The 2010 Nobel prize for physiology or medicine was awarded on Monday to Robert Edwards, 85, who introduced in-vitro fertilisation (IVF) to the world. This technique has been the hope of millions of couples who have been unable to conceive a child, and the panel that decides the Nobel prizes (at the Karolinska Institute in Sweden) felt that the significance of Edwards’ work should not go unappreciated.

In their citation, the panel lauded his “brilliant combination of basic and applied medical research” and his ability to overcome various hurdles in “his persistence to discover a method that would help to alleviate infertility”. As well as the honour of being a Nobel laureate, Edwards has won 10 million Swedish kronor ($1.5 million) for his contributions to this “milestone in the development of modern medicine”.

On 25 July, 1978, the first IVF baby, Louise Joy Brown, was born in Manchester. Since then, the method has become available all over the world, and has resulted the birth of more than 4 million babies. All this was due to the research of Robert Edwards and Patrick Steptoe, his obstetrician colleague. (Steptoe died in 1988 and Nobel prizes are not awarded posthumously.)

About 10% of all couples suffer from infertility. At the outset of his research in the 1950s, Edwards’ aim was to find a way to fertilise a human egg outside the body, and then return it to the womb. During the course of his research, he has helped to clarify the process of how human eggs mature, which hormones are involved, and the precise point where fertilisation of the egg is most likely.

Edwards got his breakthrough in 1965, when he showed that he could make oocytes – the egg cells – mature outside the body, till they could be fertilised using sperm. However, the fertilised cells failed to progress beyond the two-celled stage, and successful implantation needed an embryo with at least eight cells. The solution, to Edwards, seemed to be extracting and fertilising oocytes which had had time to mature in the ovary even before ovulation. But this procedure was complicated, involving surgical removal of a part of the ovary. Then Edwards started working with Steptoe. The obstetrician had been pioneering laparoscopic surgery techniques at the Oldham and District General Hospital, and his “keyhole surgery” made the complex extraction of mature eggs from an ovary possible.

By 1970 the duo was able to produce eight-celled embryos. But, while the scientists managed to implant the embryos in their patients’ uteruses, the IVF pregnancies kept ending in miscarriages. It took more than a hundred tries before the team had their ‘eureka’ moment. In 1976, Edwards reached the conclusion that a hormone they gave the women to stimulate egg maturation was interfering with the actual pregnancy. So they started relying on their patients’ natural menstrual cycle to mature the eggs instead. The luteinising hormones in the woman’s urine were used as a marker to indicate when the eggs had matured. This improvement in the technique led to the first successful birth.

Steptoe and Edwards established the Bourn Hall Clinic for IVF, and had reached 1,000 IVF births by 1986. Since then the technique has been taken up all over the globe, and embryo and egg freezing has become routine. Even techniques for infertile men, like intra-cytoplasmic sperm injections, have become popular.

Current support for the procedure may be misleading. Initially, it was met with hostility and disapproval. Religious leaders did not shy away from expressing moral outrage; scientists feared that the process was unsafe; and people felt it might lead to a population boom. In fact, the UK’s Medical Research Council initially denied the project key funding, and the scientists had to resort to a rich private donor, who remains anonymous to this day.

Such opinion is not just a thing of the past; the Vatican has been less than congratulatory of Edwards’ win. Monsignor Ignacio Carrasco de Paula, the head of the Pontifical Academy for Life says: “I find the choice of Robert Edwards completely out of order”.

Regardless of the lack of religious imprimatur, the medical and scientific fraternity has long endorsed the IVF technique, which has gone through various improvements. With the latest technologies, a single sperm can be injected into the egg cell outside the body, a method that has also been used to counter male infertility. Even the selection of mature eggs can be done by ultrasound and they can be removed using a thin syringe, as opposed to a laparoscope. It has been established that IVF is an effective and safe therapy, and IVF children are just as healthy as “normal” children. Almost 20% to 30% of the fertilised eggs result in childbirth, and while complications such as premature births are not unknown, they are exceedingly rare.

Colleagues and fellow scientists feel that the award has been long overdue. Martin Johnson, who teaches reproductive sciences at the University of Cambridge and recently wrote a paper on the rejection of MRC funding for Edwards’ and Steptoe’s research, feels that “the Nobel has come… late, but he [Edwards] is delighted. It is the cherry on the cake.”

The Nobel Prize panel said that IVF was a “monumental medical advance” that has benefited mankind greatly, and has altered the scope of reproductive medicine dramatically. Millions of proud parents, who would otherwise have had to give up hope of conceiving, would no doubt agree, as would Edwards’ 4 million children. DM

Read more: Reuters, Nobel website, Science Daily.

Photo: Professor Robert Edwards smiles as he addresses the media during 25th anniversary celebrations of the revolutionary fertility treatment ‘ In Vitro Fertilization’ ( IVF) at Bourne Hall in Cambridgeshire July 26, 2003. REUTERS.