The birth of IVF
By Professor Charles Kingsland, Consultant Gynaecologist & Specialist in Reproductive Medicine
Way back in 1979, the first IVF baby was born in Oldham, North of England (hoorah) within an NHS hospital, where, incidentally, most of the research had been performed too. There were three important people involved in this breakthrough.
Firstly, Professor Robert Edwards, who amongst a few other notable activities, like collecting a Nobel Prize, supervised parts of my Doctorate. He was the eminent scientist, from the University of Cambridge, but born and bred in Leeds, who carried out the ground-breaking research.
The reason Professor Edwards found himself in Oldham was that a Consultant Gynaecologist there, by the name of Patrick Steptoe, had returned in 1962 from the United States with a Laparoscope. No, he hadn’t bought it in Macys. It was a kind of telescope, small enough to put into a human abdomen with the aid of an electric bulb that you actually switched on inside the tummy, so you could see what was going on. Everything inside the abdominal cavity was a bit squashed, so in order to make more room, a gas was blown inside to create a ‘tent’ effect in order to improve visibility and make a bit more space. This gas used in humans was, and still is, carbon dioxide.
The first experiments, however, were carried out in farm animals using oxygen. Fortunately, cows exploding as soon as you introduced a naked flame to light the way, although rather embarrassing and ultimately extremely messy, was in most cases, far more acceptable than detonating humans. Carbon Dioxide, as all of you who did O level Chemistry are aware, lacks the combustibility of oxygen. Fortunately for his first human patients, so did Patrick Steptoe.
In 1962, Steptoe, originally working in London, after a bit of an altercation with the bosses at St Georges Hospital, left to seek his gynaecological fortune in Oldham. Not lost on his need to suck eggs out of an ovary, Professor Edwards thought this was a potential instrument of use and so raced up to the North as soon as he learnt about Steptoe and his non exploding laparoscopic technique to view the intra-abdominal cavity. From the dreamy spires of Cambridge, Robert set forth in his Old Volvo, back seat filled with test tubes and once there, formed the team that would change the world, unlike the other Oldham team, namely Athletic who have by and large left the football history textbooks undisturbed.
The third member of the group was Jean Purdy, Professor Edwards’s brilliant, but ultimately unassuming and hence less well recognised assistant. There were many other photo bombers in Oldham in the late 1970s, who in an attempt to embellish their own reputations and their place in history, tried to get in on the act. It was those three, who by all accounts were, the A team.
And so, it came to pass, that Louise Brown, the first test tube baby, was born in Oldham, in 1979, from an egg collected by Mr Steptoe via his laparoscope, and fertilised with her father’s sperm, by Jean Purdy, supervised by Professor Edwards. It was the 106th attempt at IVF made by the team, but crucially the first resulting in the live birth of a healthy infant in the whole of the World.
At the time, I was a second year Medical Student, just down the road in Liverpool. I remember well the cacophony of media noise made surrounding the revelation. There was widespread rejoicing in the press until someone thought, ‘hang on a minute’. The slow, but insidious realisation then came about that babies were actually being grown in test tubes.
Ethicists, Clerics, the Vatican and all sorts of opinion makers, not least society at large, jumped on the bandwagon of commentators. This is a situation that still prevails today in the specialty of reproduction; damsels in distress, babies, wicked scientists working away in dark dank laboratories, nasty doctors, sad beginnings, happy endings. The story of IVF is everything you want in a Harry Potter movie. It also provokes opinion, massive divisions in opinion, usually, but not exclusively, based on our own religious beliefs, prejudices and inherent bias. Everyone has an opinion on reproduction and the technologies associated with it.
It certainly divided opinion in 1979. Following the euphoria came the debate, confusion and opposition. Society simply wasn’t ready for the concept of babies being grown in a laboratory, especially an NHS laboratory. Heaven forbid! Our sacred NHS!
Nowadays, a generation later, everyone knows a test tube baby. 5% of all babies born in the United Kingdom are IVF babies and society readily accepts and embraces this technology. It has, however, taken a generation for it to do so and still today, new debates abound surrounding the new, scary but very exciting breakthroughs, which maybe in a future generation, be taken for granted. So, our heroes became villains. Auntie NHS rejected the concept of In vitro Fertilisation (IVF) and the A team were chased out of town together with their test tubes and microscopes.
