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The scientific father of the first "test-tube" baby won a Nobel Prize in Medicine this week for revolutionary work that toppled the natural order of things by making it possible to produce babies in the laboratory rather than under the bed sheets. There is a certain irony in the fact that it took 32 years for the Nobel Committee to recognize a signal scientific achievement with such profound consequences. The birth of British baby Louise Joy Brown shortly before midnight on July 25, 1978, spawned sensational headlines around the globe. But the 5-pound, 12-ounce baby grew up, married and is already a mother herself (the old-fashioned way). Over time, as the procedure's popularity rose around the world, the once-obscure scientific name gained household recognition. Today, in vitro fertilization (IVF) has largely replaced the Brave New World-sounding term "test-tube" baby that we journalists trumpeted when Baby Louise was born.


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Today, the procedure has become a common, almost ordinary, means of helping couples with infertility problems. Most of us have family members, friends or acquaintances who casually drop the fact that their children were born with the help of IVF. About four million in vitro children have now joined Baby Louise worldwide, with the first such birth in the United States in late 1981 at a Norfolk, Virginia, hospital. Now some 58,000 American IVF babies are born each year -- more than one percent of all births in the U.S.

While I generally avoid the widely used, but often exaggerated, word "breakthrough," this was indeed a breakthrough of the first order. The pioneering science of British embryologist Robert G. Edwards, now 85, has held up, and the safety and effectiveness of the procedure he pioneered in partnership with the late gynecologist Patrick C. Steptoe, who died in 1988, has born out (sorry) over time. The Nobel announcement concluded that "long-term follow-up studies have shown that IVF children are as healthy as other children."

But the novel scientific development also produced a host of bioethical, legal and political issues, from debates over parentage to controversies about the fate of unused embryos, that were not anticipated by those of us who covered the original English announcement.

Who expected, in 1978, that in vitro fertilization would be used in such inventive ways? At the time, the focus was on helping the more traditional infertile married couple, whose sperm and eggs could be fertilized in a Petri dish (a shallow lab tray, not the more picturesque test tube), and the resulting embryos transferred into the woman's uterus. But since then, the circle has widened considerably, with IVF helping gay couples and unmarried women, not to mention older women, some past menopause, who have pushed conventional biological boundaries.

Surrogate mothers and egg donors are increasingly part of the conversation. I recently met a married woman, looking trim and fit, who mentioned she was on her way out of town "to have a baby." Huh? She explained that she was flying to the planned Caesarian birth of her third child, a product of in vitro fertilization of her egg with her husband's sperm who was being carried by an unrelated surrogate mother. While the biological mother was unable to carry her own baby to term, Edwards' work made it possible for this couple to have a baby with genes from both of them. That child is doing quite fine. 

Who expected, in 1978, that pressures on doctors and clinics to transfer multiple embryos at a time into a woman's uterus to increase the likelihood of success would spawn dramatic increases in the number of in vitro twins, triplets or more? Between 1980 and 2004, the rate of twins born in the United States jumped by about 70 percent, in part because of IVF (about 40 percent of IVF procedures lead to twins, according to the March of Dimes). Friends of mine have lovely twin daughters, now in their 20s, who are the happy result of in vitro fertilization.

Individual IVF procedures are largely unregulated in this country, leaving the details up to the discretion of individual clinics, doctors, and their patients. The time, emotional toll and expense -- generally over $12,000 per cycle in the U.S. -- has led many patients to push for multiple embryo transfers at a time, and doctors and clinics also want higher success rates (about 20 to 30 percent of fertilized eggs lead to to the birth of a child). But how many is too many? Recognition of the added risks and consequences of multiple-birth pregnancies, including preterm delivery and low-birth weight, have led to medical group guidelines that urge more caution by reducing the number of embryos transferred at a time to minimize the prospect of multiple births.

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Cristine Russell is a senior fellow at Harvard Kennedy School of Government and the president of the Council for the Advancement of Science Writing.

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