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The Nobel Prize in Medicine: Fertile past, pregnant future

October 19, 2010

Tags: Nobel Prize Medicine 2010, IVF, controversy, Robert Edwards, Kate Scannell, pregnant future, fertile past

By Kate Scannell, MD, Contributing columnist Bay Area News Group
PUBLISHED IN PRINT 10/16/2010

ROBERT EDWARDS thought he was "doing God's work" when he began his research in the 1950s. But critics charged that he was actually trying to play the boss himself.

Still, this British biologist dreamed about helping infertile couples who dreamed about having children. If successful conception wasn't possible for those couples "in vivo," he would strive to make conception happen outside their bodies "in vitro" -- with the help of science to coax that process along.

Collaborating with a colleague (now deceased), he ultimately discovered how to fertilize a woman's egg with a man's sperm within a Petri dish to create human embryos. In doing so, he birthed the technique of "in-vitro fertilization" -- commonly referred to as "IVF."

The ultimate goal was to transfer those embryos to the infertile woman's uterus and let nature take its course -- the embryo developing into a fetus, the woman nine months later birthing a child. Finally, that goal was achieved in 1978 when a British couple gave birth to Louise Brown -- the world's first "test tube" baby conceived through IVF and Robert Edwards' dream. She was healthy, and her parents were very happy.

But during the months preceding Louise's birth, the intensely curious world was watching her pregnant mother, waiting to see "what" would be born of this strange new procedure. A few reporters even disguised themselves in attempts to gain access to the home or hospital room of the secluded mother. Some scientists were predicting that a technically-manipulated being with monstrous birth defects would emerge. Many medical ethicists warned that, with a successful birth, we'd find ourselves on a slippery slope leading to our downfall and moral ruin -- to the creation of baby farms and markets.

Nowadays in the U.S., without any such fanfare, at least one of every 100 women giving birth uses IVF to conceive a child. Enough time has elapsed since Louise was born, that other people conceived through IVF are now having children of their own.

For his contributions to the development of IVF as a treatment for infertility, Robert Edwards -- now 85 years old -- was honored this month with the Nobel Prize in Medicine. Presumably also sharing in celebration are the families and descendants of the 4 million babies who have since been conceived by IVF worldwide.

But not everyone is rejoicing over Roberts' award. In particular, various Vatican officials, quoted in the Catholic Herald, declared that his honoring was injudicious. Some claimed that IVF had generated a host of immoral consequences at cross purposes with church teachings. That IVF was responsible for "undermining of the dignity of the human person." That it had birthed a commodities market for human eggs. That unused embryos were likely to be stored in freezers and be "used for research or to die abandoned and forgotten by everyone."

Secular critics also have expressed concerns about "unintended consequences" of IVF that have evolved over time. For example, because a woman begins a cycle of IVF by undergoing powerful hormonal stimulation and surgical extraction of eggs from her ovaries, IVF is somewhat risky for her -- and quite expensive (between $10,000 and $15,000 per cycle). Even then, she must still hope that those eggs will fertilize after exposure to sperm within a lab dish, and that embryos will form and successfully negotiate transfer to her womb and evolution to a child. All along, she also contends with a known 60 percent failure rate for IVF.

In fact, because of the involved risk, expense, time, failure rate, and psychological investment, most women undergoing an IVF cycle opt to have multiple eggs fertilized all at once. This generally allows them to freeze extra "backup" embryos for future use should their first attempt at pregnancy fail. It also fosters the common medical practice of transferring multiple embryos to a womb at once, hoping that at least one will succeed through pregnancy (think Octomom here).

But the generation of backup embryos has generated considerable moral conundrums. Pointedly, according to a 2003 RAND study, about 400,000 embryos were left frozen in storage tanks across the country. So what should become of them -- and, in our choosing, become of us? How are we conceiving human life and its meaning?

Roberts did not fully envision these collateral ethical concerns when he worked long and diligently to help enable infertile couples to have children through IVF. He could not anticipate the moral uncertainty that would erupt over the use of leftover embryos for medical and stem cell research. For donation to biologically-unrelated infertile couples. For rote discard.

He could not have predicted the OctoDoctor practice of transferring multiple embryos at once, resulting in current high rates of riskier multiple delivery, preterm delivery, and low birth-weight delivery experienced with IVF.
Of some women choosing to abort if too many embryos successfully evolve into fetuses.

Roberts could not foresee how his ability to create an embryo in a lab dish would soon allow its testing for genetic defects and, even, sex selection by parents before they elected to proceed with pregnancy. He did not envision the annual $4 billion -- and largely unregulated -- industry that IVF would become in this country.

The French philosopher Voltaire once remarked: "It is said that the present is pregnant with the future." Indeed, every new milestone in medicine marks but an incomplete moment in time that will continue to unfurl at some unknown pace, in unpredictable directions, through unforeseeable future moments. Robert Edwards, thinking outside the box -- or womb -- has proved that to be true.
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Kate Scannell is a syndicated columnist and Bay area physician. Her new novel is "Flood Stage."

Copyright Kate Scannell 2010

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