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Last Updated: Tuesday, 22 July, 2003, 15:29 GMT 16:29 UK
The fertility milestones
Since Louise Brown's birth 25 years ago, IVF has become almost a routine procedure in the UK.

However, the succeeding years have brought a series of breakthroughs which have allowed more couples than ever to have the chance of a baby.

BBC News Online looks at the way the technology has developed - and the ethical dilemmas that have been tackled - over the past two and a half decades.

First test tube baby: JULY, 1978

Louise Brown just after birth
Louise Brown was the first IVF birth
The birth of Louise was the culmination of well over a decade's work in laboratories in the UK.

Her mother, Lesley, had been told there was only a million in one chance of her conceiving naturally.

In the end, no hormone drugs were used to stimulate her ovaries - and the single egg she produced was enough to lead to a pregnancy, and the birth of Louise.

Test tube twins: APRIL 1982

Britain's first test tube twins were also born in the UK.

The parents were 31-year-old Jo Smith and her husband Stewart.

Most couples undergoing IVF are delighted by the prospect of twins, although fertility doctors in the UK and Europe now try to avoid them, as a twin pregnancy does raise the risk of complications for mother and babies.

First frozen embryo birth: 1983

Embryos as well as sperm were frozen
The question of what to do with "surplus" embryos not used in the initial IVF treatment has always troubled parents.

One solution devised by experts was to store them at very low temperature, and then try to implant them at a later date.

The freezing of embryos started in 1983, and eventually one couple in the US were the first to have a second child using such an embryo.

Its existing sibling was seven and a half years old.

Surrogate baby: JANUARY 1985

There was an outcry when surrogate Kim Cotton was paid $6,500 to have a baby for an infertile couple by artificial inemination.

The child, a girl, was made a ward of court but later adopted by the couple.

Laws swiftly brought in made commercial surrogacy illegal in the UK.

Now, only legitimate expenses can be paid - and a handful of "stranger surrogates" still carry out this service each year.

First embryo screening: 1988

An embryo in a petri dish offers an unique opportunity for screening for certain devastating genetic disorders.

It is now used to make parents carrying particular genetic diseases cannot pass the illness on to their children.

There have since been applications in the UK for testing that would lead to the birth of a baby picked to be a perfect match for a sick sibling, so that cells from the umbilical cord could be used in treatments.

In the UK, "preimplantation genetic diagnosis" is outlawed unless it is for the good of the baby itself, and some applications have been rejected on this basis.

Sperm injection: 1990

ICSI: A single sperm is injected into the egg
This was the first use of what is now known as ICSI (intracytoplasmic sperm injection).

In cases where there are sperm, but they do not move properly, and so cannot fertilise the egg, a single sperm is taken, then injected across the membrane of the woman's egg.

This was a major breakthrough in the treatment of male subfertility - and success rates for ICSI now rival those of ordinary IVF.

The first UK ICSI baby was born in 1992.

Sperm retrieval:1993

Some men cannot produce any sperm in their ejaculate at all - this may be due to a blockage, or simply a deficiency in sperm production.

In the 1990s, experts managed to produce sperm suitable for ICSI by putting a probe into the testicle itself and sucking out fluid.

Sometimes doctors need to operate to remove a tiny section of testicular tissue which they examine closely for useable sperm.

'Donor Child': APRIL 1995

JAYCEE Buzzanca was dubbed "Nobody's Child" after being legally declared to have no identifiable parents.

She was conceived in a California infertility clinic from donor sperm and a donor egg, then transferred into the womb of a surrogate mother recruited by a Los Angeles couple, John and Luanne Buzzanca.

Oldest mother: NOVEMBER 1997

There was a furore when it was revealed that a 60-year-old widow, Liz Buttle, had lied about her age to receive fertility treatment at a London clinic.

She gave birth to a son.

First 'frozen egg' baby: 1997

Frozen eggs were thawed and used in IVF
While doctors were already storing sperm, and embryos, at very low temperature, there were concerns about doing the same with eggs.

Eventually however, the technique of freezing and thawing proved safe in animals, and it was transferred to humans.

The first baby conceived this way was born in the US, and the first in the UK in 2001.

The technique offered young women whose fertility was threatened by illness to store their eggs until a time when they wished to have children.

Dead man's sperm: JUNE 1998

In an infamous court case, widow Diane Blood applied for the right to use sperm stored by her dead husband Stephen just before he embarked on cancer treatment.

The Human Fertilisation and Embryology Authority ruled that he had not given written consent for this, even though Mrs Blood insisted he had told her that she could go ahead.

The Court of Appeal ruled that she could go abroad for treatment with the sperm - and she has since had two children.

The issue of consent is a thorny one - two women went to court in 2003 to try to use embryos created during IVF treatment with their now ex-partners.

Both men oppose the use of the embryos.

Laser assisted-hatching: 1999

Even good quality embryos may not implant in a woman's womb, but repeated failure to do so may indicate a problem.

One solution, which resulted in its first births in 1999, was the use of a laser beam to breach an outer "shell" around the embryo - which may help its contents get established.

Chromosome screening: 1999

Chromosome screening could reveal flawed embryos
Chromosome, or aneuploidy screening, could be one way of reducing the rate of miscarriage following IVF treatment.

It is thought that, particularly in older women, screening could pick out faults which otherwise might reduce the chance of the embryo implanting successfully.

While the technique has been offered in the US and Europe since the late 1990s, the first pregnancy following aneuploidy screening in the UK is only just underway in 2003.

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