With a new Netflix film Joy telling the dramatic story of IVF, Dr Kamal Ahuja recalls the inspirational role that the late Sir Robert Edwards played in his own career and in the foundation of the London Women’s Clinic
BY DR KAMAL AHUJA, IMAGES PROVIDED. ROBERT EDWARDS, LEFT, PATRICK STEPTOE, MIDDLE, AND DR KAMAL AHUJA, RIGHT, IN 1987
Sir Robert Edwards, recipient of a Nobel Prize for medicine in 2010 and of a belated knighthood the following year, is the subject of a new Netflix film whose real-life drama matches anything that an imaginative scriptwriter might compose. The film, which opens for public release in November, tells the 10-year story of how Bob Edwards, along with his colleagues Patrick Steptoe, a gynaecologist based in Oldham, and Jean Purdy, a nurse through whose eyes the story is told, finally achieved the birth of the world’s first IVF baby. It’s a story of science and tenacity, of one disappointment after another, in their attempt to fathom and recreate the mysteries of reproductive biology in the laboratory, to achieve conception not in its natural environment but in a glass petri dish. It took Bob and his colleagues at least 10 years of frustration and condemnation before the birth of Louise Brown in 1978 finally laid the doubts and the criticism to rest and announced to the world that IVF was no longer a mere possibility but now a reality.
Bob’s great triumph was, for me, a force of inspiration and determination. Supported by St John’s College research studentship, I had arrived in Cambridge on a wet evening in 1977 as a young reproductive scientist from India about to begin a PhD in Bob’s physiology laboratory. It was, with Louise’s birth less than a year away, a place teeming with intense activity, as Bob and his research group fitted the final pieces into their test-tube jigsaw of human conception. Yet once I’d set foot in the Marshall Laboratory and been welcomed by Bob in his third-floor office, every drop of trepidation drained from me. From that day on and for the next three decades, Bob Edwards became the most profound influence on my life and career. I was not alone.
Bob Edwards set in motion not just my own career in reproductive medicine but that too of many others round the world who would take their first tentative steps of progress in the treatment of infertility. It’s remarkable to imagine that today, 46 years after the birth of the world’s first IVF baby, there have been at least 12 million more births, each one precious to their parents and all of them no more than a dream without the technology of IVF. That technology has now exploded into genetics to enhance the safety of embryos and freezing to allow the preservation of fertility and the storage of embryos for future treatments. There has also grown around IVF a whole world of professional societies, specialist journals, regulations, supply chains and of course business investors. At the last count in one estimation the value of the fertility “industry” was put at $1.7 trillion – and all because of that one man, Robert Edwards.
When I joined Bob’s laboratory in 1977, Cambridge had already witnessed two monumental discoveries: in the early 1930s two physicists Walton and Cockcroft became the first to split the atom, which, according to their Nobel Prize citation, for the first time brought “a nuclear transmutation” entirely under human control; and 20 years later Watson and Crick presented the three-dimensional, double-helix model for the structure of DNA, again in Cambridge. IVF would be the university’s third great world-changing discovery, one which forever for many would significantly reduce the pain of infertility and shape the lives of millions of families throughout the world. Today, in countries like Belgium or Denmark with generous state support for IVF, as many as two in 10 children in every classroom will have been conceived by IVF. And even in the USA, where each IVF treatment is paid for by the patient (or their insurer), as many as 2.5% of all babies born today are conceived by IVF.
My own work in Bob’s Cambridge laboratory, for which I received my doctorate in 1985, was in the study of sperm cells and their ability to fertilise an egg within the fallopian tube or in a culture dish. It was just a small part of the huge programme Bob had been working on to understand human conception and that chain of biology which runs from fertilisation to the formation of an embryo and the beginning of a pregnancy. Bob had published each small scientific step of his work in medical journals, but in so doing had raised in the eyes of some the spectre of defying God. Even the Pope denounced IVF as unethical, forbidding its use among Catholics. “But you can never ban anything,” Bob would later say. “You can say, hang on a minute. But never say never.” Today, IVF is used as keenly by Catholics as by any other group.
