Two British Pioneers - Edwards and Steptoe
By Karen Synesiou, CFO, Managing Director, Center for Surrogate Parenting, Inc.
IVF is so commonplace nowadays it is difficult to comprehend that fertilizing a human egg outside of the body was difficult to accomplish less than three decades ago. The more daunting task was helping a human embryo by providing the right environment to allow cell division without destroying the embryo.
The pioneers of IVF are two British doctors: Patrick Steptoe, a gynecologist, and Robert Edwards, a biologist. Their lead was followed by two Australians, Alan Trounson and Carl Wood, who took the lead in IVF. To these four remarkable men, all families created through IVF owe a huge thank you.
Edwards got his genetic training by working with mouse embryos and trying to reproduce them. His early work gave him insight into genetics as well as reproduction. His initial studies revolved around inseminating mouse embryos and, later, performing ovarian stimulation in adult mice. These studies occurred in the early 50’s. At the time Edwards was perhaps the only scientist who believed that reproduction and genetics were linked fields.
By the 1960’s, Edwards and his team could make adult mice ovulate on time. Edwards and his team were also able to take a few cells off a rabbit blastocyct and identify them by gender. At birth they found they were 100% correct! In other words, in 1968-1969 Edwards had performed pre-implantation diagnosis (PGD) on a blastocyst embryo!
Edwards realized this control of ovulation could be applied to humans. The theory at the time was that almost all eggs would mature to fertilization in 12 hours. Edwards needed bits of ovary to obtain the eggs he needed. Of course, obtaining ovarian tissue was extremely difficult. A gynecologist, Molly Rose, was most helpful in sending Edwards bits of ovarian tissue. From the ovarian tissue Edwards was able to harvest human eggs.
It took Edward’s team three years to discover a human egg took 37 hours to mature instead of the commonly held belief that it took 12 hours. Actually, it was more of an accident that they discovered that egg maturation took so much longer. After years of painstakingly trying to force a human egg to mature, one night exhaustion led them to leave one experiment unattended while the team fell asleep. Upon waking they anticipated that they had lost their experiment only to discover that the egg was still intact. Curiosity and disbelief led them to monitor the egg and so they stumbled upon the fact that human eggs mature at 37 hours instead of at 12 hours. (Proof positive that a good night sleep is good for you!)
The next phase was to find a way to retrieve an egg out of the ovary – this was an insurmountable problem in 1969. It just so happened that Dr. Steptoe published a study in the Lancet Journal stating that he could get to the ovary by a technique called laparoscopy. Suddenly it all came together. If Edwards could convince Steptoe to collaborate with him, Edwards believed he could collect eggs at 36 hours – that is just one hour before natural ovulation. He needed Steptoe to help him.
Dr. Steptoe had run his own infertility clinic for eight years. He understood the pain of being denied the ability to parent a child, the pain of losing a pregnancy, the pain of trying and trying without the reward of success. Steptoe was also tough, a man with a mind of his own, not prone to conforming to the structures society built around him. Steptoe was a prisoner of war during WWII. His Italian guards quickly realized that he was one of the finest wine tasters in Europe, a recognized authority on French wines. So they brought him wines from all over Italy and soon he became an expert on Italian wine!
At the time the only way to see the ovaries resulted in the heating of the abdominal cavity and therefore a substantial risk of damaging internal tissue. Steptoe and two colleagues (Palmer of France and Frangenheim of Germany), developed a method of getting cold light into the abdomen – the beginning of carbon fibers! Steptoe and his colleagues went on to develop the instruments necessary to perform a laparoscopy as well as the instruments necessary to retrieve the eggs. Unfortunately Steptoe was despised by his colleagues. He was barred from many medical meetings and never truly seen for the pioneer that he was. His colleagues considered his laparoscopy to be a fake. Edwards called Steptoe and told him that he wanted to aspirate human eggs so he could fertilize them outside of the human body, but to do this he needed Steptoe to help him. There was silence, Edwards held his breath. A moment later Steptoe declared he would assist Edwards.
Steptoe would use his instruments to retrieve the eggs and Edwards would use his skills to help the eggs mature in a medium he made and then try fertilizing the eggs. At this stage they had controlled ovulation in a woman, aspirated eggs, matured them in vitro, fertilized them and grown the embryo to eight cell or blastocyst (100 cell). Embryos were transferred to patients but unfortunately no implantation occurred. It took three long years before they got their first embryo to implant.
Dr. Steptoe delivered baby Louise Brown on July 25, 1978, via c-section and it was forever proven that an embryo grown invitro was capable of becoming a normal, full-term baby. As the saying goes …the rest is history. But that is not the end of this story. A little know fact is that probably none of this would have occurred if it were not for one amazing woman – an American philanthropist.
The whole notion of fertilizing outside of the human body, of creating life, of actually using an instrument called a laparoscopy was considered by most gynecologists in the medical field as absurd, impossible, or even fake. The religious world was not far behind the line of doctors viciously criticizing Steptoe and Edwards. By 1972 Steptoe and Edwards had lost almost all funding and they feared their work would have to end.
Then a miracle happened. Dr. Edwards received a phone call from a lady stating that she would fund his research. This American philanthropist had read about Edwards and his work and stated “I want that work to go forward at all costs.” It turned out she was a very rich lady. Her generosity allowed them to build laboratories, employ staff, and buy equipment. When Louise Brown was born, Edwards first phone call was to this special lady to tell her she was an equal part of this miracle. To this day this American philanthropist’s identity has never been revealed. I hope she knows how many thousands upon thousands of families exist because she took the time to care. To you, we all owe a huge debt of gratitude – thank you and God bless.NOTE: Congratulations to Dr. Robert Edwards for winning the 2010 Nobel Prize for his work developing the procedure, known as in-vitro-fertilization or IVF.