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‘As early as the 1950s, Edwards had the vision that IVF could beuseful as a treatment for infertility. He worked systematically torealize his goal, discovered important principles for humanfertilization, and succeeded in accomplishing fertilization ofhuman egg cells in test tubes (or more precisely, cell culturedishes). His efforts were finally crowned by success on 25 July,1978, when the world’s first “test tube baby” was born. During thefollowing years, Edwards and his co-workers refined IVF technologyand shared it with colleagues around the world.
Approximately four million individuals have so far been bornfollowing IVF. Many of them are now adult and some have alreadybecome parents. A new field of medicine has emerged, with RobertEdwards leading the process all the way from the fundamentaldiscoveries to the current, successful IVF therapy. Hiscontributions represent a milestone in the development of modernmedicine.
Infertility – a medical and psychologicalproblem
More than 10% of all couples worldwide are infertile. For manyof them, this is a great disappointment and for some causeslifelong psychological trauma. Medicine has had limitedopportunities to help these individuals in the past. Today, thesituation is entirely different. In vitro fertilization (IVF) is anestablished therapy when sperm and egg cannot meet inside thebody.
Basic research bears fruit
The British scientist Robert Edwards began his fundamentalresearch on the biology of fertilization in the 1950s. He soonrealized that fertilization outside the body could represent apossible treatment of infertility. Other scientists had shown thategg cells from rabbits could be fertilized in test tubes when spermwas added, giving rise to offspring. Edwards decided to investigateif similar methods could be used to fertilize human egg cells.
It turned out that human eggs have an entirely different lifecycle than those of rabbits. In a series of experimentalstudies conducted together with several different co-workers,Edwards made a number of fundamental discoveries. He clarified howhuman eggs mature, how different hormones regulate theirmaturation, and at which time point the eggs are susceptible to thefertilizing sperm. He also determined the conditions under whichsperm is activated and has the capacity to fertilize the egg. In1969, his efforts met with success when, for the first time, ahuman egg was fertilized in a test tube.
In spite of this success, a major problem remained. Thefertilized egg did not develop beyond a single cell division.Edwards suspected that eggs that had matured in the ovaries beforethey were removed for IVF would function better, and looked forpossible ways to obtain such eggs in a safe way.
From experiment to clinical medicine
Edwards contacted the gynecologist Patrick Steptoe. He becamethe clinician who, together with Edwards, developed IVF fromexperiment to practical medicine. Steptoe was one of the pioneersin laparoscopy, a technique that was new and controversial at thetime. It allows inspection of the ovaries through an opticalinstrument. Steptoe used the laparoscope to remove eggs from theovaries and Edwards put the eggs in cell culture and added sperm.The fertilized egg cells now divided several times and formed earlyembryos, 8 cells in size (see figure).
These early studies were promising but the Medical ResearchCouncil decided not to fund a continuation of the project. However,a private donation allowed the work to continue. The research alsobecame the topic of a lively ethical debate that was initiated byEdwards himself. Several religious leaders, ethicists, andscientists demanded that the project be stopped, while others gaveit their support.
The birth of Louise Brown – an historicevent
Edwards and Steptoe could continue their research thanks to thenew donation. By analyzing the patients’ hormone levels, they coulddetermine the best time point for fertilization and maximize thechances for success. In 1978, Lesley and John Brown came to theclinic after nine years of failed attempts to have a child. IVFtreatment was carried out, and when the fertilized egg haddeveloped into an embryo with 8 cells, it was returned to Mrs.Brown. A healthy baby, Louise Brown, was born through Caesariansection after a full-term pregnancy, on 25 July, 1978. IVF hadmoved from vision to reality and a new era in medicine hadbegun.
IVF is refined and spreads around the world
Edwards and Steptoe established the Bourn Hall Clinic inCambridge, the world’s first centre for IVF therapy. Steptoe wasits medical director until his death in 1988, and Edwards was itshead of research until his retirement. Gynecologists and cellbiologists from all around the world trained at Bourn Hall, wherethe methods of IVF were continuously refined. By 1986, 1,000children had already been born following IVF at Bourn Hall,representing approximately half of all children born after IVF inthe world at that time.
Today, IVF is an established therapy throughout the world. Ithas undergone several important improvements. For example, singlesperm can be microinjected directly into the egg cell in theculture dish. This method has improved the treatment of maleinfertility by IVF. Furthermore, mature eggs suitable for IVF canbe identified by ultrasound and removed with a fine syringe ratherthan through the laparoscope.’