論文・講演抄録

IVF was introduced as a scientific advance to get past the problem of tubal blockage and allow the sperm and the egg to interact before putting an embryo back into the uterus. Since then IVF has been used for multiple other purposes and is part of the reproductive revolution that started in 1960 with the use of old contraceptive agents.
There have been may technological and social changes that have led to the expansion of IVF and these have often out-stripped the ethical background in each society, leading to tension between various groups who wish to expand or control IVF.

Much of what we do today in fertility management has no evidence base and given the wide private nature of IVF clinics, there is little investigation before many of
these therapies are introduced into practice. There is a clear need for us as clinicians and scientists to sort out when and where we can introduce new therapies.
In the meantime, patients have taken matters into their own hands and take multiple adjunct therapies, many of which are unproven and some of which may be unsafe.

IVF has become commercialised to the extent that patients move from country to country to obtain therapies that they cannot legally access in their own.
The growth of surrogacy and donor eggs, the use of sex selection of embryos and other technologies has led to　many patients moving to countries that offer these
treatments, but often with an inferior IVF background　and medical services. The more conservative the country,　the more patients are likely to move to other countries.
Various scandals within Asian countries have led to tightening of surrogacy and the use of donor gametes, but as some clinics are closed, new ones open.

In this talk I wish to cover issues to do with science, politics, sociology and technology behind the future of fertility management. I wish to emphasise how fertility
clinics must invest in research, education, quality staff and proven technologies if they wish to remain at the forefront of science and medicine.