Three decades ago today, on 25 July 1978, Louise Brown, the world’s first ‘test-tube’ baby was born. We asked New Zealand reproductive health experts to reflect on how far the science has come, and what may lie ahead.
John Hutton, Reproductive Medicine Specialist, Fertility Associates Wellington and University of Otago Wellington School of Medicine and Health Sciences said:
“The birth of Louise Brown just before midnight on the 25th July 1978 was an epoch event in the history of medicine, dramatically signifying the ability of our civilization to be able to take an egg from a woman, fertilise it in a test tube, grow it for a few days, replace it in the uterus and then have a healthy baby.
Since then, the growth of IVF has been phenomenal, and at least 200,000 IVF babies were born worldwide last year. In New Zealand, more than 1% of babies born last year were the result of IVF, and more than 1000 families integrated in to our society – surely better than not fulfilling your dream of a family.
This phenomenal growth has occurred because IVF has become more successful. Today, there is a >50% chance of a birth with the initial IVF, provided the woman is aged <37 years. Also, the indications for IVF now include prenatal genetic diagnosis (as IVF has embraced the new genetic technologies) as well as aging diseases such as cancer and endometriosis. In New Zealand, like other developed countries, women and men are now delaying their family well beyond their most fertile years, thereby increasing the demand for IVF.
But the fact that the natural occurrence of fertilisation of a human egg and sperm could occur unnaturally has spurred 30 years of controversy – there has been much ethical, moral and legal debate and definitions such as “family” have been questioned. Various countries including New Zealand have introduced laws to constrain the health professionals and scientists helping men and women have a healthy baby – and some of these rules have been dictated by fears rather than facts.
Whilst there have been problems during the last 30 years with the application of the technology such as too many multiple pregnancies and the occasional baby affected by chemicals early in its development in the laboratory, lessons have been learned, changes have been made and success improved – surely the best health audit circle.
And in the next 30 years, the new genetic technologies will improve the success of IVF and issues such as cloning will become accepted. The indications for IVF will also change, hopefully in part by our society changing so that reproduction occurs in younger men and women. It is, however, unlikely that by 2038 science will conquer the aging effects of egg and sperm, and diseases such as cancer and endometriosis.
Although today, 3.5million young folk have reason to celebrate Louise’s birth, in 30 years time there will be at least a further 6 million birthdays of other IVF beneficiaries.”
Wayne Gillett, Infertility Specialist, Obstetrics & Gynaecology, Dunedin School of Medicine, University of Otago said:
“In 1978 I began my own specialist training in this field, so the anniversary has special significance for me.
IVF has revolutionised the treatment of infertility. It is the dominant and most effective treatment for infertility. In New Zealand, however, there are significant gaps in access to treatment, simply from the limited funding directed towards those who would benefit. By contrast, in Australia there is unlimited access.
Much of the last 10 years has been directed towards improving the safety aspects of IVF. Nowadays multiple pregnancy is avoided.
The next 5 years will see continuing improvements in IVF delivery including embryo and host environmental factors that control implantation. In vitro maturation of oocytes is an emerging technology that has shown early promise with its main advantage in the avoidance of hyperstimulation and its consequences. Preimplantation genetic diagnosis (PGD) is also in its infancy in the routine management of female infertility. Although aneuploidy screening would seem to be valuable in older women, recurrent miscarriage and recurrent IVF failure, its routine use is yet unproven. In the next 5 years I would expect the assessment of embryo health to make significant advances. There is a rapidly evolving science that will enable advanced screening methods to select embryos with a molecular and morphological phenotype that promote successful development.”
Professor Cindy Farquhar. Postgraduate Professor of Obstetics & Gynaecology at the University of Auckland and trustee of the Nurture Foundation said:
“The arrival of in vitro fertilisation and assisted reproductive technologies 30 years ago was probably one of the greatest achievements for the latter part of the 20th century. It has made a huge difference to the many couples affected by infertility opening the way for childless couples to become parents.
“Prior to this time women were considered sterile if they had blocked tubes and there was little that we could do. At that time the success rates were very low (about 10%) but now most clinics report a live birth rate per started cycle of between 30 to 40% and if women (<40 years old) are able to complete 3 cycles of treatment then the likelihood of a baby at the end of 3 cycles is 70%.
“One of the drawbacks of treatment has been the increased multiple pregnancy rates of nearly 30% but this has now improved with the approach of replacing only one embryo at a time. The safety of the treatment has also increased with the use of less ovarian stimulation and shorter protocols. All in all, the arrival of IVF 30 years ago has provided many childless families with great hope.”
Neil Johnson, Associate Professor and Consultant in Obstetrics & Gynaecology Medical Director of Fertility Plus, Green Lane Clinical Centre, said:
“Can Louise Brown really be turning 30 years old?
“Although I was only a teenager at the time of her birth, the event stands out in my mind as something remarkable. The achievement of Patrick Steptoe and Bob Edwards with Louise’s mother Lesley was surely one of the most dramatic breakthroughs in the whole of medical science in the 20th century. In the entire field of medicine, there can be no greater wonder than the occurrence of a human life that would not otherwise have occurred!
“Thirty years have passed since the many lead up years of experimentation, frustration and innovation that led to Louise’s unprecedented birth. And we now have a new millennium of exponential progress. Fine tuning and mini-breakthroughs have now led to a treatment that enjoys high success rates: improving stimulation protocols, embryological laboratory expertise, ICSI microinjection that transformed male factor infertility overnight, PGD where the miraculous taking of a ‘cell or two’ from an embryo can give astonishingly accurate preimplantation genetic diagnosis, now even the plausibility of egg freezing. There have been disappointments and treatments that are unlikely to have wide applicability such as in vitro maturation (IVM) and ovarian tissue cryopreservation. Those that have challenged our morals and ethics, such as embryo stem cell research. And arguably some unsavoury developments, such as sex selection.
“There is virtually no-one who cannot now become parents. However in this age of so many opportunities, and as we celebrate success in infertility treatment, still a substantial minority of couples and individuals remain unsuccessful in their fertility quest – for many varied reasons. One of our biggest challenges is to assist these couples and individuals with making sure they have explored all options and, if so and if still unsuccessful, to assist them to manage the profound emotions associated with this in as dignified a way as possible.
“Furthermore, as we reflect on the advancement of hi-tech fertility treatment, we must not overlook the simpler, less invasive treatments. Our lipiodol research that has led to the development of a newly available treatment that has provided the ‘missing ingredient’ for many couples who had been unsuccessful with all other treatments (often including IVF/ICSI) is the classic example of this. At Fertility Plus, we have always been keen to individualise care to individuals’ and couples’ requirements and wishes. Whilst we pride ourselves on offering IVF/ICSI of the highest standard, shudder to think that we should ever become an ‘IVF conveyor belt’.
“So Louise, we salute you for allowing your life to become one of public interest – this has brought hope and inspiration to all those with infertility. Happy 30th birthday!
We have also put together a background paper on IVF, which is available in the Science Bytes section of the website. To speak to any of the scientists quoted about or to find more information about IVF, please contact the Science Media Centre on 04 499 5476 or firstname.lastname@example.org