Fifty years ago, the first ever landing of men on the moon was heralded as a giant step for mankind. Indeed it was, but another more recent development has altered the personal and social landscape of our times in ways that have arguably even more impact. Just 41 years ago today, the world’s first IVF baby was born. She was also the first IVF baby in the UK which was, and remains in many ways, a world leader in human reproductive medicine.
Louise Brown’s birth in Oldham in 1978 was the culmination of the work of Cambridge physiologist Robert Edwards, who in 2010 was awarded the Nobel Prize for the “development of human in vitro fertilization (IVF) therapy”. Clinical management was provided by Patrick Steptoe, an obstetrician at Oldham General Hospital. On that historic day, as well as Louise Brown, a new era was born.
From Test Tube Baby to Assisted Fertility Treatment
Robert Edwards’ work on developing fertilisation outside the human body started in the 1950s and was initially greeted with incredulity and hostility from the medical profession. The Medical Research Council, at the time the major British funder of medical research, refused funding and held this position throughout the 1970s. The work continued with private funding, culminating in the birth of the first IVF baby. It was this birth that changed everything.
Suddenly the British and world press were full of praise for the ‘test tube baby’ which, they discovered to their delight, was just like any other baby. Of course, ‘test tube baby’ was always a misnomer (there is no test tube involved and ‘in vitro’ simply means in glass) but the idea caught on like wildfire in the public imagination. Forty-one short years later the term ‘test tube baby’ sounds quaint and we have moved on. Assisted reproduction is now a normal part of everyday life.
Regulation and control in the UK and around the world
A year later Durga, aka Kanupriya Agarwal, the world’s second IVF baby, was born in India, followed by live IVF births in Australia in 1980, in the USA in 1981 and in Sweden and France in 1982. It was clear that this exciting new technology had vast potential for alleviating infertility but there were at the same time growing ethical concerns about the use of ‘spare’ embryos left over from the IVF process and the need for regulation of their uses.
The British Government set up the Human Fertilisation and Embryology Authority (HFEA) in 1990. This is the first statutory body of its kind in the world, with a remit to license, monitor and inspect fertility clinics and provide impartial information about fertility treatment, clinics and egg, sperm and embryo donation.
In Europe, the original practitioner of IVF, Robert Edwards, was one of the founding members of ESHRE, the European Society of Human Reproduction and Embryology. Its aim is to promote the understanding of reproductive medicine, provide safety guidance and maintain data records and collaborate with policy makers throughout Europe. It is not however a formal regulatory body and the legal landscapes in different European countries are quite significantly different.
For example, in Spain the strict regulations guarding the anonymity of egg and sperm donors is very different from Germany, the Netherlands and the UK where the HFEA has established comparatively open rules allowing children conceived with donor eggs or sperm to access details of the donor’s identity. This has a limiting knock-on effect on the availability of donor eggs and sperm, with resulting extensive waiting times.
Major IVF developments since the first IVF baby
Genetic screening of embryos
Since the first realisation that an embryo could be studied to determine its sex, researchers realised that this was an opportunity to screen for, and eliminate, certain sex-related heritable conditions. This has led to the current availability of techniques such as preimplantation genetic screening for aneuploidy and other genetic testing such as PGT-M, which detects certain monogenic diseases. In 2006, another world first was recorded when IVI, using IVF with the PGT technique, allowed the birth of a healthy baby to a couple in which one was a carrier of lymphohistiocytosis.
Other IVF developments and their social and personal impact
IVF means that the concept of the corporeal and consequently hidden nature of conception and the beginning of life has been changed forever. In addition, the notion of a fertility timeline defined as ovulation, conception, pregnancy and birth has lost its inevitable trajectory.
Now it has become not only possible but widely accepted and normalised for this ancient timeline to be disrupted, for example when a woman opts to freeze her eggs at a suitable age for later use, or for embryos created from an early round of IVF to be stored for future rounds if the need should arise. This has opened up new freedoms and choices for a whole generation of women and men that, 41 years ago, could have seemed like science fiction.
What is the future of IVF and assisted reproduction?
Medical research never stands still and new techniques and approaches to the way they are used are inevitable. Some of these may not be predictable, but a few developments seem likely. For example:
- Constantly improving methods of embryo selection, including genetic screening
- More young women will choose to freeze their eggs as a kind of insurance for their future options;
- New research into in vitro maturation will mean that lower hormone dosages are needed and side effects will therefore reduce;
- As genetic research goes forward, fertility experts will have the ability to screen for new diseases, perhaps even with the long-term aim of eliminating cancer.
Whether or not these possible futures come to pass, we can be sure of one thing. Just as the world changed with that momentous giant step for mankind on the moon, the birth of the first IVF baby has changed human fertility, human reproduction and all of our futures forever.