James Owen Drife
Leeds, United Kingdom (Winter 2018)
|Edwards (seated, left) and Steptoe brief the press at Oldham General Hospital after the birth of Louise Brown. A license to publish in Hektoen International has been obtained from Press Association Photos Limited, London.|
The physiologist Robert Edwards began thinking about human in-vitro fertilisation (IVF) in the 1950s and first suggested it in print in 1965. Thirteen years later Louise Brown, the world’s first IVF baby, was born in Oldham, United Kingdom. Today that sequence of events seems logical, even inevitable, but it very nearly did not happen. Edwards and his clinical colleague, Patrick Steptoe, faced hostility from many quarters including, importantly, their own disciplines. Recent research by a former member of his team has shed new light on how the scientific and medical communities resisted their radical ideas.1 We are also learning more about the women who have been airbrushed out of the story.2
Few medical advances are due to one individual and Edwards was generous in giving credit to his colleagues. It was he, however, who sought out Steptoe and recruited Jean Purdy, the nurse-turned-laboratory-worker whose cheerful determination kept the project alive during its most difficult times. Her dedication was remarkable. Every Friday for seven years she or Edwards made the 350-mile round trip from their Cambridge laboratory to the hospital where Steptoe performed laparoscopy – the technique he had introduced into the UK in the 1960s, long before “keyhole surgery” became standard practice.
Between 1971 and 1978 the team carried out 457 egg retrievals without a successful pregnancy and with no official funding. The managers of the state-run hospital let them use its operating room because Steptoe had worked there for twenty years and because Muriel Harris, the nursing superintendent, raised a team of volunteer staff to support him. Harris was another remarkable woman. A BSc graduate, she had trained as a nurse in London during the World War II Blitz and later became matron of Steptoe and Edwards’ private clinic at Bourn Hall, near Cambridge. After she retired she obtained a pilot’s license and helped start the Bourn flying club.
Thanks to the pioneering work of this tiny team, seven million babies worldwide have so far been born as a result of IVF. Why did Edwards receive no official support at the time? One reason was that in the 1960s infertility seemed the least of the world’s problems. The main concern, apart from the Cold War, was global over-population. Edwards’ early research on animal oocytes was aimed at developing methods of contraception using the then-new science of immunology. He was always ahead of his time. After graduating from the University of Wales in 1951 he had decided on a career in reproductive physiology before the double helix of DNA or the number of human chromosomes had even been discovered.
Edwards also showed foresight in being concerned about reproductive ethics. His first post was in a research team in Edinburgh which, unusually for the time, held regular discussions on ethics. This became a life-long interest and in 1971 he co-authored, with David J Sharpe of the George Washington University Law School, a landmark paper on the social and legal issues raised by embryology. But in the 1950s research on humans was regarded as ethically suspect, with its echoes of Nazi experiments. When Edwards joined the Medical Research Council (MRC) Institute in London in 1958, the director forbade any research on human eggs. To this day Edwards’ hope of preventing chromosome disorders like Down Syndrome remains a distant pipe-dream.
There were other reasons why, in 1971, the MRC rejected his application for funding for IVF research.3 Two years previously, despite difficulties in obtaining human tissue, he and his team had succeeded in fertilising human oocytes in the laboratory. They published their results in Nature, but the journal had just done a deal giving the London Times early access to its issues. The achievement of IVF was announced in The Times and on BBC television on St Valentine’s Day 1969, a day before Nature appeared. Other scientists assumed Edwards was behind this publicity stunt, and the coverage in other newspapers was universally negative, with alarming speculation about “test tube babies.”
Edwards was unperturbed. He was well equipped to defend the ethics of his work and he believed scientists should be willing to communicate with the public. But his was a minority view at the time. One of scientific referees on the 1971 funding application began his report: “Dr. Edwards feels the need to publicise his work on radio and television, and in the press, so that he can change public attitudes. I do not feel that an ill-informed general public is capable of evaluating the work … This publicity has antagonised a large number of Dr. Edwards’ scientific colleagues, of whom I am one.” The other referees agreed that Edwards’ scientific work was excellent but that, “on balance,” the application did not merit support.
If it had succeeded, Steptoe would have moved to Cambridge but he too encountered hostility from referees. Only seven years off retirement age, he was seen as a difficult character who would not fit in with the other gynaecologists in the city. The medical referees were suspicious of his “obsessive” interest in infertility and felt that laparoscopy had few clinical applications. Today we may pity their lack of vision but they were accurately reflecting the mood of the times.
