Michele and Ray L'Esperance wanted children badly, but her uterine tubes had been removed due to scarring. Happily, a procedure called in vitro (IVF) solved the couple's problem.

First, Michele received human menopausal gonadotropin to stimulate development of ovarian follicies. When an ultrasound scan showed the follicies had grown to a certain diameter, she received human chorionic gonadotropin to induce ovulation. Then her physician used an optical instrument called a laparoscope to examine the interior of her abdomen and harvest the largest oocytes from an ovary. The oocytes were incubated at 37o C in a medium buffered at pH 7.4. When the oocytes had matured, they were mixed in a laboratory dish with Ray's sperm, which had been washed to remove various inhibitory factors. Secretions from Michele's reproductive tract were added to capacitate the sperm.

Next, fertilized eggs were selected and incubated in a special medium for about 60 hours. At this state, five eight- to sixteen-cell preembryos were transferred through Michele's cervix and into her uterus with the aid of a specially designed catheter. So many preembryos were transferred to increase the odds that one or two would complete development. Michele received progesterone to prepare her uterus to receive the preembryos.

IVF worked almost too well for the L'Esperances--they had quintuplets! success rates for IVF vary from clinic to clinic, ranging from 0% to 40%, with the average about 14%. It costs thousands of dollars to become pregnant via IVF. Chart 23A describes other assisted reproductive technologies.

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