Patrick Steptoe

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Patrick Steptoe

British obstetrician and gynecologist Patrick Steptoe (1913-1988), gained international acclaim when years of hard work resulted in the birth of the world's first "test tube baby." He and colleague, Robert Edwards, delivered a healthy baby girl that had been conceived through in vitro fertilization.

Early in his medical career, Patrick Steptoe had established a successful practice in obstetrics and gynecology, with a particular interest in the problems of infertility. When he teamed with Robert Edwards in 1966, the two physicians dedicated their professional lives to perfecting a procedure known as in vitro fertilization (IVF). It involves fertilizing a human egg in a laboratory dish and implanting the resulting embryo in the mother's womb. After 12 years of work and research, Steptoe and Edwards achieved success. Louise Joy Brown, the first baby to be conceived using this method, was born on July 25, 1978.

Patrick Christopher Steptoe was born in Oxford, England on June 9, 1913. His father was a church organist while his mother was a social service worker. Although Steptoe studied music as a child, he chose medicine over music at an early age. Steptoe was educated at Kings College, London, and at St. George's Hospital Medical School of the University of London. He was a member of the Royal College of Surgeons and licensed by the Royal College of Physicians in 1939.

With the outbreak of the Second World War, Steptoe volunteered for the Royal Navy Reserve, and served as a naval surgeon. In 1941, the Germans sank his ship off the island of Crete. He was captured and taken to a prisoner of war camp in Italy. As a physician, Steptoe was allowed to move about the camp freely. He reportedly helped other prisoners escape. When his captors discovered this, Steptoe was placed in solitary confinement. He was released in 1943.

Established Medical Practice

After the war, Steptoe completed his medical studies and established a practice in Manchester, England, specializing in obstetrics and gynecology. In 1951, he began working at the Oldham General and District Hospital in Oldham, a mill town a few miles northeast of Manchester. There he studied methods of sterilization and the problems of infertility.

Steptoe perfected the technique for retrieving eggs from a woman's ovary using a laparoscope. A small incision was made, and this narrow tube, with a built-in optical fiber light, was inserted into the abdominal cavity. The laparoscope was used for sterilization procedures as well as for diagnostic reasons. It was considered to be a pioneering device at the time, and more than a few colleagues questioned his use of it.

Collaborated with Robert Edwards

In 1966, Steptoe joined forces with Robert Edwards, a Cambridge University physiologist. Edwards had developed a technique for fertilizing human eggs in the laboratory, in an effort to help women with defective fallopian tubes become pregnant. Steptoe realized that he could use a laparoscope to extract eggs from infertile women. If the eggs were retrieved at the right time and then fertilized in the laboratory (in vitro), they could then be implanted into the uterus and a pregnancy could result.

As Steptoe and Edwards wrote in an account of their collaborative effort, A Matter of Life, they received a devastating blow in April 1971, when the Medical Research Council denied their application for funds. They were repeatedly denied funds for their research until the Ford Foundation and some wealthy Americans provided the money."

In 1972, Steptoe and Edwards attempted the first implantation, but the inserted embryo failed to lodge properly in the uterus. More failures followed in the next few years. Some pregnancies did occur, but all were lost in the first trimester. Time was becoming a critical factor, as Steptoe was scheduled to retire in July 1978. However, their luck was about to change.

Began Treating Mrs. Brown

In the fall of 1976, Steptoe received a letter from Dr. Ruth Hinton, medical officer of the Bristol Central Health Clinic, regarding a 29-year-old patient named Lesley Brown. Brown and her husband, John, had been trying to have a baby for ten years, but she had severely damaged fallopian tubes. Steptoe agreed to see the couple.

As the Browns recounted in Our Miracle Called Louise—A Parents' Story, "Dr. Hinton told us there was a doctor in Oldham called Mr. Steptoe, who had done a lot of research into the problem of blocked tubes. She said what he was doing sounded almost like science fiction, but that he was trying to develop ways of helping women with damaged tubes to conceive a baby." The Browns asked Dr. Hinton to refer them to Steptoe; they were willing to try anything.

