Assisted reproductive technology (art) in humans: Facts and uncertainties

Since the first in vitro fertilization (IVF) in human, the number of patien ts using Assisted Reproductive Technologies (ART) has increased tremendousl y. ART technologies have increased in number and their spectrum has also wi dened. The first IVF babies are now more than 20 years old. All the retrosp ective analyses have demonstrated that the obstetrical and pediatrical impa ct has not really affected single births. The main problems observed occur with multiple pregnancies, including high costs for the couples and for soc iety. The decrease in the number of embryos transferred has improved the si tuation and moreover does not impair the final results. IntraCytoplasmic Sp erm Injection (ICSI) is a more debatable and questionable technique with a real negative genetic impact. The main problem is chromosome abnormalities more specifically related to the sex chromosomes. The question of a systema tic genetic work-up on the patients entering ICSI programs is discussed. No negative impact of cryopreservation has been demonstrated even though some controversy arises from time to time. Pre-implantation Genetic Diagnosis ( PGD) is now a interesting tool for patients carrying genetic defects. Blast ocyst biopsy now has a future role in reproductive medicine. Gender selecti on through sperm sorting is also now a reality. As with the other developin g bio-technologies related to reproduction, there are ethical questions. Th e decisions concerning these technologies do not belong solely to scientist s but are rather a matter for society to decide. (C) 1999 by Elsevier Scien ce Inc.