In vitro fertilization, in its first 5 years of use, has met minimum standards for efficacy and safety, as judged by published clinical reports. It is becoming more widely available as an approach for overcoming sterility in married couples and appears also to be gaining social acceptance in that context. Several technical options presented by the procedure, particularly storage of frozen embryos and embryo transfers involving third-party contributions, are less fully evaluated clinically and raise social, ethical, and legal questions that go beyond the original medical model for therapeutic intervention. The clinical success of in vitro fertilization and the options it affords call for careful policy consideration. Estimates of costs and of potential demand for and supply of services are provided and the current status of relevant policy in the United States and abroad is discussed.
KIE: A review is provided of developments in human in vitro fertilization (IVF) during its first five years. Efficacy, safety, costs, demand and supply, and feasible extensions of the basic procedure are discussed. The authors contend that, while Australia and Great Britain have made progress toward formulating public policy on IVF, efforts in the United States have not gone beyond a 1979 report and recommendations issued by the Department of Health, Education, and Welfare's Ethics Advisory Board. Given the ready clinical and public acceptance of IVF, there is need for an oversight mechanism at the federal level, perhaps via a forum concerned also with the overlapping area of human genetic intervention.