There have been 40 years since the first successful In Vitro Fertilization took place in England, where Prof Robert Edwards and Dr Patrick Steptoe pioneered a method that would change physiology and the lives of millions of couples forever. The first baby was conceived, resulting to the birth of Louise Brown, via a planned caesarean section at Oldham General Hospital on July 25, 1978.
More than 8 million babies have been born worldwide in the decades that followed, while Prof Edwards was awarded the Nobel Prize for physiology in 2010, for the development of IVF therapy, since his achievements have made it possible to treat infertility, a condition that affected more than 10% of couples around the world.
IVF, as commonly referred to, is a process of fertilization where an egg that is removed from the woman’s ovaries is combined with sperm outside the body, in a laboratory. The fertilized egg undergoes embryo culture for 2–6 days, and is then transferred to the woman’s uterus to develop.
This method represents a milestone in the development of modern medicine and is uncontroversial and widespread. But it wasn’t something easy to achieve.
Prof Edwards and Dr Steptoe had been working from 1968, trying to fertilize a human egg outside the body and take it to the blastocyst stage – the point at which the cells in the embryo differentiate. But back then embryology was not even considered as a worthwhile field of study.
Finally, two years after Brown’s birth, Bourn Hall Clinic in Cambridgeshire was established, as the world’s first IVF clinic that went on giving life to thousands of IVF babies.
The progress of the science has its roots in the sexual revolution of the 60’s in Britain. Dr Mike Macnamee, chief executive of Bourn Hall, who worked with Steptoe and Edwards in the Clinic back in the early days, says that after the 60’s, a number of women had damaged Fallopian tubes because of sexually transmitted infections. As a result, 80% of early patients had tubal damage, compared to 20-30% today.
The first steps in undergoing IVF at the clinic back then were not easy. Eggs had to be harvested by laparoscopy – or keyhole surgery – while the woman was under general anaesthetic, something that meant that she had to stay at the clinic for four or five days. There were 30 beds in the clinic, which was always full, since it was the only place in the world that was offering the treatment. It was almost 20 years later that it became possible for women to have their eggs harvested under sedation, using ultrasound, and return home the same day.
Today, scientists continue to work on developing the technique. At Bourn Hall, in a new laboratory it is being investigated why some eggs fail to mature and develop correctly, which results to miscarriage and infertility.
Except for the first successful IVF in 1978, there have also been other techniques that should be considered as important milestones and that show the impressive advances made in the treatment of infertility over the past 20 years.
In the early 80’s the embryo freezing started to make its first steps in the field of infertility treatment, using a less invasive method, because ovarian stimulation or egg retrieval were not required. When the embryos are frozen, they can be stored for prolonged periods.
At the same period of time, the egg donation had also become more widespread and had created a new option for women having fertility problems because of the quality of their eggs. It is a fact that younger women’s’ eggs have normal chromosome numbers more often. For the convenience of numerous women looking for that kind of a solution, there are agencies that help match patients with egg donors from diverse backgrounds and see whether the donor is known, anonymous or semi-anonymous.
A bit later, in 1991, the ICSI (intracytoplasmic sperm injection) has progressed gradually, resulting to a percentage of 70% of US ART cycles using it as a first step in the solution of infertility. The method is using a single sperm that is directly injected into each mature egg, so that the risk of a not successful fertilization due to poor semen is reduced.
Two years earlier, Preimplantation genetic diagnosis (PGD) was first reported successfully in human IVF to identify a sex-linked disorder and to choose an unaffected embryo. This has helped a numerous diseases to be identified since then, with tens of thousands of couples with the potential for having a child affected with a severe genetic disease being able to avoid such a disappointment.
In the mid 1990’s, a helpful method for predicting the healthiest embryos came to light in science. It’s the embryo grading that in a world where almost 30% of IVF are twins, it distinguished which embryos were best to implant, leading to elective single embryo transfer (eSET), now considered an IVF “best practice” for most, but not all, patients.
In the late 90’s, Preimplantation genetic screening (PGS) had also started to make a strong appearance in embryology. This method follows a procedure that is performed before embryo transfer so that doctors can pick one without an abnormal number of chromosomes, increasing the chances of selecting a healthy embryo that will develop into a healthy baby. This is very important, since it is a fact that an abnormal embryo almost always fails to implant, or may lead to miscarriage, fetal death later, stillbirth or a baby with abnormalities.
Apart from the methods that have helped enormously in the procedures of infertility treatments, there have been also advances in the preservation of eggs and embryos that have benefited women with cancer, single women delaying motherhood and family building.
Vitrification or flash freezing is a method of cryopreserving embryos and sperm that together with conventional (slow) freezing are in the hands of each center to decide which method is best to use for each case.
The egg freezing has also helped women facing medical issues like cancer where chemotherapy or radiation could permanently impact fertility. Cancer survivors have a choice of having babies through egg freezing, embryo freezing, or experimental ovarian tissue freezing. It is important for patients who are diagnosed with cancer to work closely with their oncologist and review their options, as soon as possible.
Single women who need to know they will have the chance of becoming mothers have also this ability through egg freezing, though doctors generally don’t recommend the process for women over 38. Moreover, non – traditional families, like lesbian and gay couples have been wishing of bringing a baby into their lives more and more over time. For their convenience, ART helps family-building through a variety of options including reciprocal IVF or co-maternity for lesbian couples where one partner provides the eggs and the other partner carries the pregnancy, allowing both women to be physically involved in the pregnancy.
Gene editing is a method practiced for the last year (2016) and is a new technique (CRSPR) to edit embryonic genes that may eventually lead to more effective infertility treatment. It also helps those with a family history of disease such as muscular dystrophy through gene editing to make the embryos disease-free.
Infertility methods’ discovery has been on the rise for the last 20 years, with an enormous impact in the lives of millions couples all over the world. Time will tell more about the outcome of these progresses, though the revolution has already begun.
