Author: Robert Edwards and Patrick Steptoe
Overview
With a gentle and humorous prose, this book tells the inspiring odyssey of the making of the first ever test tube baby. Applying a narrative in which the coauthors provided their separate perspectives, the book conveys the journey they took, from conception to fruition, of the extraordinary idea of human invitro fertilisation. The book is a seamless chronicle of passion and perseverance on one hand, and science and innovation on the other – the ingredients that were the driving forces of the pioneers who ‘wanted to help people who had seemingly insoluble infertility problems’. The story is also symbolic of the process of discovery as it shows how ‘science moves haphazardly and often unpredictably‘, and how creative people overcome setbacks and seemingly unsurmountable challenges. At the heart of the narrative is the supremely empathic concern of the authors about ‘the right of our patients to found their family’ and ‘to have their own children’ – what they referred to as a ‘priceless asset’ and ‘a gift’ (pages 1, 6, 79-80, 90, 100 and 215).
Synopsis
The concept of human invitro fertilisation first occurred to the co-author, scientist Robert Edwards, who said he ‘gained a more detailed understanding of genetic inheritance, embryology, animal breeding, evolution, and the amazing growth of cells’ whilst studying at the Institute of Animal Genetics in Edinburgh. He particularly attributed this enlightenment to a lecture he attended in which fertilisation expert Alan Beatty demonstrated that a mouse egg fertilised externally could develop into a foetus when transferred into the womb. Edwards recalled how he ‘became more and more excited‘ at learning this, maintaining that ‘without the knowledge I was to gain in Edinburgh my later discoveries would not have been possible’. Equally important was Edward’s collaboration with Patrick Steptoe, a gynaecologist working at Oldham General Hospital, who was critical to the success of the project. Edwards described Steptoe, an expert in using laparoscopy to obtain Fallopian tube specimens, as ‘a man I could trust and respect and work with’, and as a man who ‘knew his mind‘. In explaining the secret of their successful endeavour, Edwards referred to their firm resolve, their total agreement with each other, their ‘exact understanding of their ‘respective tasks’, and their joint ability to that ‘make quick decisions‘ and ‘grasp each other’s problems’ (pages 9-14, 58, 61 and 82-83).
In narrating the challenges that dogged their attempts to achieve successful implantation of a viable zygote, the authors described the countless futile techniques they tried, from implanting thawed embryos and applying fertility drugs, to using bromocriptine to lengthen the menstrual cycle. Edwards also described how he repeatedly failed to fertilse the eggs in vitro, even using his own spermatozoa, adding that it took them about a year to ‘understand with certainty the ripening programme of the eggs in different species’. A different challenge the authors also faced was the antagonism of their colleagues and fellow scientists; referring to this as ‘the wounds of opposition‘, the authors attributed it partly to their observation that ‘scientists still did not truly believe that laboratory fertilisation of the human egg was feasible’. The authors however also referred to the hostility of those they called ‘absolutists‘ – those who ‘regard fertilisation as a kind of holy event above the interference of man’, and who ‘thought such a procedure undesirable‘, repugnant, and ‘unacceptable in principle’. Other objections the authors reported were theological and moral concerns that were based on the fear of selective breeding, eugenics, and cloning, and the challenge of declined funding by the Medical Research Council on supposedly ethical grounds (pages 4-5, 48, 51-57, 88-89, 115, 118-120, 103-104 and 109-110).
In describing the eventually successful stages of their project, the authors portrayed how they used fertility drugs to ripen the eggs in the ovary, and then removed them for fertilisation outside the body. They eloquently conveyed their sense of excitement at seeing an invitro blastocyst for the first time, referring to it as ‘the last stage of growth before the embryo begins its implantation in the mother’s womb’. Edward’s sense of awe at this was evident when he described these earliest stages of fertilisation as ‘some of the wonderful events of embryology‘, and as a process that ‘makes one more humble, more aware of the wonders of Nature as they unfold in all their beauty‘. He also expressed his sense of wonder at witnessing the chromosomes ‘just beginning their march through the centre of the egg’ – what he said was ‘a sight to reward all my past efforts’. Depicting all this as the culmination of their work, Edwards referred to it as ‘the realisation of an objective, a goal, which clinches and clarifies years of effort’, and as ‘the moment when everything became possible, when my hopes and endeavours over a long time began to take in their final realisation‘ (pages 40-41, 92-97 and 101-102).
