Wombs with a view: 40 years of successful IVF - but what comes next?

31 October 2017 - 07:11 By Rosa Silverman
LAB BRAT Louise Brown, the first test tube baby Picture: Chris Radburn/Getty Images
LAB BRAT Louise Brown, the first test tube baby Picture: Chris Radburn/Getty Images

There's a video on YouTube of the moment Louise Brown entered the world, via a planned Caesarean section at Oldham General Hospital in the UK on July 25 1978. The first few seconds of her life resemble any other newborn's, as she is wiped clean, weighed and checked. But Louise was a sensational medical breakthrough: she was the world's first IVF baby.

Next week marks 40 years since her conception, following years of work by Professor Robert Edwards and Dr Patrick Steptoe, who pioneered a technique that would give millions the chance to have children.

The process of in vitro fertilisation involves removing an egg from the woman's ovaries, fertilising it with sperm in a laboratory and then returning the fertilised egg (the embryo) to the womb to develop. Today, it is uncontroversial and widespread. More than five million IVF babies have been born in the past four decades. But back then, quite the opposite was true.

Edwards and Steptoe had been working to try to fertilise a human egg outside the body and take it to the blastocyst stage - the point at which the cells in the embryo differentiate. Yet in 1968, when this was achieved by Edwards (who in 2010 won the Nobel Prize for physiology), embryology was not even deemed a worthwhile field of study.

Another nine years passed before Louise's mother, Lesley Brown, became the first woman to successfully conceive after treatment by the pair.

The development of the science has its roots in the sexual revolution of the 1960s. Dr Mike Macnamee, who worked with Steptoe and Edwards, says: "A number of women had damaged Fallopian tubes as a result of sexually transmitted infections, such as chlamydia - 80% of our early patients had tubal damage, compared to 20% to 30% now."

Undergoing IVF in those early days was no small matter. Eggs had to be harvested by laparoscopy - or keyhole surgery - while the woman was under general anaesthetic. This meant she had to stay as an inpatient, usually for four or five days.

It wasn't until the late 1980s that it became possible for women to have their eggs harvested under sedation, using ultrasound, and return home the same day.

Louise Brown's birth sparked fears that scientists were creating "Frankenbabies", and religious leaders voiced concerns about the use of artificial intervention to create life.

Louise's family received hate mail after her birth, and it was not until the early 1990s that attitudes started to shift. But with success rates so low, there were many couples left disappointed.

"The drive to have children is so enormous, particularly if you can't have them, that people are prepared to go to great lengths," says Macnamee. "But part of our job is to set people's expectations before they embark on this."

With so many couples experiencing problems conceiving, the medical fertility industry is booming. Yet the process is never a walk in the park. Firstly, it's time-consuming, involving a series of appointments. Then there are the drugs the woman must take to control her hormones.

The process can leave women feeling tired, hormonal and bloated. For some, though, the worst part is the two-week wait after embryo transfer to find out if the treatment has worked.

Macnamee predicts that in 20 years' time, the rate of live births per cycle will have hit between 50% and 60%. Scientists will probably also be able to correct genetic abnormalities in embryos by then, he suggests.


Light-sheet microscopy

This groundbreaking new form of microscope has already been used to monitor foetal development - in real-time, in full 3D and with sub-cellular resolution - a practice that scientists hope will enable them to better understand what causes infertility and prevent miscarriage in the future.

Uterus simulator

The key to improving the success rate of IVF hinges on a more complete understanding of how the egg and womb lining interact. The ability to create a uterus "simulator" could mean success in two or three cycles.

Gene editing

In 20 years, gene editing techniques could be used during the IVF process to remove defective genes and prevent babies from being born with debilitating illnesses and disabilities, such as diabetes and Down's syndrome.

The cost of IVF will go down

Researchers are exploring ways to make IVF cheaper, including starting embryos off inside the womb, which will negate the need for large incubators and reduce laboratory costs.

- The Daily Telegraph