Part 1: History
As I have previously described in an earlier blog post, this year has been a great one for those of us who practice in the field of reproductive medicine as Dr. Robert Edwards was awarded the Nobel Prize for the pioneering work that led to the world’s first IVF baby Louise Brown in 1978.
However, Dr. Edwards did not just wake up one morning and decide to do human IVF on the spur of the moment. His work represented years of careful research into egg/sperm/embryo physiology. In the early 1960s he began research on the development of the human egg and in 1965 worked with Howard and Georgiana Jones at Johns Hopkins in Baltimore. Howard Jones provided Dr. Edwards with slices of human ovary from patients with PCOS who were undergoing ovarian wedge resection as a fertility treatment. The immature eggs were isolated and matured in the laboratory but the process was inefficient and Dr. Edwards was not convinced that fertilization was occurring.
Meanwhile, Dr. Patrick Steptoe, an accomplished gynecologic surgeon, was making startling advances in minimally invasive laparoscopic surgery. Dr. Edwards realized that laparoscopy would enable a less invasive means to retrieve eggs...especially if fertility drugs were used to induce the growth of multiple follicles. You have to remember that this was before high tech ultrasound or rapid hormone assays or GnRH agonists (Lupron) or GnRH antagonists (Centrotide).
By 1971 they had grown fertilized embryos out to the blastocyst stage and decided to begin attempting to transfer the embryos back to the uterus with no success in nearly 100 attempts. Finally, in 1975 they had a positive pregnancy but it was an ectopic. Concerned that the use of fertility medications to induce multiple follicles was the problem, Dr. Edwards dramatically changed course and decided to attempt Natural Cycle IVF with Dr. Steptoe attempting retrieval of the single dominant follicle. Lesley Brown, who had no fallopian tubes as the result of previous surgeries, was the second patient to attempt Natural Cycle IVF. And the rest, as they say, is history....
Louise Brown’s imminent arrival was a worldwide phenomenon in the summer of 1978. I remember reading the Time magazine article about IVF and even remember the striking cover that graced the magazine’s July 30th issue. However, when I realized that the embryo was actually growing in Lesley Brown’s uterus, I was much less impressed. Heck, anyone who reads science fiction knew that IVF was anticipated for years or even decades...but an artificial womb...well that would have been pretty cool to my 13 year old way of thinking.
Natural Cycle IVF was technically more challenging that stimulated IVF and the tide soon turned towards the use of clomiphene or a combination of clomiphene and gonadotropin injections. The next IVF babies were born in Australia and India.
While Steptoe and Edwards were making advances in the mid 1970s, Howard and Georgiana Jones at Johns Hopkins were preparing for retirement. Hopkins had mandatory retirement at age 65 and allowed Howard to stay on for 2 years until his wife reached 65. One of their close friends and proteges was Dr. Mason Andrews, an obstetrician-gynecologist who lived in Norfolk, Virginia. He was able to launch a fledgling medical school (Eastern Virginia Medical School) in Norfolk but was having trouble recruiting faculty. He convinced both of the Jones to join his faculty upon their retirement from Hopkins.
Louise Brown was born the day that the Jones arrived in their new home in Norfolk. Sitting among the packing boxes a reported asked Howard Jones if IVF would be possible in the US. He replied that “all it would take would be money.” His comments were published in the local paper where one of their former patients saw the need and called the next day to pledge support. The Jones Institute was soon launched. Although they initially attempted Natural Cycle IVF they had failure after failure. Finally, they decided to try fertility injections and were successful with Judy Carr who had come to Norfolk from Massachusetts (where IVF was illegal).
Dr. Howard Jones is now 100 years old and amazingly bright and energetic. He spoke at this year's ASRM and was amazingly erudite and witty. If only we could all be so lucky. Not bad for someone who "retired" 35 years ago!So although IVF began with Natural Cycle IVF, the technical challenges of the time made the use of fertility drugs more attractive. Next up..Part 2: Why Natural Cycle IVF Remains Appealing to Patients.
If you are interested in reading more about the early history of IVF, then I recommend the following book by Robin Marantz Henig. Pandora’s baby: How the first test tube babies sparked the reproductive revolution. 2004. Houghton Mifflin Co. Boston, Massachusetts, USA. 256 pp. ISBN: 0-618-22415-7 (hardcover).
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