A theme that permeated the saga of invitro fertilisation is the number of established but erroneous scientific dogmas the two pioneers had to dispel before they could make progress at every stage of their research. For example, Edwards described how he upturned the inaccurate paradigm, established by notable biologist Gregory Pincus, that human eggs only require 12 hours to ‘ripen outside the body and become ready for fertilisation’; on the contrary, Edwards described how he had to culture the human eggs for more than 24 hours before they ripened. Another scientific belief his research invalidated was the principle that egg ripening required the addition of external hormones, referring to this as ‘the orthodox scientific opinion‘ that ‘the mature ovary was not susceptible to gonadotrophic hormones‘. The constituents of the traditional invitro culture medium also turned out to be wrong, and the authors had to modify this for their work to progress – what Edwards called ‘a paradigm-breaking point‘ where ‘once again orthodox scientific opinion had been proven wrong’. Aside from overcoming false scientific doctrines, the success of the programme was also favoured by chance discoveries, such as when Edwards fortuitously read the work of M. C. Chang, a collaborator of Pincus, who showed that rabbit eggs needed to complete part of their ripening in the womb before implantation could occur (pages 23-25, 38-40, 45-46 and 84-86).
The culmination of the frustrating roller coaster project was the successful invitro fertilisation, implantation, pregnancy and birth of Louise Brown – the first ever test tube baby. The authors explained that her mother, Lesley, had infertility caused by blocked Fallopian tubes. The narrative highlighted various facets of Lesley’s story, from family fallouts and previous failed treatments, to the operation she underwent to clear adhesions. The authors also chronicled the strategies that facilitated their success with Lesley, for example removing toxic liquid paraffin from the culture fluid; measuring the levels of LH to guide when to remove the egg from the mother; and implanting the embryo at night when the levels of hormones were highest. The book also described the operative techniques the pioneers applied which involved the laparoscopic removal of spermatozoa from the Fallopian tube after intercourse, and the Caesarean delivery of the precious baby on 25th July 1978 (pages 82-83, 130-179 and 192-207).
Opinion
This book graphically highlights the value of basic science in making clinical advances by the way it demonstrates how a proper understanding of physiological mechanisms is essential to making scientific breakthroughs. It is also a potent reminder of how medical advances can be hampered by established but erroneous dogmas, and how new paradigms require that the old order be challenged. In showing that every new advance is built on breakthroughs in diverse fields, the book also conveys the point that innovation is the application of different tools to solve new problems. Also relevant is the book’s portrayal of the importance of the trial-and-error approach in virgin research fields – perhaps in its most extreme incarnation. The lack of an index and references was a glaring downside of the book, but the inspiring content adequately compensates for this shortcoming.
Overall assessment
The value of collaboration in making medical advances is perhaps this book’s key lesson. In depicting the unselfish and respectful approach both authors brought to their collaboration, they reinforced the value of healthy cooperation for all healthcare research and activities. The authors also bring to the fore the need to confront challenges in a determined way when seeking to make advances; they particularly illustrated how to overcome the opposition of the medical establishment which frequently hinders the emergence of major breakthroughs. More importantly, the book demonstrates how a wide knowledge of diverse fields come together to achieve a remarkable feat, and I recommend it to all doctors.
Book details
Publisher, Place, Year: Sphere Books Limited, London, 1980
Number of chapters: 26
Number of pages: 215
ISBN: 978-0722181736
Star rating: 5
Price: £6.76
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