Received for publication November 23, 2004.
Revised March 10, 2005.
Accepted for publication March 11, 2005.

The Evolution of In Vitro Fertilization: The Integration of Pharmacology, Technology and Clinical Care

Abstract

For the couple having trouble achieving pregnancy, the options and opportunities for assistance have never been brighter. Options such as controlled ovarian hyperstimulation and in vitro fertilization have been developed over the past five decades and provide hope for couples that previously would have been considered infertile. In vitro fertilization, in particular, represents a coalescence of advances in physiology, endocrinology, pharmacology, technology, and clinical care. In vitro fertilization has assisted well over one million couples in their efforts to start or build a family, and the demand for such services continues to increase. The purpose of this manuscript is to review the pharmacological advances that made controlled ovarian hyperstimulation, and therefore in vitro fertilization, possible. We will discuss the early stages of gonadotropin use to stimulate ovarian production of multiple mature eggs, the advances in recombinant technology that allowed purified hormone for therapy, and the use of other hormones to regulate the menstrual cycle such that the likelihood of successful oocyte retrieval and embryo implantation is optimized. Finally, we will review current areas that require particular attention if we are to provide more opportunity for infertile couples.

Key words: controlled ovarian hyperstimulation, gonadotropin releasing hormone, human menopausal gonadotropin, in vitro fertilization, pharmacology, progesterone