For me it all started at my home in Reno, Nevada on one snowy, late October evening in 1982. My close friend (to this very day) Dr. Victor Lewis (who was visiting from England) and I were enjoying a hot tub at my home. After quite a few beers he began to describe how the pioneering work of Patrick Steptoe and Robert Edwards in 1978 had culminated in the birth of the world’s first IVF baby, Louise Brown. I was totally captivated and spellbound so I asked Victor, who at that time was Secretary of the Royal Fertility Society and a close friend of Patrick Steptoe, whether he would facilitate my visiting the U.K. center to learn the new technology. On the spot, Victor picked up the phone and placed a call to Patrick Steptoe in England.

The very next day I went to talk to Bob Daugherty MD, then Dean of the University of Nevada School of Medicine (where I was a Clinical Professor) and asked him to recommend a trained embryologist that would travel with me to the UK to learn the new science and technology. He referred me to Clifford Stratton PhD (then Professor of Human Embryology). Cliff and I reviewed the IVF literature which at that time comprised about 35 published manuscripts (in total), and within 10 days later were on our way to London. From there we went to the Bourne Hall clinic where, through the good grace of Drs. Steptoe and Edwards, we were introduced to IVF and learned their approach. About three weeks later we returned to the United States and began laying out plans to open the Nation’s first private, non-university-based IVF program (the country’s 4th clinic overall ) in Reno. The rest is history…

In the early days, IVF technology was far from what it is today. The multitude of variables that we now understand can affect IVF outcome were not all known; those that were known were, to say the least, poorly understood. It was truly a hit and miss process. A point in fact: few realize that it took Steptoe and Edwards about 100 attempts before Louise Brown was conceived. In fact, it was not until the second half of the 80’s that clinics were reporting birth rates of above 10% per initiated cycle of treatment. Consider the following few evolutionary reasons:

First, retrieving eggs from the ovaries was no simple matter. It required an invasive, time consuming, traumatic and often painful surgical procedure known as laparoscopy. The process involved the introduction of a telescope like instrument via the belly button into the pelvic cavity. At least two additional lower abdominal incisions were needed to allow for the introduction of a grasping device of the ovaries (to steady them) and to permit passage of a long needle to aspirate eggs from the ovarian follicles. Success was in large part predicated upon having full visualization of the ovaries and since (at the time) most women underwent IVF because of blocked or damaged fallopian tubes (due to infection or endometriosis) it was often necessary to first free adhesions in the pelvis in order to gain sufficient access and visualization.

I vividly recall the very first such procedure I performed (1983) and how, upon learning from Cliff in the lab that he had found the first egg, the pent up emotion, followed by relief and gratitude brought me to tears. Today it is quite different. We no longer use laparoscopy to harvest eggs. We retrieve them much more rapidly, far less traumatically and usually with minimal residual discomfort, by inserting a needle transvaginally, directly into ovarian follicles, under ultrasound guidance.

Second, preparation of the ovaries for egg retrieval went through a rapid evolutionary process as well. Steptoe and Edwards at first retrieved eggs during the natural ovulation cycle without the use of fertility drugs. This yielded (and still does) very poor results. The eighties heralded the introduction of fertility drugs to stimulate the formation of more follicles and increase the number of eggs available for harvesting. At first, the standard method for stimulating the ovaries to produce eggs was through the use of clomiphene citrate (Clomid, Serophene), an oral fertility drug. The results using clomiphene were (and still are) poor. In 1976 I was among the first to publish (Acta Scandinavica) on the use of injectable gonadotropins (urinary gonadotropins) to “superovulate” women with “unexplained” infertility… so I knew that this would promote the development of more follicles than could clomiphene. It was against this background that I decided in mid-1983 – after five clomiphene IVF stimulation attempts – to switch (completely) to the use of gonadotropins to prepare women for IVF. Upon making the switch, 3 of the next 4 IVF candidates conceived. From among them came the first Native American to have an IVF baby. Change came slowly but by the late eighties most IVF programs had switched to this approach as well. Today virtually all IVF centers use a similar approach albeit with much improved drugs and protocols.

My IVF practice soon became all-consuming and by 1987 I had stopped accepting general gynecology and obstetrics patients and was fully committed to treating reproductive failure. But my obsession with what I was involved in did not come without a price. No matter how hard I tried to disassociate work from family I was unable to avoid taking every “failure” very personally. This became tough on my family I recall once early on in my IVF career when my wife Charlene felt that my obsession with my work was so depriving her and the family of my attention that she literally booked and paid for an office appointment through my front desk one day so she could be guaranteed a full hour of my time to discuss family affairs. That was a real reality check for me — a big wake-up call! Ever since then I have tried hard to be more available and attentive, and a better husband and father.

But then there is the enormous upside to what I do…the, joy, exhilaration and great privilege that goes with witnessing the indescribable bliss of a prospective parent who first learns that they have a positive pregnancy test that progresses to a fluttering heart beat seen on ultrasound, and then culminates in the birth of a beautiful child.

In 1987, I had the good fortune of meeting Ghanima Maassarani, Dr. Med, a talented German-trained IVF Physician who had relocated to the United States. I hired her into an administrative position since she was not licensed to practice medicine here. She soon became so involved and accomplished in the running of our IVF practice that she enrolled at Pepperdine University where she obtained an Executive MBA degree and then returned to run and operate the business of IVF at SIRM. Proudly, Ghanima became my professional partner in the 90’s and truth be known, SIRM could not function as it does without her at the helm.

SIRM now has seven programs located throughout the United States and proudly reports outstanding IVF success rates even in the toughest cases. Thousands of patients travel from out of state and from abroad for treatment by the outstanding physicians, embryologists and nurses that make up the SIRM family. Their total dedication, commitment and innovation has undoubtedly helped fashion the entire field of IVF.

Proudly, and most importantly is the fact that this initiative started in 1983 has to date been influential in the births of more than 16,000 babies. That really says it all.