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Louise Brown and Her Parents

Louise Brown and her Parents

Assisted Reproduction

Photograph

By: Ray Foli

Date: September 7, 1979

About the Photographer: Ray Foli contributed this photograph to Corbis, a media agency headquartered in Seattle, Washington, that supplies photographs and other images to magazines, newspapers, television, and advertising concerns.

INTRODUCTION

Failure to conceive is not uncommon—between one in six and one in twenty couples are affected by infertility in either the male or female partner. The British gynecologist and obstetrician Patrick Steptoe (1913–1988) had long been interested in both laparoscopy, the process of looking into the abdominal cavity through a tiny incision in the umblicus, and infertility. He joined with Robert Edwards, a physiologist at Cambridge University, to investigate the possiblility of in-vitro fertilization (IVF)—that is, creating an embryo by fertilizing an egg with sperm in the laboratory. The embryo would then be placed back in the mother's uterus in the hope that a pregnancy would be established.

After a decade of research, involving some unsuccessful clinical trials, IVF claimed its first success with the birth of Louise Joy Brown in Oldham District Hospital, England, on July 25, 1978. Mother Lesley had been told she had only a one in a million chance of conceiving naturally because of blocked fallopian tubes. Her egg was fertilized with husband John's sperm in a glass dish—or petri dish—in the laboratory and replaced in Lesley's uterus for a relatively uneventful pregnancy.

Of course, Louise Brown's appearance in the world was no ordinary birth. While her appearance on Phil Donahue, depicted below, shows her as a normal, healthy child, she has had to spend years explaining to people that she was not actually born in a laboratory. Misunderstandings no doubt arose by the "test tube baby" shorthand that was used from the beginning to describe the IVF approach.

PRIMARY SOURCE

LOUISE BROWN AND HER PARENTS

See primary source image.

SIGNIFICANCE

Louise Brown was guest of honor at a twenty-fifth birthday celebration at Bourn Hall, which has become one of Britain's main IVF centers. She is a normal and healthy young woman; however, whether there are long-term health effects from being born by IVF remains to be seen from ongoing research. A few years later, sister Natalie was also born by IVF and since 1978, well over one million other IVF babies have been born to infertile couples around the world.

Originally seen as a treatment for blocked fallopian tubes, the indications for IVF are now far wider and the technology has become more advanced. However, success rates remain at between 20 to 30 percent. For infertile men, intracytoplasmic sperm injection (ICSI)—where sperm that do not move properly or fail to penetrate the egg—has proved to be a particularly valuable form of IVF. ICSI involves the direct injection of a sperm into the egg and it has about the same success rate as IVF.

More controversially, perhaps, IVF allows the separation of egg, sperm and uterus, allowing for unconventional pregnancies to be established. Donor sperm and donor egg can be used to create an embryo that can be implanted in the uterus of a third person. This happened in 1995, when a Los Angeles couple recruited a woman to act as a surrogate mother for such an embryo, creating uncertainty about issues of parental rights. And, infrequently, lab mix-ups have occurred where an embryo has been transferred to a woman that was intended for another.

Post-menopausal women, who would not be able to conceive naturally, could also have an embryo made from donor sperm and egg implanted into their uterus. IVF also offers the possibility of parenthood to homosexual couples. Meanwhile, babies have also been born from frozen eggs, taken from women whose fertility was otherwise threatened from illness, and from the sperm of a dead man. Clearly, IVF now offers parenthood to many people other than the physically infertile.

The laboratory setting of IVF has also led to the screening of embryos for genetic disease. Today's fast DNA analysis technology means it is possible to take just one cell from an eight-celled embryo, prior to placing it in the uterus, and test it for genetic defects. Typically, the woman undertaking IVF receives drugs that allow the production of more than one egg so that several embryos are produced. In so-called pre-implantation diagnosis, each embryo can be screened for faulty genes and only healthy ones placed in the uterus. Then the parents can continue with the pregnancy, confident that a healthy child will be born. For many, this procedure is preferable to chorionic villus testing during pregnancy followed by the option of termination if a genetic problem is encountered. However, this was not the original purpose of IVF. The ethical issues around IVF which are brought up by genetic testing or third party involvement clearly need careful assessment and control.

FURTHER RESOURCES

Books

Porter, Roy, ed. Cambridge Illustrated History of Medicine. Cambridge, UK: Cambridge University Press, 1996.

Web sites

BBC News. "Profile: Louise Brown. A quarter-century on, and the clamour surrounding 'test tube baby' Louise Brown has barely died down." 〈http://news.bbc.co.uk/1/hi/health/3056141.stm〉 (accessed December 21, 2005).

BBC News. "Fertility Milestones." 〈http://news.bbc.co.uk/1/hi/health/3056141.stm〉 (accessed December 21, 2005).

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