For years, the Nobel Committee for Physiology or Medicine passed over in vitro fertilization.
Its members were urged by obstetricians and gynecologists, among others, to award the Nobel Prize to British biologist Robert G. Edwards, Ph.D., and to recognize IVF for its reach and impact. Yet for years – for reasons which are discussed but may never be fully detailed – the committee made other choices, leaving in vitro fertilization and its main visionary to continue waiting in the wings.
In October, after Dr. Edwards’ wife was informed that her 85-year-old husband was being awarded the Nobel Prize for the decades of work he spent developing IVF; committee members explained that the time was right. And infertility specialists and other ob.gyns. felt vindicated.
“One to two percent of all newborns are conceived through IVF,” said Professor Göran K. Hansson, secretary of the committee, in announcing the decision. “IVF children are as healthy as other children … and many of the IVF children born in the 1980s now have children of their own, conceived without the help of IVF.”
Reproductive endocrinologists who are now active leaders in their field have called the award “gratifying,” “exciting,” and “long overdue” at a time when some 4 million babies worldwide have been conceived with IVF. For many of them, the 1978 birth in England of Louise Brown, the first child conceived through IVF, either drew them into the specialty, or propelled them forward with new or renewed drive.
They practiced amidst a steady stream of ethical and moral questions, and watched the technology go from one that, in many quarters, including some within their own profession, was vilified and considered a threat to humanity, to one that – while not without controversy, cost, and complexity – is now widely accepted as a key treatment for infertility.
They experienced the succession of developments that improved the success rates and possibilities of IVF – from the first birth of a baby conceived with a donated egg in 1983 and the first successful use of a frozen embryo in 1984, to the development of preimplantation genetics diagnosis (PGD) in 1990 and the development of intracytoplasmic sperm injection (ICSI) in 1991.
“IVF has enabled us to dissect the human reproductive processes in a way we weren’t able to do in the past. … There are very few things in medicine that have changed not only how we look at reproduction but life itself,” said Dr. Zev Rosenwaks, director and physician-in-chief of the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine at Cornell University and the New York Presbyterian Hospital, both in New York.
“From a social, ethical, human, medical, and scientific point of view,” the award was well deserved and long overdue, he said.
A Progression of Advances
In comments made after the Nobel Prize announcement, Professor Christer Höög, a member of the Nobel Committee for Physiology or Medicine, said that the prize was given to Dr. Edwards alone because “he had the vision [for IVF]. Others assisted … but it was really Dr. Edwards who saw the vision and made it happen.”
Some believe, however, that if his collaborator Dr. Patrick Steptoe were alive (he died in 1988), he might have shared the prize. Dr. Edwards, now a professor emeritus at the University of Cambridge, England, had called Dr. Steptoe to ask him for his help in 1968, after reading of his work with laparoscopy and having come to appreciate the fragility of in vitro–matured oocytes.
“Then the world’s master of this method, he could easily aspirate [matured] oocytes from their follicles. We teamed up for IVF and discussed in detail the safety of our proposed procedures, and the underlying ethics,” Dr. Edwards wrote in 2001 (Nature Medicine 2001;7:1091-4). “We agreed to work together as equals, pursue our work carefully, and stop if any danger emerged to patients or children, but not for vague religious or political reasons. We stayed together for 20 years, until his death. I reckon he taught me medicine.”
Dr. Alan H. DeCherney, editor in chief of the journal Fertility and Sterility, heard Dr. Steptoe present their experience with the first IVF baby at a conference in Venice, Italy, held shortly after Louise Brown’s birth. “People knew about it, but this was the first scientific presentation,” he recalled. “I thought, this is the future, and when I returned to Yale – where I was at the time – we immediately starting putting together an IVF program.”