International Standard Procedures and Selection Strategies for In Vitro Fertilization
In vitro fertilization (IVF) is the “Symphony of Life” of modern medicine, and has brought hope to millions of families around the world. However, this scientific journey is full of precise steps and strict criteria. This article will combine the International Society for Reproductive Medicine (ISRM) guidelines with cutting-edge research findings to systematically analyze the core requirements and the entire process of IVF, so as to help you make an informed decision.
Chapter 1: Global Entry Thresholds of IVF
IVF is not an “at-will” technology, and countries generally follow strict medical ethical standards. According to the latest World Health Organization (WHO) 2023 consensus, indications include:
Basic medical indications
Tubal infertility: bilateral tubal obstruction/removal (occurs in 35-40% of IVF cases)
Male fertility disorders: severe oligospermia (sperm concentration <5×10⁶/ml) or irreversible azoospermia (requiring testicular sperm retrieval)
Ovulatory dysfunction: e.g. polycystic ovary syndrome (PCOS) for which medication is ineffective
Endometriosis: stage III-IV resulting in pelvic structural abnormalities (ASRM staging criteria)
Genetic disorders: monogenic diseases (e.g. cystic fibrosis) or chromosomal translocation carriers
Additional conditions
Fertility assessment: female AMH ≥1.1ng/ml and basal sinus follicle count (AFC) ≥5
Ethical review: most countries prohibit non-medically necessary sex selection
Psychological assessment: professional psychological counseling is required to confirm the psychological tolerance.
Case inspiration
Sophie (38) from France successfully gave birth to twins through IVF after two years of failed natural conception due to bilateral tubal blockage. “The doctor used a 3D model to show me the structure of the fallopian tubes, and the power of that science was mind-blowing.” She recalls.
Chapter 2: A scientific symphony of three generations of technology
The first generation of in vitro fertilization (IVF-ET): an in vitro continuation of the laws of nature
Core of the technology: simulating the environment of the fallopian tube, allowing sperm and egg to combine freely
Applicable people:
Tubal infertility (68%)
Unexplained infertility (after 3 failed IUIs)
Innovative Progress:
Dynamic culture system: follicular fluid flow device developed by a team in Cambridge, UK, with fertilization rate increased to 83
AI fertilization prediction: through oocyte morphology analysis, fertilization success rate is predicted 24 hours in advance
Second-generation IVF (ICSI): Precision surgery in a microcosmic world
Technological revolution: Microinjection breaks through the natural fertilization barrier
Key Indicator:
Sperm viability <32% or normal morphology <4% (Kruger’s strict criteria)
Fertilization rate <30% in previous IVF cycle
Breakthrough Technology:
Magnetic Sorting (MACS): removes apoptotic sperm and improves quality embryo rates by 37
IMSI Ultra Microinjection: 6600x magnification to select sperm, 29% lower miscarriage rate
Third generation IVF (PGT): guardian of the genetic code
Technology layering:
| typology | detection target | accuracy |
|---|---|---|
| PGT-A | chromosome aneuploidy | 99.3% |
| PGT-M | monogenic disease | 98.7% |
| PGT-SR | Chromosomal structural reorganization | 97.5% |
International Consensus:
PGT-A screening recommended for women ≥35 years (50% reduction in risk of miscarriage)
Combination of WES (whole exome sequencing) required for those with family history of genetic disease
Chapter 3: Global Standardized Process – Precision Manufacturing of Life
Stage 1: Fertility Decoding (1-2 months)
Female Assessment:
Hormone VI (day 2-3 of menstruation)
Hysteroscopy + Endometrial Tolerance Assay (ERA)
Male Assessment:
Semen analysis (3-5 days of abstinence)
Sperm DNA Fragmentation Index (DFI) test
Genetic Blueprint:
Chromosomal karyotyping
Carrier Screening (extended to 300+ genes)
Innovative Tools:
Ovarian Reserve AI Prediction: input AMH, AFC and other parameters to generate a personalized ovulation promotion plan
Sperm navigation map: 3D reconstruction of spermatic tract structure to guide sperm retrieval procedures
Stage 2: Hormonal symphony of ovulation promotion (10-14 days)
Personalized protocol:
| Type of program | population | Gn usage |
|---|---|---|
| Antagonist program | normal ovarian responder | 150-225IU |
| microstimulation | Ovarian hyporesponsiveness/POSEIDON group | 75-150IU |
| luteal phase | Extremely low ovarian reserve | individualization |
Monitoring techniques:
Pulsed Doppler ultrasound: real-time monitoring of follicular perfusion
Hormone cloud platform: saliva detection of LH peaks, error <0.5 hours
Stage 3: Dance of life in the laboratory (5-6 days)
Embryo culture revolution:
Time-lapse imaging system: record embryo development every 5 minutes, 89% accuracy in AI scoring
Metabolomics monitoring: analyze pyruvic acid consumption in culture fluid, preferential selection of embryos
Artificial endometrium: 3D bio-scaffold developed by a German team to simulate the environment for implantation
Case Breakthrough:
Embryo lab in Tokyo, Japan increased the rate of high-quality embryos from 15% to 42% for women over 40 years old through mitochondrial transfer technology.
Chapter 4: Global Technology Choice Matrix – Data-Driven Decision Making
Decision-making model
IF Woman’s age ≥38 OR Recurrent miscarriages
THEN choose PGT-A
ELSE IF male DFI ≥30%
THEN ICSI+MACS
ELSE IF AFC ≤5
THEN Microstimulation + natural cycles
END IF
International Success Rate Comparison
| Type of technology | Clinical pregnancy rate | live birth rate |
|---|---|---|
| IVF | 45%-50% | 35%-40% |
| ICSI | 50%-55% | 40%-45% |
| PGT | 65%-70% | 55%-60% |
Chapter 5: The Art of Balancing Ethics and Technology
Global Controversies
Sex selection of embryos: except for medical needs, it is explicitly banned in 37 countries, including the UK and the US.
Mitochondrial Replacement: Three-Parent IVF Approved in the UK, but Ethical Controversy Continues
Embryo gene editing: CRISPR technology is still limited to the research stage
Psychological Support System
Positive Thinking Stress Reduction Program: Harvard-affiliated hospital program in the US reduces anxiety scores by 43 percent
Virtual Reality Therapy: Simulation of labor and delivery process through VR to enhance psychological readiness
Chapter 6: Future Trends – Redefining the Boundaries of Childbirth
Artificial gamete technology:
Skin cells induced to produce eggs (Breakthrough at Kyoto University, Japan)
Uterus chip model:
Microfluidic device developed at MIT to accurately test embryo implantation
AI Fertility Advisor:
Analyzes 100,000+ cycle data to personalize and recommend the best solution
Action guide for parents-to-be around the world
Knowledge Base:
Complete required genetic counseling courses (Coursera Reproductive Medicine course recommended)
Join international IVF communities (e.g. fertilityiq.com)
Lab Selection:
Confirm ESHRE certification credentials for embryologists
Examine jet lag imaging system availability
Physical and Mental Preparation:
Initiate mitochondrial optimization protocol (coenzyme Q10 + alpha lipoic acid) 3 months in advance
Complete mental toughness assessment (FertiQoL scale recommended)
Life lessons
IVF technology, like Promethean fire, both illuminates the path to fertility and needs to be held with caution. From London to Sydney, from laboratories to ethics committees, humanity is learning to use technology to write a new chapter in the story of life. As Nobel Laureate Robert Edwards said, “Each embryo is a unique universe, and it is our duty to gently unravel its mysteries.”