Book contents
- Presenting the First Test-Tube Baby
- Presenting the First Test-Tube Baby
- Copyright page
- Contents
- Illustrations
- Tables
- Acknowledgements
- Foreword
- Abbreviations
- 1 Introduction
- 2 From Oldham and Cambridge to the Rest of the World
- 3 The Lecture, 1979
- 4 The Professional Reminiscence, 2019
- 5 The Local Reminiscence
- 6 The Legacy
- Index
- References
4 - The Professional Reminiscence, 2019
Retired Fellows Look Back
Published online by Cambridge University Press: 23 February 2023
Book contents
- Presenting the First Test-Tube Baby
- Presenting the First Test-Tube Baby
- Copyright page
- Contents
- Illustrations
- Tables
- Acknowledgements
- Foreword
- Abbreviations
- 1 Introduction
- 2 From Oldham and Cambridge to the Rest of the World
- 3 The Lecture, 1979
- 4 The Professional Reminiscence, 2019
- 5 The Local Reminiscence
- 6 The Legacy
- Index
- References
Summary
This chapter describes, and transcribes in full, a Reminiscence event in which ten original members of the audience of the 1979 lecture were invited to talk about their impressions of the meeting forty years before. They describe the atmosphere and reflect on how things were considered then and now. Notes explaining other relevant work and biographies of individuals mentioned are appended.
Keywords
- Type
- Chapter
- Information
- Presenting the First Test-Tube BabyThe Edwards and Steptoe Lecture of 1979, pp. 131 - 178Publisher: Cambridge University PressPrint publication year: 2023
References
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Participant note: ‘I think a lot had to do with the transfer of the embryos. At that time Patrick did all the embryo transfers using the sheath of a Venflon catheter which were usually used for giving intravenous infusions. It was in the early days at Bourn Hall when, because Patrick was not in the best of health, I started doing all the transfers. I found the Venflon sheath to be unsatisfactory so I contacted Harry Wallace who made catheters and explained what I wanted and he came up with a beautiful catheter which I understand is now used worldwide. Incidentally Bob put his name to the catheter, it became known as the Edwards–Wallace catheter and it was a couple of years later that Patrick, much to his annoyance, found out that he was also receiving a royalty on these despite having had no input whatsoever in the design’.Google Scholar
Participant note: ‘Bob thought that the gonadotrophin were shortening the luteal phase and used HCG and bromocriptine, if I remember correctly, in an attempt to correct this. I don’t think pure progesterone products were available then’.Google Scholar
Participant note: ‘Chatting with Robert Edwards and Martin Johnson, an early graduate student of Bob’s’.Google Scholar
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For details of funding for the Oldham research, see Johnson, MH, Elder, K. The Oldham Notebooks: an analysis of the development of IVF 1969–1978. IV. Ethical aspects. Reproductive Biomedicine and Society Online 2015;1:34–45, supplementary material 1: edited transcript of interview with Noni Fallows and John Webster conducted at Bourn Hall on 19 May 2014.Google Scholar
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Participant note: ‘To insufflate the abdomen’.Google Scholar
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Participant note: ‘How to insufflate the peritoneal cavity. Initially there were no gas insufflators or bipolar diathermy. Technical breakthroughs came when a telescope, cannula and cold light source became available. Initially only diagnostic laparoscopy was done, then sterilisation using tubal diathermy’.Google Scholar
Cartoonist who invented unfeasibly complicated machines. Participant note: ‘The device was made from an unused Boyle’s anaesthetic machine for CO2 insufflation’.Google Scholar
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Participant note: ‘I was keen to set up laparoscopy techniques in Southampton’.Google Scholar
Participant note: ‘John Hirst, a physician, asked Patrick to biopsy the liver of a nurse he was looking after … Hirst was extremely supportive and insisted that the outcome of his first attempt should not deter him from continuing to develop the technique and said he would talk to the patient and suggest she consider allowing Patrick to have another attempt … The nurse agreed to this and fortunately on this occasion the procedure was uneventful’. See ML, pp. 71–72.Google Scholar