In late 1976 and into early 1977, Steptoe "felt confident about things." As he recalled in A Matter of Life, after meeting the Browns, he determined they were "an ideal couple for our attempted treatment." Preparation for the attempt at in vitro fertilization began in February of 1977. Steptoe knew that, for his patients' sake, he needed to have a success. He reflected in A Matter of Life that: "For the last five years particularly, I had had to console them [his patients] repeatedly. True, I had been frank with them all. They all knew that our approach was novel and unpredictable. But of course it did not help them when our method failed. We had to be successful. For their sake. There was no turning back now."

On November 10, 1977, an egg was taken from Brown and fertilized in the lab. For this attempt, Steptoe and Edwards had decided to implant it after two and a half days, at the eight-cell stage. In the past, they had waited four or more days, during which time the fertilized egg underwent about 100-cell divisions. His wife's birthday dinner delayed the implantation until late evening. This may have inadvertently helped the process. Subsequent findings revealed that implanting the fertilized embryo in the evening, rather than the morning or afternoon, would more likely result in a pregnancy.

Everyone waited. Brown did not begin her menstrual cycle. An eventual pregnancy test came back positive. Her damaged fallopian tubes had been removed in a previous surgery, so there was no chance of an ectopic (pregnancy in the fallopian tubes) pregnancy, which had occurred with some other in vitro attempts. The daring strategy had worked. The Browns were expecting a child.

The pregnancy progressed to everyone's delight. Reality also set in for the Browns, as they soon realized how important their baby was. In Our Miracle Called Louise—A Parents' Story, Lesley Brown recalled thinking that "perhaps there wasn't hundreds of babies like mine. There must be just a few, I told myself. I still couldn't believe that mine was really the first." The local media heard rumors of the pregnancy. Soon, the national and international media wanted to know about the world's first 'test tube' baby. Reporters followed the doctors and their patient, offering large sums of money for their story. As Brown remembered Our Miracle Called Louise—A Parents' Story, "Dr. Steptoe took such good care of me. He wasn't going to let anything go wrong." Steptoe knew he needed to protect his patient and her unborn baby, so Brown was admitted to the hospital under an assumed name.

Baby Made History

Brown developed toxemia in the final stages of her pregnancy. Steptoe and his team determined that a caesarean delivery would be best for both mother and baby. To avoid a media frenzy, the baby was to be delivered in secret. The nursing staff was unaware that the delivery would occur that night. Even John Brown wasn't told of his child's pending birth, until about two hours before the delivery.

On July 25, 1978, at 11:47 pm, a five pound, twelve ounce baby girl was born. As Golden reflected in an article for Time, "Conceived in a lab dish or in vitro, from the egg and the sperm of a working class couple who had tried for years to have a baby, she seemed as miraculous as any baby in 2,000 years." In A Matter of Life, Steptoe and Edwards recalled, "The new citizen continued to cry very loudly, and how we all loved that glorious sound."

Louise Joy Brown was a miracle. She was on the cover of magazines like Time, Newsweek, and Life, as well as the front page of every major newspaper in the world. Gerard DiLeo wrote in Essays and Other Articles, "Her birth was marked by marvel and disbelief." DiLeo continued that although the baby had a father and mother, "there was a third person necessary in her being born, Dr. Patrick Steptoe. His team was the group of physiologists and reproductive endocrinologists who orchestrated the very complex steps needed to make the whole thing work." DiLeo concluded that it wasn't enough to mix the egg and sperm in the dish, that "failure after failure taught them something new about just how complicated the whole process is." In A Matter of Life, Steptoe simply stated, "I doubt if I shall ever share such a moment in my life again."

