History Seen Through a Test Tube
Octomom Post Facto: One Egregious Aberration Does Not a Case Make
SOURCE: AP/ALASTAIR GRANT
Louise Brown, front center, with Alastair Macdonald front fourth left, the first in vitro fertilized female and male babies born, attend the 25th anniversary reunion at the Bourn Hall Clinic near Cambridge, England in 2003.
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The birth of Nayda Suleman’s octuplets unleashed nothing short of a tsunami of negative commentaries on the discipline of Assisted Reproduction in general and in vitro fertilization in particular. We have heard it all. The unregulated Reproductive Industrial Complex. The purveyor of the scourge of high order multiple births. The spawner of conveyor-belt medicine. And that is just for starters. Indeed, much worse has been said about this discipline, a perennial punching bag so many love to hate. Clearly, it’s high time for the cavalry, the absence of an appropriate anniversary or some such excuse notwithstanding. After all, the 30th red-letter day of the birth of Louise Brown has come and gone. But no matter, it is time. So too say the proud parents of the 3 million “IVF babies” in our global midst.
For those of us born after 1978, IVF is just as plain a fact of life as is coronary angioplasty. As such, IVF is no more special than any of the other dazzling medical technologies all around us. And yet, history was made and barrenness vanquished forever when Louise Brown was born on July 25, 1978 at the Oldham General Hospital in Oldham, England. Now married and the mother of a three year old (naturally conceived) son, Brown has rightly earned an unassailable and indeed storied spot in this special human enterprise. And so of course did Patrick Christopher Steptoe and Robert Geoffrey Edwards—the pioneering scientists who made it all possible.
Oft forgotten in the haze is the personal triumph of Lesley and John Brown, Louise’s parents, whose primary infertility (attributable to Lesley’s blocked fallopian tubes) remained unrequited through Lesley’s 30th birthday. Having endured untold hormonal tests, multiple painful radiologic assessments, several surgical procedures, and a complicated high-risk gestation, Lesley finally prevailed. To those who say that infertility is not a disease, we point out the hurt of childlessness, the agonizing wait, and the all-too-frequent letdowns. To those who say that the right to a family is elective, we suggest that they take up the argument with the untold number of those affected—10 percent of couples worldwide.
More familiar is the personal triumph of Edwards and Steptoe, whose dogged 12-year collaboration and daring conviction finally resulted in success. Indeed, Edwards had gone down that road several times before only to be rebuffed. Although one can only guess how the physician-scientist pair felt that fateful day, it must have been grand. This was after all a real game changer. The Lasker Award Committee reached similar conclusions, as it selected Edwards (Steptoe passed away in 1988) to receive the 2001 Clinical Medical Research Award “For the development of in vitro fertilization, a technological advance that has revolutionized the treatment of human infertility.” In that Lasker Awards often presage future recognition by the Nobel committee (76 Lasker laureates have received the Nobel Prize, including 28 in the last two decades), a Nobel Prize may well be in the offing.
Talk about disruptive innovation. Defined by Harvard Business School Professor Clayton M. Christensen as an innovation that creates a new (and unexpected) field of endeavor, IVF fits the bill: a radically creative innovation meeting an unfulfilled need. Indeed, prior to 1978, there was precious little one could offer the Browns in their desperation. The ascent of IVF changed all that. However one characterizes the nature of the innovation involved, to many, the abolition of infertility for all practical purposes ranks right up there with the greatest medical discoveries of all time.
In retrospect, Louise Brown almost never happened. Indeed, the odds for success were hardly favorable, perhaps quixotic. And yet, success knocked when a single egg—laparoscopically retrieved by Steptoe in the course of a natural menstrual cycle—was fertilized in vitro by Edwards to yield an implantation-worthy eight-cell embryo. What are the odds of this going on to be a viable pregnancy following the transfer of a single embryo with 1977 technology? Impossible to tell but likely below 10 percent per embryo transferred. After all, the very best which today’s natural-cycle IVF technology can offer might yield no better that a 15 percent ongoing pregnancy rate per embryo transferred. Even contemporary IVF technology would be hard-pressed to yield better than an 18 percent live birth rate per single embryo transferred. It stands to reason that neither Edwards nor Steptoe paid any attention to the odds. Toughened by multiple prior failures, it was too early for the pair to call it a day. Such is the power of conviction and the world has never been the same since.
At the time of this writing, well over 3 million “IVF babies” will have been born worldwide. What this means is that innumerable barren couples have been spared the agony of Lesley and John Brown. This also means doing away with the painful physician utterance: “So sorry but there is nothing more we can do for you,” standard fare prior to 1978. Hard to imagine but it was not all that long ago that the walking child-less were quietly suffering in our midst. To think about the countless couples doomed to a child-less life is to realize a collective pent up pain, only occasionally relieved by adoption when elected. Parenthood is a presumption after all: one we are led to expect; one we mourn if denied. It is a big piece of what we are here for. Keep the aspidistra flying.
This is not to say that assisted reproductive technologies are all about benefaction and entirely beyond reproach. Issues in need of resolution abound. Just consider the ongoing multiple-gestation epidemic. And yes, constructive criticism is welcome. But as the debate rages on, let us neither forget nor forsake the fundamentals and the magic of that distant summer night, the echoes of which will continue to reverberate for a long time to come.
Eli Y. Adashi, MD, MS, FACOG, is a professor of medical science, the outgoing Dean of Medicine and Biological Sciences, and the Frank L. Day Professor of Biology at Brown University.
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