Bourn Hall Clinic, cofounded by Edwards and Steptoe in 1980
The Fascinating Prehistory of IVF by Sarah Franklin1, Martin Johnson2 and Nick Hopwood3
This autumn the embryologist Robert Edwards, one of the leading figures in the development of human in vitro fertilization, was awarded the Nobel Prize in Physiology or Medicine. He and his late colleague, the obstetrician Patrick Steptoe, led the team that in 1978 achieved the first live birth after IVF. Many saw this recognition as late, but the development of IVF was always highly contested. Most importantly, in 1971, Edwards and Steptoe submitted an application to the UK Medical Research Council (MRC) requesting support for research on human in vitro fertilization and embryo transfer. For reasons that turn out to include a mixture of ethical caution, institutional politics and inexperienced grantsmanship, their application was rejected. Given the subsequent success of IVF, with over four million babies born and spin-offs such as In Full? PGD and embryonic stem cells, the MRC decision offers an interesting case not only of science not ‘racing ahead’ of society, but also of the side-lining of ‘high-impact’ research. In historical work supported by the Wellcome Trust and assisted by Matt Cottingham, we reconstructed a comprehensive paper trail that allowed us to reanalyse this controversial decision. A paper in Human Reproduction reported the results just a few months before the announcement of Edwards’ prize. Edwards (Cambridge) and Steptoe (Oldham) sought state funding for an elaborate programme of work on human conception. They wanted, above all, to bring Steptoe south in order to overcome the separation of scientific and clinical work. The bid amply satisfied a strategic policy only recently developed within the MRC to encourage joint clinical and scientific research in UK academic departments of obstetrics and gynaecology, which were then considered weak in research. This weakness had made it difficult to recruit highquality reproductive scientists and clinicians to the MRC’s newly opened flagship enterprise, the Clinical Research Centre (CRC) at Northwick Park Hospital in west London. Its first director, Graham Bull, seized the opportunity presented
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by Edwards and Steptoe to offer them both positions at the CRC, together with a full set of staffed laboratories plus 20 research beds in obstetrics and gynaecology. Keen to remain connected to Cambridge, Edwards declined the offer. Crucially, he did not fully appreciate the strategic reasons behind this initial enthusiasm, nor how much more difficult it would be to gain funding as an external applicant. So he told the MRC that he preferred to remain in Cambridge, where he found the intellectual atmosphere more stimulating, and that he wished to apply for a five-year grant or even an MRC unit there. This course of action was to prove ill-advised for several reasons. Perhaps most important was the fact that there was then no academic department of obstetrics and gynaecology at the University of Cambridge, which was only then in the process of establishing a Clinical School. The local consultant obstetricians and gynaecologists were reportedly hostile to the prospect of Steptoe’s moving there. So Edwards’ bid was given somewhat ambivalent local support at his home institution, significantly weakening its chances of success. Newmarket General Hospital threw a lifeline, however, again driven in part by local logistical problems. Short of consultant cover, the East Anglian Regional Hospital Board offered Steptoe a part-time consultant’s position, so that the rest of his time could be spent on the MRC research. The board even offered to build a 20-bed research ward – if the MRC paid. Steptoe was all set to come, although in the end he and Edwards went for a clinical research base closer to the central Cambridge laboratories. They identified a large house nearby, recently vacated, ironically, as a home for unmarried mothers. Edwards’ and Steptoe’s application to the MRC, submitted in February 1971, proposed this arrangement, with a half-time MRC position in Cambridge for Steptoe, plus a part-time NHS consultant position in Newmarket.
BIOS News Issue 17 • Lent 2011