It was in England in the year 1978 when the phenomenon of In vitro Fertilization became a reality with the birth of Louise Brown, the world's first test tube baby. Though condemned by the Catholic Church, In vitro Fertilization has become by far the most common reproductive procedure. In the 24 years since the birth of Louise Brown it has gained wide acceptance. This procedure has even been adopted in Muslim countries, and Iran celebrated it's first born from this procedure in 1990.

Factors for Using In vitro Fertilization (IVF)
There are many reasons that a couple chooses to undergo alternate means of reproduction, both male and female. When a woman experiences tubal problems is one. When this occurs, a woman's fallopian tubes can be blocked or damaged, which makes fertilization difficult or can inhibit the embryo to travel to the uterus. A woman may also have ovarian tissues that prevent the release or production of an egg. Endometriosis may be a factor as well. This is a disease state in which some tissue has spread elsewhere in the abdominal cavity. Endometriosis can cause pain and infertility, however 5 to 10% of woman have it and are able to become fertile. On the other hand, 30 to 40% of infertile woman are diagnosed with endometriosis.

Other reasons for infertility may be abnormal uterus shape, fibroid tumors or exposure to diethylstilbestrol (DES) as a fetus, DES is a non-steroidal synthetic estrogen that affects release of pituitary gonadotropins and inhibits ovulation. It is present in the morning after pill, medication for menopause amongst others, and is known to create an abnormal uterus. With all of the reasons listed above, 10% of couples experience unexplained reasons for infertility, containing two groups. The first group is, simply, that the couple is unlucky and could be fertile. The second being that the reason for infertility is so miniscule that technology is unable to detect the problem.

The problem does not always rests on the woman, and in fact many men suffer from infertility as well. The man may have problems with low sperm count or sperm mobility which may inhibit them from fertilizing the egg itself, in which the couple turns to IVF to solve the problem.

PROCEDURE
In vitro Fertilization is the procedure of fertilizing an egg by sperm in a laboratory. Each medical facility differs slightly in procedure but they all use basically the same steps. Before the procedure begins the couple must deal with any ethical issues they may have, possibility of complications, and the expense of the procedure. Once these are addressed the six-step procedure takes place.

This first step is to increase the amount of follicles that the woman produces for an increased chance of a successful In vitro Fertilization. Follicles are the fluid-filled sacs within the ovaries that contain the eggs. This is usually done with a combination of drugs. The most common drugs are human menopausal gonadotropins and menotropins, which stimulate ovulation. Once the follicles are produced and the eggs are mature, the second step is ready to begin. The second step is involves the removal of the eggs. Once the eggs reach its correct size, about 17 mm, another drug, called Human Chorionic Gonadotropin, is given to the women. The drug prepares the eggs for ovulation and fertilization. The eggs are then removed from the follicles by a needle placed in the ovary through the vagina. The third step involves the male extracting sperm that will be used for fertilization. This is usually done by self-administered ejaculation, or if needed, medical assistance is provided, such as Testicular Sperm Aspiration or Epididymal Sperm Aspiration. The fourth step separates the sperm from the seminal fluid. It is then fertilized with the female's eggs in dish, placed in an incubator at the woman's body temperature. If the sperm count is low or if it's poor, the sperm is then injected into the eggs. Fertilization does not occur until the sperm actually enters the egg. The sperm then loses its tail and its head enlarges. The fertilized egg will then begin to divide and become a pre-embryo. Once the fertilization is successful, the fifth step will take place. The fifth step is the transfer of the embryo. The pre-embryo is placed into the woman's uterine cavity, usually done by placing a tube into the women's uterus through the cervix and then dropping the pre-embryos into it. The sixth step is a follow up to see if pregnancy was successful, done by examining the women's menstrual cycle, blood tests, and an ultra sound. And the process of In vitro Fertilization is complete.

Success Rates
As with many medical technologies, In vitro Fertilization has increased its success rate over the past decade. As illustrated between the years 1998-2001: In 1998-1999, the success rate of the procedure was 19.5% and in 2000-2001 the success rate increased to 21.8%.

One of five couples attempting pregnancy with IVF result in childbirth. The success rate per attempt is about 19% for women under forty, while older women have a success rate of about 7%, along with an increased risk of harm to the female.

Negative Side Effects
In vitro fertilization has blessed many families with what they thought hopeless, birthing their own child, however it is not fail proof. The initial procedure is highly invasive, and expense. Couples can find themselves paying up to $10,000 per treatment and that is not including the fertility medication which ranges between $1,700 to $3,500 depending on the age of the patient. However, there are financial plans available. When purchasing more than one treatment, doctors offer package deals to the couple to lessen the expense.

Multiple births are also an issue that many families must consider. Due to the drugs used to increase fertility and using more that one egg to increase chances, many times more than one egg is fertilized ending with twins, triplets, or more. In 2000, in woman under the age of 35, 31.4% of 103 cycles resulted in twins, and 7.8% resulted in triplets. The use of fertility drugs or hormonal treatments to induce increase ovulation for multiple eggs can also cause the ovaries to develop cysts, which have unknown long term side effects.

The chance of multiple births also has other problems associated with it. For instance, with more eggs the chance of prenatal mortality is heightened. The rate of miscarriages and premature birth increases as well.

And as with any medical procedure, there is always the risk of anesthesia. Nevertheless, this procedure adds the risk of ovary damage with the removal of the eggs from the female.

Conclusion
However invasive the process, In vitro Fertilization allows couples the chance to birth their own child which would be seen as impossible without it. Although there are many children and babies available for adoption, people tend to want genetic offspring. As of July 31,1998, and only 20 years of development, over 300,000 children have been born through In vitro Fertilization. The ethical issue of this procedure has also minimized and about 75% of the US population approves of IVF.