The award of the 2010 Nobel Prize for Medicine to Robert Edwards was a mark of recognition for development of the first successful in vitro fertilization. The award, though, goes far beyond a mark of personal accomplishment. The real significance of the Nobel Prize is the immense impact of Dr. Edwards’ work on medicine.
The growth of research, education, and clinical care that emerged from this work continues to echo to this day, and the pace of this advancement shows no signs of slowing. Pacific Fertility Center exists as a result of these efforts; however reproduction is not the only field that has been affected by Dr. Edwards work. All fields of medicine have benefitted from the outgrowths of technology that show their origins in Dr. Edwards’ work.
His work arose during a time of sparse knowledge concerning reproduction. Little was known about the early steps of egg, sperm, and embryo development, and even less about the implantation of an embryo into the uterus that establishes pregnancy. Dr. Edwards worked through many of the early details of IVF technology, such as ovulation induction, sperm capacitation, and embryo culture. Each stage of egg development and maturation, sperm management and fertilization, and embryo transfer, had to be studied, modeled, and attempted in the clinic. When a technique did not work, it was back to the drawing board to try again.
The work was never easy. In the beginning, success was difficult to achieve and the worries were high. One of the earliest in vitro fertilization pregnancies ended in miscarriage. A second ended in the fallopian tube, as an ectopic pregnancy. Professional associates often, and loudly, doubted that in vitro fertilization was possible or safe.
In the midst of these doubts, a normal child, Louise Brown, was born in 1978 after in vitro fertilization. It was a pregnancy much like any other, except born after conception assisted by technology. Concern and worry were replaced with the simple beauty of a newborn child in its mother’s arms.
All of us clearly remember the day we heard of Dr. Edwards’ work. The ideas were startling at first, but soon created a newly opened door to a vast area of possibilities. New techniques for fertility treatment, avenues for treatment of genetic illness, and new ways of thinking about medicine became possible. For me, a young man in college, deciding on a career path, it was a call to learn and resulted in medical school and fellowship. For researchers, educators, and clinicians already in the field, suddenly there was a new way to help patients, and an array of interesting pathways for research.
There began a massive change in medicine, with the development of a network of research, education, and clinical care. Educational programs were established at most major medical institutions for training new practitioners and researchers. Funding, mostly private, was established for research into fertility. Professional journals, like Fertility and Sterility, and Human Reproduction, emerged to document the research findings. A network of clinical care grew applying research findings.
Pacific Fertility Center was established in the midst of this development, in the late 1980s, as a center of excellence in fertility care, by a group of doctors at Pacific Presbyterian Hospital (now California Pacific Medical Center) in San Francisco. A small program in the midst of a very busy medical care system, the Pacific Fertility rapidly established success as a leading private practice for in vitro fertilization and ovulation induction. The five doctors that run the program today were true innovators in the field of IVF.
Pacific Fertility Center sought to improve a high standard of care from its early days, seeking the best proven technologies for patient-focused fertility care. Early innovations included the move from laparoscopic to ultrasound-guided procedures, requiring less anesthesia and less risk to patients. Intracytoplasmic Sperm Injection (ICSI) for male factor introduced in the mid 1990s, and methods to reduce multiple pregnancy rates and chromosomal testing of embryos (preimplantation genetic diagnosis and screening) were all mastered and introduced to Pacific Fertility Center within the last decade. We continue these efforts today with innovations in fertility medications, vitrification, and fertility preservation.
Today, some 4 million children have been born worldwide through in vitro fertilization technology. Pregnancy rates have steadily improved, while the risk of multiple pregnancy has declined. Treatments have emerged for specific problems such as male factor infertility, and diminished ovarian reserve. Fertility preservation, oocyte donation, and the prevention of genetic illness all are growing areas of reproductive medicine. All of this came from the birth of one child three decades ago.
We are pleased at the recognition of Dr. Edwards’ work by the Nobel Prize committee. We are honored to have been able to participate in the development of these technologies, and we look forward to helping patients at Pacific Fertility Center benefit from this work, one healthy baby at a time.
-Philip E. Chenette, M.D.