RECENT ADVANCES IN ASSISTED REPRODUCTIVE TECHNOLOGIES

Assisted reproductive technologies (ART) have received considerable at tention, both clinically and empirically. Drs. Steptoe and Edwards rem oved one oocyte surgically from a woman with infertility related to tu bal disease, They fertilized this oocyte in vitro and transferred the formed embryo to the woman's uterus and achieved pregnancy and deliver y. The technique of in vitro fertilization (IVF) and embryo transfer ( ET) quickly became widely utilized for other causes of infertility as well as for tubal disease, In the last 5 years there has been a number of new developments that are reviewed in this article. The most impor tant and now widely practiced technology has been direct intracytoplas mic injection (ICSI) of the husband's sperm into the wife's oocyte. Th is was developed for treatment of infertility related to low sperm cou nt. Subsequently it was shown that sperm can be aspirated from epididy mis or found in testicular biopsy in obstructive azoospermia, Another promising development is in vitro maturation (IVM) of immature oocytes , This has the potential of avoiding ovarian hyperstimulation, which c an be uncomfortable and occasionally dangerous. Some oocytes are unabl e to fertilize and/or develop into normal embryos. It may be possible that the problem is with the machinery of cytoplasm of the oocyte. The refore cytoplasmic transfer from a normal oocyte to an abnormal oocyte may overcome the problem. Infertile couples may be faced with many ps ychological problems that become even more complex with various treatm ents. Whereas donation of oocytes or embryos can be technically quite simple, there are many psychological issues involved, As can be gather ed from aforementioned discussions, the treatments developed for infer tility appear to be somewhat illogical and in the style of ''shot gun therapy.'' In the field of infertility, as in other areas of medicine, it is of paramount importance to know the details of disease mechanis ms, This in turn will allow specific and logical treatments to be deve loped.