4 Million Test-Tube Babies and Counting

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.

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 4 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.

Who expected, in 1978, that in vitro fertilization itself would become so routine? The procedure itself has largely been cocooned from direct controversy -- who wants to fight the parents of healthy babies? Instead, the most highly charged controversies have focused on the fate of the unused embryos that are byproducts of in vitro fertilization. They have become political footballs in the embryonic stem cell fights: while proponents extoll the untold opportunities for scientific research and potential benefits for combating a host of diseases, abortion opponents have gladly taken on that fight.

Recently, however, IVF has fallen in the crosshairs of anti-abortion efforts across the U.S. that have sought to get controversial and confusing "personhood" initiatives on state ballots; they variously define personhood as starting at the "beginning of biological development" and seek legal rights for "preborn people." Opponents warn that this could give IVF embryos legal rights and threaten those who do IVF procedures. Even ardent conservatives have been divided over the prospect of such initiatives in states like Colorado, Nevada, Alaska, Missouri, Mississippi and Florida. The only such initiative to make the ballot in the upcoming November election is in Colorado (a related version was resoundingly defeated in 2008). Add that to your election night checklist.

Given the rapid pace of development, who knows what to expect three decades hence from the science honored in 2010 by the Nobel Committee? Edwards' cutting-edge discoveries have already paved the way for genetic screening of embryos outside the womb ("pre-implantation genetic diagnosis"). But the prospect of genetic therapies to come has created predictable warnings and unresolved, ethical and political debates. Will there indeed be a parent push for designer babies, created and selected for special characteristics, from eye color to brilliance? Or will the genetic interventions focus on preventing serious diseases that can have devastating consequences for babies and families alike?

For those of us who covered the birth of Louise Brown, the story was the ultimate medical science drama, writ large over the international stage. We used the code words "test-tube" baby in part because in vitro fertilization, was, well, not very sexy. It's encouraging to find out that when folks are really interested they can easily digest big technical terms like in vitro fertilization.

Looking back, one recalls that IVF itself was made possible because a scientific maverick like Edwards had the courage and conviction to overcome the early political and religious barriers that stood in his way. When the British government shied away from public support, Edwards sought help from private funders who were willing to step in. Later, after the birth of Louise Brown, Edwards moved on to the controversial field of embryonic stem cell research, but was again hit by political pressures, so much so that he got out of the field, noted veteran science writer Nick Wade in his excellent New York Times account.

Wade's story also revealed a sad twist of fate. The Nobel Committee waited so long to give the prize to Edwards and Steptoe, perhaps because of the political, religious and ethical controversies involved, that Steptoe was long dead (no posthumous Nobels) and Edwards' once-brilliant mental faculties have apparently faded to the point that he no longer comprehends the long-deserved but long-delayed recognition of his signal achievement.

But millions of parents around the world read stories of the in vitro fertilization Nobel Prize and smiled. They knew firsthand how much it meant. One friend marveled at the story, noting that her adorable two-year-old granddaughter would not be here but for the work of Edwards and Steptoe.

Louise Brown couldn't agree more. In a statement issued through the Bourn Hall Clinic founded by Edwards, she said: "It's amazing news. Me and mum are so glad that one of the pioneers of IVF has been given the recognition he deserves."

The first American "test-tube" baby, Elizabeth Carr Comeau, now 28 and herself the mother of a two-month-old son born by natural means, was similarly congratulatory to "Bob" Edwards. In a public web chat after the Nobel news, Comeau, now a producer for the Boston Globe's website, responded to a typical audience question with this simple declaration: "Without IVF, I would not be here."

Who could say it better?