State of the A.R.T.(Advanced Reproductive Technology)
by Pak Chung, M.D.
(excerpt of presentation at the 1998 CAMS Semiannual Meeting)

Since the birth of the first baby from in vitro fertilization twenty years ago, reproductive medicine has become a specialty with cutting edge clinical and embryological research, opening far more treatment options for infertile couples than ever. Infertility, traditionally defied as inability to conceive after one year of unprotected intercourse, now has to be redefined as we continue to observe the trend whereby women are postponing marriage and child-bearing. The impact of female age on reproduction has been well recognized. More importantly, ovarian age and chronological age should be critically distinguished from each other. Older (38 years old) patients deserve more immediate attention and should not wait one whole year before evaluations are carried out. Treatment for this group of patients also has to be more aggressive. Advanced maternal age has become one of the most important indication for in vitro fertilization. In the area of male infertility, the advent of the use of intracytoplasmic sperm injection (ICSI) in human since 1992 has dramatically revolutionize treatment of the infertile male. Not to mention men with compromised sperm parameters, even totally azospermic men can undergo epididymal aspiration or testicular biopsy. from which sperm retrieved are used for ICSI. Another powerful tool in assisted reproductive technology is preimplantation genetic diagnosis (PGD). As opposed to prenatal genetic diagnosis which involves testing the fetus in utero, PGD offers diagnosis for certain genetic diseases on the embryos before they are replaced in the uterus. Albeit offered in very few centers, aneuploidy, certain translocations and single gene defects can be diagnosed by polar body or blastomere biopsy using PCR or, more commonly, fluorescent in situ hybridization (FISH). Last but not least, intense research is being performed to devise a reliable protocol for oocyte cryopreservation, which will directly benefit young females with cancer or single females to preserve their fertility potential.