What they had done, however, was to create a massive evolutionary breakthrough for countless thousands of couples across the world who without IVF would never have the chance to become parents, nature’s most powerful driving force. The need was there, all that was needed was the supply chain. The solution was created by the purchase of an old Jacobean hall, some 15 miles from Professor Edwards laboratory in Cambridge. And so the world’s first dedicated IVF clinic was conceived at Bourn Hall, Cambridgeshire.
I had the pleasure of working there for a short while in 1988 shortly after the death of Patrick Steptoe. Robert Edwards, however, was still as enthusiastic and as inspiring as ever. It remains one of my greatest memories and privileges to have been able to work alongside a true genius
Edwards went on to receive a Nobel Prize in 2013, sadly, too late for him to recognise the achievement as by then, he was in the later stages of dementia and sadly died shortly afterwards. Even then, we all knew in the specialty that he should have been rewarded many many years earlier for such a truly monumental breakthrough, but that’s bias for you.
I’ve had the pleasure to see and speak with four Nobel laureates since then. I’ve noticed a commonality between them. They have all been truly charismatic individuals, unfailingly pleasant together with an uncanny ability to make their subject seem unnaturally easy to understand.
Incidentally, if a Doctor appears to be talking nonsense to you, don’t blame yourself; it’s usually due to the fact that he doesn’t know what he’s talking about... you think I’m joking don’t you?
Alternatively, if they do know what they are talking about and make it sound complicated, they are showing off, so avoid them. You should also avoid doctors in shiny suits, grey shoes or jackets with elbow pads. That’s nothing to do with general opinion, it’s my own prejudice.
Scruffy unkempt Doctors are what they are, scruffy and unkempt. Just imagine what’s going on inside their brains. Similarly, beware the Doctor sporting a shiny stethoscope jauntily around his or her neck. They are simply showing off and would prefer to be on the set of that truly dreadful and totally unrepresentative teledross, Holby City.
Let’s recap: IVF has by 1979, been hounded out of the NHS. Bourn Hall subsequently became the epicentre of Reproductive Medicine. The demand for IVF far outweighed the supply. The NHS wanted nothing to do with it.
So, what happened next? Centres for IVF starting sprouting out all over the place, exclusively in the private sector. You couldn’t get treatment within the NHS so you had to pay. The ultimate commodity, a baby was available to many infertile couples, but at a price. A great business model was emerging.
Slowly, as society became more acceptable to the concept, so too did the NHS with the result that gradually and very carefully funding became available.
Kings College hospital in London was the first large NHS IVF Hospital under the eminent leadership of Dr John Parsons. This was closely followed by Professor Brian Leibermans, unit in St Mary’s Hospital in Manchester.
I arrived back in Liverpool as a fresh faced University lecturer in 1989. I had seen, researched and worked in the IVF system in London and Cambridge for two years. It now became my passion and goal to create a leading IVF unit within the NHS so that treatment would be available for patients in the City of Liverpool, free at the point of access.
Safe in the knowledge that stealth and cunning would always trump knowledge and ability, we borrowed £30,000 from the university to set up our first lab. A nurse and an embryologist were recruited, the laboratory was kitted out and were ready to go. In order to make ends meet, a decision was made to charge each patient £750 for their IVF cycle. Thereby we could pay back our loan.
A patient support group was established. I cannot begin to tell you how important these groups are in helping to lobby for recognition, funding and general day-to-day support for any unit. The embryonic IVF unit was viewed as slightly quirky by some, of little consequence by others, but by the Hospital Managers, it was nothing more than an inconvenience.
Hospital managers; what a bunch they are. I recognise that my view on all things might be one of over simplification, but if the Secretary of State were to drop by my house for a cup of tea and a bun during his ministerial downtime, I could offer my opinion, and it would resemble many of my Medical colleagues own opinions, as to how to solve the problems prevalent within the NHS.
I digress; our next challenge was to secure NHS funding for our new service. As I said before, IVF is very high profile but low priority. No one was at all interested in our service, until, of course, they suffered with a fertility problem themselves. At that point, Managers became extremely interested and engaged.
Despite exhaustive efforts by myself, my little staff group and above all, the patient support group, growing in number everyday, we were making little headway.
That was all to change around Christmas 1990. It just so happened that another of my abiding passions at the time was the Regional Hospitals Choir, run by an old boss of mine, Robert Sells, the recently retired transplant surgeon, who was now devoting his life to creating ‘rich brown noise’ amongst the songbird employees of the Liverpool Hospitals.
