Infertility is not a character failure. It is a medical condition that affects millions of couples silently, carrying its weight through marriages, families, and everyday social interactions. In many societies, particularly here in Nepal, it remains misunderstood, frequently blamed on women, and rarely discussed with the sensitivity it deserves.
This emotional reality is the context in which IVF was born.
IVF was not invented as a commercial product. It was invented to solve a specific medical problem: the inability to conceive naturally due to a physiological barrier. Louise Brown, the first IVF baby born in 1978, is the clearest evidence of this original purpose. Her mother, Lesley Brown, had blocked fallopian tubes, the very site where egg and sperm must meet for natural fertilization. IVF bypassed that barrier by bringing fertilization into the laboratory, forming the embryo outside the body, and transferring it back into the uterus.
That single intervention changed reproductive medicine permanently.
In the decades that followed, IVF evolved significantly. Oocyte retrieval moved from surgical laparoscopy to transvaginal ultrasound-guided aspiration. ICSI transformed outcomes for severe male factor infertility by allowing direct injection of a single sperm into the oocyte. Vitrification made reliable embryo freezing possible. Blastocyst culture, time-lapse monitoring, and AI-assisted embryo assessment have each pushed clinical outcomes further.
Every one of these advancements was developed to improve patient outcomes. That remains the purpose, or it should.
The concern is that somewhere between scientific progress and commercial expansion, the purpose has begun to shift.
When clinics compete on packages rather than protocols, when success rates are quoted as marketing figures rather than clinical data, when donors are recruited without adequate medical screening or psychological counseling, and when embryos are handled without proper traceability and documentation, we are no longer practicing medicine as it was intended. We are operating a service industry built on the hope of vulnerable couples.
As a clinical embryologist, I find this deeply troubling.
An IVF laboratory is not simply a technical facility. It is the environment in which gametes and embryos are handled at their most vulnerable stage. Temperature, pH, air quality, VOC control, culture conditions, witnessing protocols, and documentation are not administrative preferences. They are clinical standards. A lapse in any one of them can have consequences that are invisible in the moment but significant in outcome.
This is why qualification matters. This is why regulation matters. This is why traceability matters.
The same standards apply beyond the laboratory. Donor programs must include centralized tracking, strict usage limits, legal clarity, and genuine informed consent. Not because regulators require it, but because the children born from these cycles carry genetic and legal identities that will matter for the rest of their lives. Genetic testing technologies like PGT have legitimate clinical applications for chromosomal disorders and known hereditary conditions. Using the same technology for non-medical sex selection is not a clinical service. It is a misuse of science to serve social preference.
In countries with mature regulatory frameworks, IVF is governed by enforceable standards: laboratory accreditation, embryologist registration, honest reporting of success rates, and clear oversight of donor and surrogacy programs. These systems exist not because practitioners cannot be trusted individually, but because the field is too sensitive to depend solely on personal honesty.
In Nepal, it is time to ask difficult questions. Are all IVF laboratories maintaining verifiable quality standards? Are embryologists properly qualified and practicing within a recognized professional framework? Are donor cycles being tracked centrally? Are patients receiving informed, accurate success rate data? Are gametes and embryos fully traceable from collection to transfer?
These questions are not attacks on the field. They are the responsibility of anyone who works in it.
IVF remains one of the most significant achievements in modern medicine. The birth of Louise Brown was not simply the birth of one child. It was the beginning of a medical pathway that has since helped millions of people build families they might never have had otherwise. That legacy is worth protecting.
But protection requires honesty. Technology advances quickly. Ethics must advance with it.
The original purpose of IVF was clear: one healthy child, through a safe, evidence-based, and ethical treatment pathway. That purpose has not changed. The question is whether we are still honoring it.