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For the next 40 years of in vitro fertilization—let’s sharpen our focus on iatrogenic harm reduction

      For a relatively nascent field, reproductive medicine has made dramatic strides in improving pregnancy outcomes. The initial studies of in vitro fertilization (IVF) conducted in women undergoing natural menstrual cycles yielded on average 0.7 oocytes per retrieval and a 6% per cycle pregnancy rate (
      • Edwards R.G.
      • Steptoe P.C.
      • Purdy J.M.
      Establishing full-term human pregnancies using cleaving embryos grown in vitro.
      ). Forty-two years later, IVF accounts for millions of births worldwide and 1%–3% of all births every year in the U.S. and Europe. A more nuanced understanding of ovarian stimulation, a focus on the importance of the endometrium, and monumental improvements in the embryology lab have afforded our patients a chance at pregnancy that would have been impossible just a generation ago. As we garner data on delivery outcomes from pregnancies conceived through assisted reproductive technology (ART), it has become clear that this treatment modality is not a benign undertaking. While current treatment strategies allow our patients to achieve pregnancy easily than ever before, we must also remain aware of the increased iatrogenic obstetric risks associated with ART.
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        Establishing full-term human pregnancies using cleaving embryos grown in vitro.
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