Of course, the birth of Louise Brown in 1978 ended some, but not all, of the criticism – which is why IVF was never embraced by the National Health Service (NHS) and why Bob himself had to search for a private clinic after the birth of Louise. Indeed, he had had very little financial support for his work throughout the 1960s and 70s – even from the UK’s Medical Research Council – but was still driven by his neverending enthusiasm and a belief in the evidence he had by then accumulated from human biology. So, it was not until the birth of Louise Brown that Bob’s work was recognised for the achievement it was, both as a triumph of science and, in the demonstration of IVF, a means at last of treating infertility in women. Subsequent developments in assisted reproduction – such as the introduction of intracytoplasmic sperm injection (ICSI) in the early 1990s for the effective treatment of male infertility – were equally monumental events, but would never have happened without the lead and inspiration of Bob Edwards. The use of stem cells for regenerative medicine, preimplantation genetic testing (to remove the risk of inherited diseases in the children of affected couples), and single embryo transfer for the avoidance of multiple pregnancy in IVF were all predicted throughout this remarkable decade before the birth of Louise. It was all, reported The Times newspaper in 2003, “the medical equivalent not just of climbing Everest, but of discovering an even higher mountain and climbing it unaided”.
Bob and Patrick Steptoe eventually established their private clinic at a country house outside Cambridge called Bourn Hall, and it was here where their IVF programme would once again get under way. I in the meanwhile had joined another of the great pioneers of IVF in Ian Craft at a private hospital in London, where we would also develop our own programme and eventually establish Britain’s first satellite IVF clinic – in Darlington.
Just a few years later Bob had extended his clinical interests to London with the opening of the Bourn-Hallam Medical Centre at 113 and 115 Harley Street, a centre which would soon after become the London Women’s Clinic. It was here that IVF was firmly established as an outpatient day procedure, and many important studies – particularly in the development of the GnRH agonist drugs to trigger ovulation in IVF – were conducted here. In 2004, I had the opportunity to acquire the Harley Street Institution and it was a privilege to know that Bob had already played a significant role as its Scientific Director.
By 1990 Bob’s prolific career had been behind the worldwide take-off of IVF, the establishment of Europe’s premier professional society in reproduction European Society of Human Reproduction and Embryology and its journals and subsequently the founding of a new breakthrough medical journal under his own editorship. That journal, Reproductive Biomedicine Online (RBMO), was edited by Bob from its foundation in 2001 and when Bob’s health declined I gladly became its chairman in 2010, joining several of his former colleagues in support. Today, RBM Online is one of the world’s leading journals in reproduction, and yet another tribute to Bob’s unfailing vision and drive.
Every one of Bob’s great achievements needed endurance and tenacity, two characteristics which would serve me well in my later career. But the truth is that to be on the ground floor of an emerging medical specialty like IVF and have a ringside view of the many ethical, regulatory and social changes taking place, was truly serendipitous. Whenever I was with Bob I was in the right place at the right time.
Luck, of course, has played a part, but here at the London Women’s Clinic we have, like Bob, always put the patient first and followed their direction within the framework of the law and social change. Indeed, it was three patients back in the 1990s who led us to our first big ethical and clinical challenge – in egg sharing, a scheme suggested by three Tyneside patients at our satellite clinic in Darlington: free IVF treatment in exchange for anonymously providing a portion of their eggs for someone else’s treatment. It took many years and many studies to show that this scheme of mutual benefit neither contravened the UK’s code of practice nor offered advantage to one patient over another. Today, the concept of egg sharing is practised globally mostly in Freeze and Share programmes available to those women preserving their fertility by egg freezing. Indeed, egg freezing, seen by Bob 50 years ago as a speck on the scientific horizon, is today a core treatment at most IVF clinics worldwide.
Bob set the science of IVF in motion for the benefit of what are already millions of families. Today, those families are of multiple forms made possible by egg and sperm donation, surrogacy and of course routine IVF and ICSI. There are now families born to same-sex female and male couples, to single women, even women whose natural fertile life seemed almost over. Societies have kept pace with these changes, both in terms of cultural acceptance and the regulations which keep them in check. And as time has marched on so we too at the London Women’s Clinic have kept pace, responding to our patients but ensuring that what we do is ethical and responsible. That’s how Bob saw IVF. He saw the ethical challenges from the very beginning and was the first to support a code of practice held in place by legislation. He was a guiding force for most of us now in IVF, but for me personally he was the inspiration to which I and our patients owe so much. A celebration of his life and achievements, as created by Netflix in this the centenary year of his birth, is a fitting tribute to that force of inspiration.
Joy, a Netflix movie based on the story of the world’s first IVF birth, is in cinemas now. The film is titled after the middle name of Louise Joy Brown, the world’s first “test-tube” baby.
Dr Kamal Ahuja is the chairman of Reproductive BioMedicine Online and Scientific and Managing Director of London Women’s Clinic. Find out more at londonwomensclinic.com
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