I can hardly believe that it has been 32 years since the 1st successful IVF conception, (initiated by Patrick Steptoe, the father of human IVF) resulted in the birth of Louise Brown. Time has certainly flown.

I first met Patrick Steptoe in the very early 70’s when he was a visiting professor at the University of Cape Town, South Africa where I was a young professor. I was assigned the responsibility of chaperoning Dr. Steptoe around Cape peninsula and I got to know him quite well. When Dr. Steptoe, a passionate musician, met my wife Charlene, a professional stage actress, they immediately clicked. A friendship soon developed.

So, why am I mentioning this and what does it have to do with IVF? To me…everything because it literally opened the door for me, when 8 years later, he and Robert Edwards introduced human IVF. In fact, I vividly recall the day that Dr. Steptoe called my home to speak to my wife. He and Charlene were talking and at the tail end of the conversation when I got a few minutes to talk to him, he shared with me that he and Robert Edwards had after more than 100 unsuccessful attempts, succeeded in initiating the world’s 1st human IVF pregnancy. He suggested that I visit him in England, learn the technology and then set up an IVF program in the US where, at the time, there were only a handful of existing programs (today…almost 400).

So, off I went with Cliff Stratton PhD (a professor of embryology at the University of Nevada), to England. A few weeks later we returned and established the first private (non-university based) IVF program in the US. (Our 1st IVF babies were born less than 1 year later).

To be quite honest, establishing a “private” IVF program did not sit well with those of our colleagues who operated the other 3 (university-based) IVF programs in the US. The general feeling was that procedure was still in the research stage of development and did not belong in the “private setting.” But we were lucky because we were able to turn to Dr. Steptoe and Robert Edwards who were very forthcoming and eager to help when we hit the inevitable bumps.

When I look back to where I started in 1982 and where we are today, I can hardly believe my good fortune in having known Drs. Steptoe and Edwards. I am in awe of how the field of assisted reproduction has evolved over a mere three decades.

This was also a time when most women received an oral medication, clomiphene citrate to stimulate the development of follicles and eggs in their ovaries. This yielded a low number of eggs and also created a less than ideal uterine environment for embryo implantation. I recall being one of the first in the world to switch from clomiphene to injectible fertility drugs (Pergonal and Humegon at that time). Our results immediately improved dramatically, allowing us to differentiate ourselves from the competition. It also heralded a major advance in the IVF arena, since injectible fertility drugs were found to be much more effective than clomiphene. As a foot note, it was around this time that I remember getting the idea that it might be possible by washing and preparing semen and then inseminating the enhanced sperm directly into the uterus and so improve results with artificial insemination (hitherto very poor). And so….the now common procedure known as Intrauterine Insemination (IUI) was born.

In the 80’s and early 90’s few people were performing in vitro fertilization in women over the age of 40 or for non tubal causes of infertility. The results were simply too poor, and with most IVF practitioners competing for business it was important to report the best possible outcome statistics. But the IVF field was growing as more and more physicians, both in the private and academic sectors, became captivated by the new technology and the promise it offered. Yet at that time IVF success rates were dismal, ranging from 5-10% per procedure, even in young women.

Then, in the mid 90’s, clinical researchers in Europe began reporting on a technique referred to as Intracytoplasmic Sperm Injection (ICSI) in cases of IVF of male infertility where results using conventional fertilization in the Petri dish had been dismal. With ICSI, a single sperm was injected into an egg to force fertilization. The success rate with IVF for male infertility shot up, to the point where they were comparable to cases of non-male factor.

I knew the researchers who had developed ICSI and contacted them. Within weeks I sent a team of embryologist to Europe to learn ICSI and upon their return, became among the first in the US to apply the technology in cases of male infertility. Today, we at SIRM, rather than fertilizing eggs conventionally in a Petri dish, prefer to perform ICSI across the board (for male factor and non-male factor cases alike). We (and other IVF programs) have found that routine ICSI improves fertilization rates as well as pregnancy rates without posing any significant risks to the offspring (read on ICSI elsewhere in this blog).

It was also in the latter part of the 90’s that everyone in the IVF field started moving away from using clomiphene to stimulate a woman’s ovaries for IVF, to injectable fertility drugs. Originally, these injectible fertility drugs (gonadotropins) were all derived from the urine of menopausal women which is rich in gonadotropins (active ingredients). Then, around the turn of the century came the widespread introduction of recombinant DNA, purified gonadotropin products such as Gonal F, Puregon and Follistim which have since all but replaced urinary-derived fertility drugs since they apear to be more effective ….to the great benefit of patients worldwide.

By the year 2000, the number of IVF programs in North America had risen to above 200in number and the quality of service had improved dramatically. Birth rates were now ranging between 20-30% per procedure with some programs reporting even higher results.

Unfortunately, the level of accountability in reporting IVF statistics did not keep pace with the evolution of the science and the technology. In fact, our governing body, the Society for Assisted Reproductive Technology (SART), that had been charged by central government with the responsibility of ensuring accurate reporting of success rates was unable to do so. This was largely because member programs were non-compliant and because SART lacked the will and the means to enforce compliance. This meant that, often unbeknownst to IVF patients, they could not rely on IVF outcome statistics reported by SART. Sadly even now , in this regard things have not changed . Yes, even mow in 2010 the so called “SART Report” that is supposed to accurately portray annual IVF outcome statistics on a dedicated website simply, regurgitates the IVF success rates reported to them anually by member programs without any audit or other verification of authenticity. Clearly this is something that must change… Consumers derserve more.

The most recent paradigm shift in the field of IVF occured with the emergence of genetic testing of eggs and embryos to identify those that are the most “competent” (i.e. the ones that have by far the greatest potential to propagate healthy pregnancies). Technologies such as comparative genomic hybridization (CGH) and polymerase chain reaction (PCR) now allow us to identify genetically “competent” embryos. The same technology also affords an opportunity to selectively freeze only the most competent eggs, opening the door to fertility preservation and egg banking.

Perhaps one of the most important benefits of CGH egg/embryo testing its use to select the most competent embryo for transfer, thereby promising a reduction in the risk of multiple pregnancies that cause much of the morbidity and mortality associated with IVF babies.

The changes that have occurred in the field of IVF over the last 32 years since Louise Brown was born would have been almost unimaginable to Dr Steptoe when he initiated all of this. For me, the 28 years that I have been involved in this medical field have been nothing short of a spectacular ride.

Yes indeed, things have come along way. Just consider the fact that IVF success rates which were under 5% in the early 80’s are now better than 50% per procedure in certain categories of patients. Then consider the introduction and the potential impact of CGH egg and embryo selection where the birth rate per single embryo transferred is now almost 70%. Now consider where we are likely to be headed with the emergence of applied genetic techniques that could have the potential to identify horrific life threatening diseases in advance.

No doubt, to Patrick Steptoe the consummate musician, this would have been “music to his ears”.