Participant note: ‘Which is the bigger story is debatable but there’s no doubt that IVF has certainly brought more happiness to far more people than the moon landing. On the other hand, as far as I am aware, the landing on the moon didn’t upset anyone whereas IVF, or rather the failure of IVF, has caused a lot of heartache for many people’.Google Scholar
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Mr Ray Garry, consultant at Middlesborough General Hospital, was interested in introducing minimally invasive surgery using a TV monitor in gynaecology.Google Scholar
Participant note: ‘Guided remotely by TV monitor’.Google Scholar
The lecture was divided into three parts: see Chapter 2.Google Scholar
Four colleagues from Australia appeared on the audience list: Dr R Stanley, Dr A. Lopata, Dr A. Trounson, Dr D. M. Saunders; RCOG file E4/19 Registration List.Google Scholar
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Although this was a common criticism, Edwards had produced a very detailed, comprehensive article summarising his work. Edwards RG. Early human development from the oocyte to implantation. In Philipp, EE, Barnes, J, Newton, M, eds. Scientific Foundations of Obstetrics and Gynaecology. London: Heinemann Medical, 1977; 175–252; see alsoGoogle ScholarGoogle Scholar
Participant note: ‘What was different at Bourn Hall’.Google Scholar
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Bourn Hall, Cambridgeshire, was the clinic established by Edwards and Steptoe in autumn 1980, after they had completed their work at Oldham. An early conference on human conception in vitro was held there on 3–5 September 1981. The proceedings of the meeting, together with a list of attendees, were later published: Edwards, RG, Purdy, JM, eds. Human Conception In Vitro: Proceedings of the First Bourn Hall Meeting. London, 1982.Google Scholar
The Fourth Serono Clinical Colloquium on Reproduction, organised by Pier Giorgio Crosignani, occurred on 24–26 October 1982. It took place in Carmel, CA, USA. Days before this, in early October, the fifth FIGO congress on reproduction occurred in San Francisco, CA. Participant note: ‘In the USA as in Europe the stars of those congresses were predominantly the Australians’. For details, see Brown S. ESHRE: the first 21 years, www.eshre.eu/Home/About-us/History.aspx, accessed 8 February 2021, pp. 18–19. Proceedings of the Serono Colloquium in Carmel were published: Crosignani, P, Rubin, BL, eds. In Vitro Fertilization and Embryo Transfer: Proceedings of the Serono Clinical Colloquia on Reproduction, no. 4. London, 1983.Google Scholar
Participant note: ‘I did not attend Carmel as I was left to look after things at Bourn Hall. Evidently it was there that Patrick confronted Robert Winston and as I understand Winston apologised for what he’d said about IVF in the past, but Patrick wouldn’t accept his apology’.Google Scholar
After the births of Louise Brown and Alastair Montgomery in the UK (25 July 1978 and 14 January 1979, respectively), ‘firsts’ for other countries were Candice Reed (23 June 1980, Australia) and Elizabeth Carr (28 December 1981, USA). Lopata, A, Johnston, I, Hoult, I, Speirs, A. Pregnancy following intrauterine implantation of an embryo obtained by in vitro fertilization of a preovulatory oocyte. Fertility and Sterility 1980;33:117–120;Google ScholarGoogle ScholarGoogle Scholar
Participant note: ‘Alan Trounson was the senior embryologist with the Monash IVF group who between 1971 and 1976 was a research fellow at the ARC Institute of Animal Physiology in Cambridge, UK, where he worked on embryo freezing and embryo transfer in farm animals’. See Leeton, J. Test Tube Revolution: The Early History of IVF. Melbourne, Australia: Monash University Publishing, 2013.Google Scholar
Participant note: ‘referring to stimulation regimes and collection of eggs’.Google Scholar
For the actual sequence of pregnancies, see Chapter 3.Google Scholar
For the sequence of four pregnancies, see Steptoe, PC, Edwards, RG, Purdy, JM. Clinical aspects of pregnancies established with embryos grown in vitro. British Journal of Obstetrics and Gynaecology 1980;87:757–68; E&J.Google Scholar
Participant note: ‘I decided not to get involved as I had other priorities’.Google Scholar
