On 25 July 1978 Louise Brown was born. The event was surrounded by controversy, even moral condemnation; the world's first in vitro fertilisation (IVF) baby, following treatment by a uniquely British team--Patrick Steptoe, a district general hospital consultant in Oldham and Robert Edwards, a Cambridge don. (1) Since then assisted reproductive technology (ART) has developed at an extraordinary rate, resulting in the births of more than three million babies worldwide and achieving international public acceptance. Novel treatments for infertile couples have developed and IVF has become acceptable to patients and society. (2-4) The ease of treatment has improved, for example with the introduction in 1983 of vaginal aspiration of oocytes under ultrasound guidance, avoiding the risks and discomfort of laparoscopic oocyte recovery. (5) Some treatment advances have had spectacular results, such as the introduction of intracytoplasmic sperm injection (ICSI) in 1992, which revolutionised the management of male infertility. (4) Coupled with epididymal and testicular aspiration of sperm, ICSI has even allowed men with azoospermia to have their own genetic children. (6-7) Adjustment to new practices in medicine is usually slow, yet no other field in medicine has integrated new knowledge into daily routine practice more quickly than ART. Many countries have introduced tight ethical regulation of ART to ensure good practice, protect patients and prevent unacceptable clinical practices and research, such as human reproductive cloning. (8-9) However, despite advances in ART the proportion of embryos leading to live offspring has increased only slowly since its inception, so there is still room for progress in terms of increasing healthy live births but decreasing multiple pregnancy rates. (10)
