In‐vitro fertilization — a gift for the infertile or a cycle of despair?

The chromosome constitution of 22 human preimplantation embryos from donor oocytes fertilized in vitro by donor sperm was studied to assess the contribution of lethal chromosome anomalies to the high failure rate of implantation of in vitro fertilized embryos after embryo transfer in infertile women. Evidence was found of nondisjunction, resulting in trisomy, monosomy, and nullosomy; structural abnormalities; haploidy; and triploidy. Despite the lethality of their chromosome complements, these embryos could not be distinguished morphologically from those with normal chromosomes.

To investigate the incidence and types of abnormalities of chromosome number in oocytes, we recovered preovulatory oocytes from 17 women who were undergoing clomiphene stimulation and laparoscopy because of infertility. Twenty-three oocytes were recovered and studied after they had been fixed with a gradual-fixation method: 17 of the oocytes had numbers of chromosomes in the haploid range (19 to 25 second-metaphase chromosomes), 4 had only 1 to 5 chromosomes, 1 was not analyzable, and 1 had 23 chromosome bivalents in the first metaphase. Of the oocytes with chromosome numbers in the haploid range, nine had an apparently normal haploid set of 23 chromosomes. Two had 1 to 2 additional chromosomes, three lacked 2 to 4 chromosomes, and three had totals of chromosomes that were close to 23 but could not be determined with certainty. We conclude that infertile women undergoing clomiphene stimulation have a high proportion (nearly 50 percent) of oocytes with an abnormal karyotype. If this is also true of fertile women, including those not taking clomiphene, it may explain the high frequency of chromosome aberrations occurring in early spontaneous abortion and the low pregnancy rate after in vitro fertilization.

The technology of IVF not only presents society with a range of social and ethical difficulties, but also consumes vast resources from the ‘public purse'. This paper provides an estimate of recent government expenditure on IVF programs and argues that the $32 million figure arrived at is far short of the actual sums involved. Pregnancy rates are also examined, and the conclusion is reached that on average 34 treatment cycles are required to produce one pregnancy which results in the birth of a baby that is is not premature, defective or dead at birth.