Infertility treatment at the edge: discovery and risk converge at the limits of knowledge
- Correspondence to Associate Professor Michael J Davies, Research Centre for the Early Origins of Health and Disease, Robinson Institute, University of Adelaide, Adelaide, South Australia 5005, Australia;
- Received 7 November 2012
- Accepted 15 November 2012
- Published Online First 7 December 2012
The latter half of the twentieth century saw the rapid promulgation of technologies that continue to transform patterns of fertility globally. The introduction of the oral contraception pill in the early 1960s demonstrated an unrivalled capacity to precisely and reliably manage voluntary infertility, transforming the age distribution of female age at first birth and effectively emancipating women to engage with careers and education. In 1978, parallel research in assisted reproductive technology (ART) saw the first birth from in vitro fertilisation which proved the feasibility of effective treatment for involuntary infertility. Following this initial Nobel prize winning breakthrough by Edwards and Steptoe, ART has undergone a rapid transition from laboratory experiment to routine medical care. We are now confronted with the compression of reproductive careers as delayed age at first birth collides with a steep age-related decline in female fertility, with increasing reliance on ART. With approximately 5 million individuals born from ART treatment, we are confronted with a series of questions regarding the effectiveness, safety and long-term social and biological consequences of treatment; both for the recipients of treatment and for the resulting offspring.
Adverse events associated with ART may be attributable to several sources, including patient factors related to infertility, treatment strategies such as multiple embryo transfer, and factors related to specific aspects of treatment such as gamete manipulation or embryo culture media. While ART patients tend to be wealthier and less likely to be smokers, they are on average older with higher body mass, and with a higher prevalence of metabolic disorders such as preexisting diabetes and polycystic ovary syndrome. These …