Voices of Concern

As noted by Dr. Gifford-Jones in Health, not all people applauded in vitro fertilization. This amazing feat brought criticism as well. Despite a healthy, thriving baby, the work of Steptoe and Edwards was considered controversial and unorthodox. As noted by Golden in Time, the Roman Catholic Church and other religious groups denounced it as "playing God." Dr. James D. Watson, who won the Nobel Prize for Medicine in 1962, as the co-discoverer of the molecular structure of DNA, denounced their research. He questioned tampering with procreation. On behalf of the pro-life movement, Charles E. Rice called in vitro fertilization a "perversion." He accused Steptoe of "destroying lives" as fertilized eggs that were not implanted in the mother were discarded.

In October 1978, a Chicago-based fertility research organization, the Barren Foundation, canceled the presentation of its award to him. The chairman of the Foundation's medical advisory board said the decision was based on the failure of Steptoe and Edwards to publish their findings in a reputable scientific journal. Rumors swirled that the doctors had made a six-figure sum when they sold their story to the tabloid press, before presenting their findings to the scientific community.

Steptoe and Edwards were reluctant to discuss the new procedure. Critics voiced ethical and moral concerns about tampering with human life and questioned their motivations. An article in Time noted that some "envisioned baby breeding farms." As reported by Time, Steptoe responded to the criticism, stating, "I am not a wizard or a Frankenstein. All I want to do is help women whose child-producing mechanism is slightly faulty."

IVF Gained Acceptance

The debate faded when it became apparent that in vitro fertilization was a desperately sought service. Steptoe received thousands of letters after the birth of Louise Brown. People who were unable to conceive now had reason to hope that their problems could be solved with the help of this new procedure.

Steptoe gave numerous presentations and interviews around the world after the in vitro success. He spoke at a meeting of the Royal College of Obstetricians and Gynecologists in London and at a conference of the American Fertility Society in San Francisco, California. Steptoe and Edwards achieved further acclaim when a second "testtube" baby, Alastair Montgomery, was born in Glasgow, Scotland in January 1979.

Honors continued for Steptoe. He was awarded a Blair Bell Gold Medal by the British Society of Medicine. In 1979, he was an honoree of the American Academy of Achievement, and received a special award of achievement from the American Fertility Society. In 1980, he chaired the British Fertility Society. The Associated Newspapers paid for a new clinic for Steptoe after the birth of Brown. In 1980, he became the medical director of Bourn Hall Clinic, in Cambridgeshire, England. Steptoe and Edwards were pleased to learn that the first U.S. birth clinic using their method of conception had opened in January 1980. Later in 1980, Steptoe and Edwards published the story of their professional collaboration in A Matter of Life.

Steptoe received one of the highest accolades in the scientific world when he was named a Fellow of the Royal Society in 1987. He died of cancer in Canterbury, England on March 21, 1988. Steptoe was survived by his wife, Sheena, and their two children, Sally and Andrew.

Further Reading

Brown, Lesley and John, with Sue Freeman, Our Miracle Called Louise—A Parents' Story, Paddington Press, 1979.

Edwards, Robert, and Patrick Steptoe, A Matter of Life, William Morrow and Company, Inc., 1980.

New York Times, March 23, 1988.

Time, April 4, 1988, p. 69; March 29, 1999, p. 178.

DiLeo, Gerard, "When Unnatural Things Cause Natural People, "Essays and Other Articles,http://www.gynob.com/Essays2.htm (October 17, 1999).

Gifford-Jones, Dr. "Birthing Miracles Twenty Years Later," Health,http://www.sunmedia.ca/HealthNews/980604_jones.html (October 17, 1999).

Rice, Charles E., "In Vitro Fertilization," The Pro-Life Movement: A Spiritual Perspective,http://www.ewtn.com/library/PROLIFE/CF2.TXT (October 17, 1999).

Science Now, July 24, 1998, http://bric.postech.ac.kr/science/97now/98_now/980724c.html (October 17, 1999). □

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