In vitro fertilization (IVF) was initially developed to treat patients with damaged Fallopian tubes. IVF treatment has since been extended far beyond tubal infertility to treat a whole host of indications, including unexplained infertility, endometriosis, and male infertility. Infertility treatments include timed intercourse, ovulation induction, intrauterine insemination (IUI), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), IVF, and intracytoplasmic sperm injection (ICSI). Standard stimulation protocols require pituitary desensitization with a GnRH agonist, and this strategy has become almost a universal practise in assisted conception clinics with the induced hypogonadotropic hypogonadism enabling almost complete control over follicular development. The presence of endometrial polyps, submucous fibroids, and intrauterine adhesions may be associated with reduction in pregnancy rates and increase in risk of miscarriage with IVF. Cryopreservation of supernumerary good-quality embryos is vital to optimize pregnancy rates per cycle started without the need to superovulate the patient again.

Gamete intrafallopian transfer (GIFT) involves a direct transfer of human gametes, sperm and oocytes into the fallopian tubes. Zygote intra-fallopian transfer (ZIFT) involves the transfer of embryos at the pronucleus stage into the fallopian tubes. In in vitro fertilization (IVF), the four- to eight-cell embryo is transferred 48-72 hours after oocyte collection and thus reaches the uterine cavity some two to three days earlier than would occur in a natural cycle. Centres offer comprehensive assisted conception, including IVF, GIFT and ZIFT. IVF-embryo transfer has become acceptable, with improvements in vaginal ultrasound, oocyte retrieval techniques and ambulant care with local sedation and analgesia. In women aged above 40 years, a flexible number of oocytes transferred during GIFT maximizes the chance of achieving singleton pregnancy. ZIFT is indicated for couples who have had repeatedly failed IVF cycles. GIFT/ZIFT is considered for patients who have cervical stenosis or in utero exposure to diethylstilbestrol.

Fertility is markedly compromised several years before the menopause, suggesting that factors other than complete depletion of the follicular store play a role in the loss of oocyte competency in ageing women. The reduced reproductive potential of older women is related to the functional and structural qualities of the oocytes. Older women are more likely to be affected by a number of pathologies that can reduce their fertility potential. Increasing maternal age is also associated with an increase in ovulatory dysfunction. Reduction in uterine receptivity as a possible contributing factor to the decline in fertility with age has been difficult to ascertain. Fibroids that distort the uterine cavity can reduce the chances of successful implantation. This chapter discusses various assisted reproductive technologies, namely, in vitro fertilization (IVF)/gamete intrafallopian transfer (GIFT), ovarian stimulation for IVF/GIFT, donor insemination, oocyte donation, assisted embryo hatching, blastocyst transfer and preimplantation genetic diagnosis (PGD) of aneuploidies.