." When Steptoe and Edwards first reported on IVF, the pregnancy rate per cycle was no more than 2 percent. This made it simply an exotic procedure, too expensive for most, and not likely to result in very many happy couples. Even though the pregnancy rate with in vitro fertilization improved in the mid-1980s, the true pregnancy rate per cycle (taking home a baby) was still only about 8 percent.

So although in vitro fertilization was an exciting, new horizon for infertility treatment, it remained just a curiosity for most patients and, indeed, in the eyes of most fertility specialists it took a back seat to the plodding, conventional treatments.

What led to the sensational popularity of the new technology, with IVF clinics springing up everywhere, was the improvement in pregnancy rates caused by a few very technical modifications. The first modification to IVF that improved results was the "GIFT" procedure.

With classic in vitro fertilization, sperm and eggs are mixed in a culture dish, put in an incubator, and the eggs are allowed to fertilize. Two days later the fertilized egg or embryo is replaced in the woman's uterus. The laboratory technology for this in vitro fertilization has improved dramatically. Fertilization in a petri dish was not a problem. The frustrating stumbling block to the wider success of in vitro fertilization was not in getting fertilization to occur, but rather in getting the transferred embryo to implant in the uterus and result in a pregnancy. Hundreds and thousands of fertilizations were accomplished in IVF laboratories around the world bypassing all of the hurdles presented by infertile couples, but when those precious embryos were replaced in the uterus, only a small percentage of them were able to "implant" and become babies. We now understand this dilemma much better and can dramatically increase pregnancy rates.