The project might have ended there but for three factors, all involving women. Lillian Lincoln Howell, an American heiress, had heard of Edwards’ work and began to support it financially in 1968. Her philanthropy became crucial after 1971, when the team set up a small laboratory in Oldham on a shoestring budget.4 Howell was the daughter of a self-made millionaire who had founded the Lincoln Electric Company in Cleveland, Ohio. She supported academic projects in California, where she grew up, and was the owner of KSTF TV in San Francisco, one of the USA’s first multi-ethnic television stations. This, not her pivotal role in IVF, was the focus of the obituaries when she died in 2014, aged ninety-three.
The second factor was the team’s dogged determination. Jean Purdy was a Christian with an engaging sense of fun. Patrick Steptoe had been a navy doctor during World War II and had survived being torpedoed and taken prisoner. Robert Edwards was the son and grandson of miners and had spent his youthful summers working on hill farms. They were the strongest of characters but seven years of disappointment tested them to the limit. Edwards became disillusioned and entered local politics but failed to be elected to Parliament. He later attributed IVF’s success to Purdy, who refused his offer of a transfer to another project.
The third factor was the letters the team received from infertile women who felt medical science had given up on them. They were desperate but no-one else was listening. Ironically, it was Edwards’ much-derided publicity that now gave the team a reason to carry on.
On 25 July 1978 their efforts were rewarded when Louise Brown was born, alive and well. Steptoe had turned sixty-five and had to retire from the National Health Service but continued as medical director at Bourn Hall until his death in 1988. Purdy died tragically of malignant melanoma in 1985, aged just thirty-nine. Edwards, his energy undiminished, lived on, supported by his wife Ruth, whom he had met when they were both researchers in Edinburgh. Back then he had been overawed to discover that she was the grand-daughter of a Nobel laureate, Ernest Rutherford, the father of nuclear physics. Ruth and Bob married in 1956 and fifty-four years later it was Ruth who picked up the phone and learned that her husband had become the second Nobel prize-winner in her family. By then, however, he had developed dementia and was unable to appreciate the belated award or the knighthood that followed in 2011. He died in April 2013, aged eighty-seven, and Ruth died six months later.
The Nobel was greeted with approval everywhere except in the Vatican, where the Head of Bioethics said it was completely out of order. Religious objections to IVF have the virtue of being public but this project was almost stopped by private reports. Would it happen today? A lot has changed in forty years. The world of science now agrees with Edwards on public communication, and women are no longer routinely ignored. But things are no easier for maverick thinkers. Research is increasingly done by large collaborative groups singing from the same hymn sheet, and controls on research, hospital space, and the medical profession are tighter than ever. In more ways than one, Edwards, Steptoe, and Purdy got there just in time.
- Martin H. Johnson, “The path to IVF,” Reproductive Biomedicine Online 23 (2011): 245-262.
- Roger Gosden, “Jean Marian Purdy remembered – the hidden life of an IVF pioneer,” Human Fertility, DOI:10.1080/14647273.2017.1351042.
- Martin H. Johnson, Sarah B. Franklin, Matthew Cottingham, and Nick Hopwood, “Why the Medical Research Council refused Robert Edwards and Patrick Steptoe support for research on human conception in 1971” Human Reproduction 25, no. 9 (2010): 2157-2174.
- Martin H. Johnson and Kay Elder, “The Oldham Notebooks: an analysis of the development of IVF 1969-1978. VI. Sources of support and patterns of expenditure,” Reproductive Biomedicine and Society Online 1 (2015): 58-70.
JAMES OWEN DRIFE, MD, FRCOG, FRCPEd, FRCSEd, FCOGSA, FFSRH, graduated and trained in Edinburgh, United Kingdom. He worked in Bristol and Leicester before moving to Leeds in 1990 as professor of obstetrics and gynaecology. He retired in 2009. He has been a vice-president of the Royal College of Obstetricians & Gynaecologists, Editor-in-Chief of the European Journal of Obstetrics & Gynecology, and a regular columnist for the British Medical Journal. He was Clinical Director of the UK Confidential Enquiry into maternal deaths and, for ten years, a consultant adviser to the World Health Organisation’s Making Pregnancy Safer program.