Why the first test tube baby nearly didn’t happen
As our Wellcome Film and Image of the Month posts yesterday indicated, it was 32 years ago that the birth of the world’s first ‘test tube baby’ using the new technique of in vitro fertilisation (IVF) occurred.
It revolutionised reproductive science but this major development was privately – rather than publicly – funded as the largest funder of biomedical research at the time, the Medical Research Council (MRC), had declined to provide support, rejecting the grant application in 1971.
The reasons behind that much-criticised decision are revealed in a paper published in Human Reproduction, and it was not simply due to establishment hostility to a controversial new technology.
Professor Martin Johnson, from the University of Cambridge, and colleagues spent three years studying MRC records at the National Archives at Kew in Surrey, and documents from the Royal College of Obstetricians and Gynaecologists, Addenbrooke’s Hospital, Cambridgeshire County Council and Cambridge University Library. The researchers gained access to the private papers of Bob Edwards, one of the original researchers, and also interviewed many of the key people involved in the MRC’s decision.
Their analysis reveals an extremely cautious attitude from the MRC and the referees judging the grant application. They had concerns about the quality of the embryos resulting from IVF and whether the babies born would have severe abnormalities. There were also doubts over the success rate of the technique, which at the time were extremely small, and the use of laparoscopy to recover human oocytes, a technique that had yet to be widely adopted by clinicians.
These and other concerns over patient safety made them doubt the wisdom of funding embryo transfer without conducting studies in primates first (although, in an accompanying editorial in Human Reproduction, Professor John Biggers from the Harvard Medical School, argues that “work on primates was so impractical that the development and adoption of IVF would be delayed for many years”).
Moreover, infertility treatment was a low priority for the MRC. There were also questions over whether the funding body should be favouring research into limiting human reproduction (contraception) or promoting it (infertility treatment), as well as ethical concerns over interfering with the process at all.
But Professor Johnson and colleagues suggest that the two researchers, Bob Edwards and Patrick Steptoe, also made strategic errors in their funding strategy. There was enthusiasm for the technique from some quarters of the MRC, matching the organisation’s overall push toward research in obstetrics and gynaecology. Edwards and Steptoe were invited to join the directly funded Clinical Research Centre at Northwick Park Hospital in Harrow but they declined the invitation, instead choosing to seek long-term grant support at the University of Cambridge. This decision left them competing for funding with other research projects and opened them up to the scrutiny of sceptical referees.
The University also lacked an academic Department of Obstetrics and Gynaecology at the time, which made it difficult when Edwards insisted on establishing a clinic in Cambridge rather than at other sites that had been suggested by the MRC. And their application to the MRC was a substantial one – equivalent to £600,000 to £700,000 a year today. Some referees also felt Edwards was trying to do too much and, in his Editorial, Professor Biggers wonders if a more modest application, focused on improving the techniques, would have been more successful.
The high media profile of Edwards and Steptoe also did them no favours. The referees strongly disapproved of the media circus, which they felt was an inappropriate way to discuss with the science and ethics of infertility treatment in public.
Professor Johnson disagrees with this, arguing that Edwards did a service by stimulating an extensive ethical debate on clinical IVF, contrary to the standard view that bioscience and biomedicine is only ever reactive when it comes to ethical considerations.
“Although attitudes to medical scientists in the media have changed significantly since the 1970s, scientists and clinicians engaged in high-profile work still face a dilemma. If they encourage public discussion of their work – which they may see as both necessary to securing support and desirable to ensure full ethical debate – must they inevitably weaken their standing among their peers?”
The backgrounds of the two main researchers may also have played a part. Neither of them was seen as part of the “medical establishment”. Steptoe was a gynaecologist at a relatively minor hospital in Oldham. Edwards, a physiologist, was not medically qualified or a professor, and his PhD was from the Institute of Animal Genetics (although it was a leading institute in developmental genetics at the time).
Nevertheless, Professor Johnson says the story is far from a tale of two courageous mavericks pitted against an overly conservative establishment. “Edwards and Steptoe were outsiders and did pioneer – against prevailing wisdom – new ideas, therapies, values, public discourses and ethical thinking. But the process of decision-making was more complex than the myth allows,” he says.
Edwards’ science was held in high regard by the MRC and it seems a combination of their caution, circumstance, and Edwards and Steptoe’s ambitiousness and grant tactics led to the unsuccessful application.
Johnson believes that the decision-making processes for awarding funding today are more open and transparent, with discussion in the wider community and the media actively welcomed, as evidenced by the two Human Fertilisation and Embryology Acts in 1990 and 2008. And, lest we forget, Edwards and Steptoe’s determination saw that their research succeeded, despite the early funding setback. Good science can find a way.
- Johnson, M., Franklin, S., Cottingham, M., & Hopwood, N. (2010). Why the Medical Research Council refused Robert Edwards and Patrick Steptoe support for research on human conception in 1971 Human Reproduction DOI: 10.1093/humrep/deq155
- Biggers, J. (2010). Editorial Human Reproduction DOI: 10.1093/humrep/deq156