Robert had asked me to stage manage the 1990 Regional Carol Concert. I thought this to be a very worthwhile addition to my Curriculum Vitae until I realised the role of the Liverpool Regional Hospitals Choir, Stage Manager was to arrange the chairs and stack them away again after the concert. Roberts enduring charm that had prevailed again.
It came to pass on this holiest of all nights in the Choirs Calendar, that after I had painstakingly set out over a hundred chairs around the font of the Anglican Cathedral, I found myself sitting next to a crusty old baritone on the back row. We were idly chitchatting immediately after ‘Away in a Manger’ and just before ‘Ding Dong’ (oh, how I enjoyed the glorrororoorohia bit), when it turned out that he was the Chairman of the then Strategic Health Authority, an old retired Cheshire Pig Farmer by the name of Sir Donald Wilson. Not only did it turn out that he was an accomplished singer, he was also interested in Pig breeding. He also had an infertile secretary, I was later to find out, soon after I had described to him, my ambition in life.
After the concert, Sir Donald not only helped me to stack away the chairs after another successful choral interlude graced as ever by Ken Dodd who always turned out to read at least one of the lessons. I’m sure, if asked he would not only read all of the missives, but spend at least three hours at the end of the evening talking and telling jokes to anyone who would listen. Sir Donald and I went for a quick pint after securing the Cathedral. It became clear that Sir Donald was not only extremely interested in the new technology, but being a successful businessman, maybe he saw the opportunity for a spot (or Old Spot, sorry pig joke) of impromptu porcine IVF.
Sir Donald visited my unit a week later. We chatted over a cup of coffee. I introduced him to the staff and he looked down a few microscopes and into our incubator. He recounted the sad story of his secretary and her years of unsuccessful trying for a much wanted child. We sighed and shook hands as the doors of the lift outside our unit slowly closed. That was the last time I ever met Sir Donald, who had a farm.
Sometime later, I received a letter, from him, thanking me for my sterling work for the Regional Choir. He wished me luck with my career and new venture in Liverpool. He signed the letter “Best Wishes, Donald” it was the first time I had ever received a letter from a knight of the realm.
As I shuffled the envelope, out fluttered a previously concealed small piece of paper, oblong, no more than six inches by two inches. It was a cheque, made payable to my unit, for £250,000. On the reverse in small spidery writing, a short sentence was scrawled which was to change my life: “For your NHS IVF unit. Donald”. I had witnessed the birth of the first Assisted Conception Unit in Liverpool and that opened the door to many countless of thousands of subsequent births over the next 25 years.
The next piece in the jigsaw is a little less palatable, but serves to illustrate my lifelong challenges with NHS hierarchy. Once the management of the hospital discovered their clinical windfall, I was a reprimanded for not informing them about the Chairman of the Strategic Health Authorities unscheduled Hospital visit.
The cheque was whisked away from under my nose. I received not a thank you, kiss my backside or anything resembling gratitude, mainly because I had been innovative, single-minded, determined and willing to circumnavigate, quite legally the turgid overly bureaucratic administrative system, as existed at that time. Sadly, as the years have progressed, the system has worsened. The NHS Administration doesn’t like those sort of Doctors. They can be very dangerous and actually achieve something.
As you can now see, hopefully, IVF grew up in the private sector. Over 50% of all IVF treatment still resides outside of the NHS. IVF is, therefore, a business, a business dedicated to the welfare of the patients, not unlike the internal market of the NHS today, but nevertheless, a business.
To succeed, a business needs to be profitable. This is why the world of IVF still has a very strong commercial aspect to it. The cost of IVF per se, is not very expensive. Certainly nowhere near as expensive as say, a hip replacement or in my specialty, a hysterectomy.
The cost of running an operating theatre in your average district general hospital, for example, is about £20 per minute. For each patient that fails to attend their hospital appointment and does not bother to tell anyone, costs that hospital about £80. Health is a very expensive business and there are massive profits and losses, to be made.
IVF, as we have established, is very high profile and can be highly profitable, so it can attract all sorts of practitioners and from the peripheral world of pseudo medicine. Two or three generations ago, these non-medically qualified practitioners would have been known as ‘Quacks’ selling their dubious wares from the back of a caravan. This is where it can get very difficult for a patient to choose a Doctor or other Medical Practitioner to help them.