This chapter focuses on in vitro fertilisation (IVF), the most common assisted reproductive technology (ART) procedure. The use of IVF has radically transformed the way in which we approach the management of infertility, irrespective of the diagnosis, and it is integral to the infrastructure of a modern fertility service. Monitoring of treatment includes follicle tracking with ultrasound and ovarian steroid measurement. In the early days of IVF, oocyte collection procedures were done under laparoscopic guidance. After oocyte retrieval, freshly ejaculated seminal fluid is prepared to concentrate motile spermatozoa in a fraction that is free of seminal plasma and debris. Embryologists then have to decide whether they are going to perform conventional IVF or need to inject sperm directly into the oocyte (intracytoplasmic sperm injection (ICSI)). Two major complications of ART to consider are multiple pregnancy and ovarian hyperstimulation syndrome (OHSS).

Pregnancies and live births from human cryopreserved in vitro fertilization (IVF) embryos provide proof of principle and lead to the adoption of embryo cryopreservation as a routine adjunct to IVF and embryo transfer (IVF/ET). Embryo cryopreservation is an essential tool when embryo transfer is not possible in the cycle of oocyte collection. The widely accepted criterion for embryo survival and eligibility for transfer in a clinical situation is that a minimum of 50% of the original blastomeres survive. Human embryos can be successfully cryopreserved using a range of techniques at all stages of development and can result in the birth of normal, healthy children when transferred back to the uterus. Application of this technology in the context of infertility treatment has had a major impact on the development of more conservative approaches to the number of embryos transferred and the overall cumulative efficiency of treatment.

The major indications for treatment by in vitro fertilization (IVF)-surrogacy are congenital absence of the uterus and previous hysterectomy for haemorrhage or malignancies. The genetic couple is seen in consultation so that a full history can be taken and a full examination carried out. A surrogate host may be a relative of the genetic couple or a close friend. Counselling and appropriate legal advice is essential to all parties of a surrogacy arrangement. Usually, the genetic mother undergoes an (IVF) cycle with a standard follicular stimulation regimen and oocyte collection. After the process of examination, counselling and Ethics Committee approval, the surrogate host is reviewed and her treatment cycle arranged. To date, relatively few reports of large series of IVF-surrogacy treatments have been published. The major complications arising out of treatment by IVF-surrogacy have involved legal issues, the custody of the resulting child being the main example.