Participant note: ‘Looking back at those early days in Oldham and knowing what we know now it’s pretty obvious that the lack of success then was largely due to poor egg quality. Patrick could collect eggs and Bob could achieve fertilisation in vitro providing the egg was of good quality but the problem was in getting good quality eggs on a regular basis. Although the sequence of events occurring in the natural cycle had been known for some time Bob had no way of monitoring these, we had no scans and Bob had no ready access to rapid assays such as they were in those days and had to rely on assaying total twenty-four-hour urinary oestrogens which is … time consuming. However even after doing these he had no idea when an egg would be mature and it was much later in the early days at Bourn when treatment was offered in the natural cycle, when we found that a mature follicle produces 80–120 micrograms/millilitre of oestrogen. The early work therefore was done in stimulated cycles using gonadotrophins the thinking behind it being that it would at least improve their chances of getting some mature eggs. However although gonadotrophins had been used since the 1950s they had been used in anovulatory women but now Bob and Patrick were using them in women who were ovulating so a problem arose as regards the dosage. The big breakthrough came in 1976 when HiGonavis, an immunochemical test which could detect rising levels of LH in urine, came on the scene which allowed the timing of egg collection to be more precise following which patients were treated in the natural cycle and pregnancies started coming through. Getting back to the question of secrecy surrounding the research, we had many visitors coming to Oldham mainly to observe laparoscopy but some of these wanted to know about the research and although a few were invited to see the set-up at Kershaw’s I can’t remember anyone actually being allowed to watch the oocyte recoveries or embryo replacements. Don’t forget Patrick and I were involved in running a busy obstetrical and gynaecological unit and the research was carried out at unsocial times, early in the morning and late at night so as not to interfere with the NHS work, so we didn’t have much time to talk to visitors. I know at times Patrick got downhearted about the lack of success and talked about packing it in and I’m sure Bob on occasions had similar feelings particularly with having to drive up and down from Cambridge. I think Martin Johnson summed it up best of all when we were on the Reunion programme on Radio 4 [‘The reunion’, broadcast on BBC Radio 4, 27 July 2003] when he said, ‘It was all done on a shoestring, in true British fashion!’Google Scholar
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A memory possibly relating to part of a celebration of the golden jubilee of the college.Google Scholar
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The first fertilisations in the Oldham programme were in 1969; E&J.Google Scholar
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Steptoe’s interest in Sinha was owing to the latter’s research in the immunological causes of infertility, studying local immune response in the cervix of infertile women. Sinha was also doing research in materno-fetal immunology on the placenta, on trophoblast antigen etc, all of which was key to understanding the mystery of the failure of the embryo to implant.Google Scholar
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Participant note: ‘The arrangement to deliver Mrs Brown had been made with some secrecy and only the essential staff were there together with the film crew of the Central Government Office for Information. The theatre porters hadn’t been notified so Patrick and myself went to pick up Lesley Brown from the Maternity Unit and this involved walking along a corridor which led from the main hospital past the theatre suite down to maternity, it was a walk of around seventy yards or so. Before he came to Oldham Patrick had applied for a consultant post at St George’s, his old alma mater, and the fact that he failed to get the job really rankled him, it was the monkey on his back, and every so often he’d bring this up’.Google Scholar
Azim Surani was an early graduate student of Edwards; Johnson, MH. Robert Edwards: the path to IVF. Reproductive BioMedicine Online 2011;2:245–62. He has been Marshall–Walton Professor at the Wellcome Trust/Cancer Research UK Gurdon Institute at the University of Cambridge since 1992 and Director of Germline and Epigenomics Research since 2013.Google Scholar
Professor Simon Fishel joined Bob Edwards in 1975 and then worked at Care Fertility, first based in Nottingham.Google Scholar