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In spite of the increasing use of in vitro fertilisation for fertility disorders, overall less than 20% of the cycles of treatment which are commenced, result in a live birth at term. There are three major stages in the IVF procedure which could be improved. These undoubtedly need better understanding and more research. The first involves the identification and collection of healthy mature oocytes which are currently produced after relatively unphysiological attempts to induce ovulation. The second crucial stage is when gametes and fertilised oocytes are place in culture, often for up to six days in a poorly defined environment which is likely to be suboptimal. The final stage is when an embryo is placed into the uterine cavity where there is still inadequate knowledge of the uterine environment and the molecular messages between zygote and endometrium and what processes lead to successful implantation.
This paper reviews these stages with accent on our own research on embryo culture. The limitations of our knowledge about egg and embryo culture is considerable. What research must be considered in this area to improve the results of this demanding treatment