IVF

A former Fellow of the University of Cambridge in 1963, Sir Robert Geoffrey Edwards was a physiologist who pioneered the study of reproductive medicine. His most notable piece of work, however, was the invention of in-vitro fertilization alongside Patrick Steptoe a Consultant Gynaecologist at Oldham General Hospital which led to the birth of Louise Joy Brown on the 25th of July 1978 by the process of IVF. However, it was only until 2010 that he was awarded a Nobel Prize in Physiology  ‘for the development of in vitro fertilization’  - an entire thirty six years after the birth of Brown.

Throughout the course of this talk, I will touch on a series of points ranging from the potential ethical issues in vitro fertilisation raises for certain members of the public to how Edwards’ and Steptoe’s initiated their research. My background in Philosophy and Ethics, a subject that I took for one of my A-Levels, not only furthered my interest in science as a general but made me query the key issues that surround those in the medical profession and the impact their actions and discoveries have on society. Hence, this one of the most prominent reasons as to why I will not only focus on the scientific arguments for why the invention of IVF was groundbreaking but also on the ethical dilemmas it brings to members of society.

The term ‘in-vitro’ stemming from Latin, simply translates as ‘in glass’ or perhaps more colloquially known as ‘outside the body’. This is basically the fundamental principle that both Edwards and Steptoe achieved that is now widely used within the NHS. I should probably stress that there are two main methods for IVF, namely natural and mild IVF which differ very slightly. Louise Brown was conceived through a process of natural IVF where drugs for ovarian stimulation are not administered but ovulation suppression drugs are. Once the follicles have reached a certain degree of maturation, final oocyte maturation is induced by an injection of human chorionic gonandotropin. The egg is then retrieved transvaginally using ultra-sound guided needle which pierces the vagina wall to reach the ovaries. This approximately removes around 30 eggs and once this has been established, the eggs are fertilized accordingly before the embryo is embedded into the uterus using a thin, plastic catheter.

Contrary to belief, neither Edwards’ or Steptoe initially explored the concept of experimentation on fertilised animal gametes outside of the body. The first scientist to show an interest was in fact John Rock in 1937, one of the most prominent leaders in the field of infertility in the United States who foreshadowed the probability of IVF in his editorial the New England Journal of Medicine, ‘Conception in a Watch Glass’. It was, however, only years later that Rock inspired the minds of Edwards and Steptoe who developed in-vitro fertilisation into what it has become now.

In 1969, after prolonged experimentation on mice eggs to try and mimic vivo maturation in vitro, Edwards established that maturation was also possible on human follicles.

However, Edwards’ faced significant issues when trying to source a regular supply of human ovarian tissue. Local Cambridge supplies provided unreliable, so Edwards’ sourced a supply of eggs from America. It was the second scientific struggle that was then occupying most of his attention, namely that in order to fertilize these in-vitro matured eggs, he had to ‘capacitate’ the spermatozoa, a final maturation process which spermatozoa undergo physiologically in the uterus and that is essential for the acquisition of fertilizing competence. This issue was solved in 1968, where it discovered that altering the pH of the medium allowed a higher rate of fertilisation. Once this was established, treatment was relatively straightforward.

There are those that question whether IVF was more of an hindrance to modern medicine than good, however at face value the procedure definitely appears beneficial in more than one sense.

Since Edwards’ ground-breaking discovery, an enormous five million babies have been delivered by a means of in-vitro fertilization. Although this value may not mean much to ourselves, it has given the ability for infertile couples to finally have children of their own.

The possibility of deriving human embryonic stem cells also arose. These embryonic stem cells have the potential to ‘...differentiate into various cell types, and, thus may be useful as a source of cells for transplantation or tissue engineering’. However, use of ES cells are scarcely used.

An important scientific argument for IVF was that by studying fertilization and early embryonic development outside the womb, scientists might learn more about how to prevent certain birth defects. The knowledge gleaned from IVF would advance medicine in general, helping with prenatal care, for example. One negative impact is that IVF does bring certain medical complications with it such as ovarian hyperstimulation syndrome where symptoms include nausea and abdominal pains and ectopic pregnancies.

However, not everyone regards it a scientific endeavor.

Accompanying the concern that IVF wouldn’t work were fears that it might work too well; another group of critics warned that it would lead to the end of the nuclear family, with marriage replaced by laboratory breeding. Conservatives feared the creation of all sorts of non-traditional families, while some feminists worried that with new technology enabling more women to have children, the pressure to do so would increase. Others fretted that test tube babies would be socially ostracized.

Then there were those whose opposition did not depend on any specific bad outcomes; they considered IVF inherently wrong because it was unnatural. These critics saw it as an attempt by scientists to “take the Lord’s work into their own hands,” in the words of Pope Pius XII, and replace the divinely ordained means of making life with a technological process.

Robert G Edwards, however, was well aware of the ethical confrontation he received from not only the Catholic Church but also society and on many an occasion spoke of how IVF was morally acceptable. He wrote in the 2001 article, Nature: “Ethicists decried us, forecasting abnormal babies, misleading the infertile and misrepresenting our work as really acquiring human embryos for research.”. Similarly, many feared that the work of both Edwards and Steptoe would lead to the development of designer babies and thus fuel the work of eugenics, something which was a prominent issue during the 1940s in Hitler’s reign. The new scientific endeavor, some say, has had a negative impact on society.

The work of Edwards and Steptoe, as stated before, received much skepticism and when news of their discovery spread, many of their peers who were still scarred from the experience of Thalidomide, were incredibly belligerent. One particular critic stated that he hoped one day, that the child would be born seriously impaired to be a lesson to society that no child should be created by the process of IVF and even the notable James Watson, who pioneered DNA, forewarned Edwards.

Despite the controversy that surrounded IVF and objections some still have, it is obvious that IVF is here to stay and is widely accepted.