Is the success of human IVF more a matter of genetics and evolution than growing blastocysts?

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Abstract
Quality is clearly deficient in many human embryos growing in vitro. Fewer than 20% implant after transfer to the uterus in the majority of patients, so two or more are replaced which results in high-order multiple pregnancies. Among many approaches to improving quality, co-culture with supporting cells has claimed to be successful (e.g. Bongso et al., 1994), although it is now being replaced by the use of sequential culture media (Ménézo et al., 1998). Zona drilling was also introduced to enhance implantation rates (Cohen et al., 1990). In recent studies, co-cultures combined with assisted hatching failed to improve implantation rates above 23–26% per embryo, which were overall similar to controls (Hu et al., 1998). Perhaps variations between clinics account for differences in the success of these approaches.

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