40 Years of IVF – A Personal Perspective
By N.C Sharp, Senior Director at Bath Fertility
I graduated from medical school in 1976, having decided to pursue a career in Obstetrics & Gynaecology. I was therefore a Junior Doctor when the birth of Louise Brown was announced in July 1978, and the collaboration of a Scientist (Robert Edwards), a Gynaecologist (Patrick Steptoe) and an Embryologist (Jean Purdy) had achieved this miracle of fertilisation of a human egg in vitro. The speciality of IVF was launched with subsequent far-reaching benefits for millions of people.
I was particularly excited since my chosen career now embraced IVF, and I decided that this was something that would definitely be of interest to me later in my career. My general training continued in Obstetrics & Gynaecology for the next nine years, by which time it was concluded. Before applying for a consultant position in the UK, I requested a sabbatical year to train in IVF. This was granted, and I was fortunate to obtain a position as Honorary Visiting Consultant in a premier IVF unit in Adelaide, South Australia, where I started in May 1987. At this time there was still much development work in the IVF field, as we constantly sought to improve the pregnancy rate from IVF.
During my year in Adelaide I was asked to initiate the Donor Egg Programme for South Australia & the Northern Territory. This was a new area of treatment, and there was no “recipe book” to follow, so I just had to do it from first principles. I called up the patients who had been put on a waiting list pending the invitation of the service. I took various measurements of their uteruses and started them on hormones, measuring the uterine responses in terms of size increase and endometrial development, and from this worked out a possible hormone sequence and dosing that would prepare the uterus for a donated egg. We had to make our own progesterone pessaries and tried three different recipes to find the best one.
No one was more surprised than me when the first donation we tried actually worked and the first donor egg pregnancy in South Australia – a girl – resulted from my Donor Egg Programme. Another first in South Australia from my work was the birth of GIFT Quadruplets, which although not an entirely ideal outcome resulted in four healthy babies and hugely enhanced the reputation of the unit. GIFT stands for Gamete Intra Fallopian Transfer, and was developed because laboratory culture was still sub optimal compared to the human body; so for women with normal fallopian tubes, GIFT could be an option.
The eggs would be collected under General Anaesthesia using laparoscopy (key hole surgery) and the Embryologist would be in the operating theatre with portable a incubator (a modified baby incubator with holes in the side for microscope eye pieces). Two of the collected eggs would then be loaded into a tiny catheter, along with a droplet of concentrated, washed, prepared sperm, separated by a tiny air bubble. This catheter would then be handed to the surgeon who would then introduce this through the laparoscope, into the open end of the fallopian tube. The eggs and sperm meet inside the fallopian tube, mimicking nature and avoiding laboratory culture, and fertilisation then occurs inside the tube. In this case, all the eggs fertilised and successfully implemented, but this was the first time this had occurred with the standard protocol. GIFT is now obsolete, as IVF culture conditions have improved hugely. Other obsolete techniques: Sub Zonal Insemination (SUZI) and Zonal drilling (which didn’t work) have been replaced by ICSI (Intra Cytoplasmic Sperm Injection) which does work, allowing treatment for men with only a tiny number of sperm available.
Many other developments have occurred improving pregnancy and increasing availability of treatment to a wider range of problems, and over the last 40 years the pregnancy rate and success of IVF has steadily improved and will continue to do so.
In the early days of IVF, some workers in the field who could not replicate the success of Steptoe and Edwards felt there was some secret step or ingredient that was being used by the pioneers that made it difficult for others to follow. Steptoe and Edwards maintained that it was simply attention by detail, nothing more than that was the reason for their success. I had the pleasure of sitting next to Patrick Steptoe at lunch years ago. He was a shy modest man with “greatness thrust upon him” and he confirmed there were no secret steps. Even today, “attention to detail” remains the bedrock of effective treatment in any successful treatment centre.
It still seems unimaginable that those experiments 40 years ago have led to the most important development in medicine, probably since the discovery of Penicillin, and millions of people have since benefitted as a result of those early pioneers. I have had a fortunate career in my chosen specialty, but my work in the field of IVF over the last 30 years has undoubtedly been the most rewarding. There is nothing more delightful to me than showing the presence of an early pregnancy on an ultrasound scan for someone who feared that they might never have a child of their own. As an Obstetrician I have also been able to deliver some of the children and in a few cases I put the embryos inside the uterus, and I then removed them again nine months later, when they were “done”. How cool is that? – fantastic is what!