Bourn Hall: how IVF was developed

Research scientist Kay Elder started working at Bourn Hall in the 1980s. Kay took Chris Smith through her collection of memorabilia documenting the story of how Bob Edwards, Jean Purdy and Patrick Steptoe made IVF happen...

Kay - “It’s a girl; here she is the lovely Louise. The first “test tube” baby is born and medical history is made as a mother’s dream comes true.”

Chris - We’ve got the original press cuttings when the Daily Mail, which is dated Wednesday July 26th, 1978 cost the princely sum of 8 pence!

In order to arrive at this day, with the birth of Louise Brown, where did the story begin and how long had they been working on this in order to achieve the birth of Louise?

Kay - The story began when Patrick and Bob Edwards met at a meeting at the Royal College in London on February 28th, 1968. Bob had had visions of what he wanted to achieve in terms of fertilising human eggs in-vitro and he needed the help of a clinician. Patrick immediately understood what the goal was and they decided to begin collaborating.

Chris - What was Patrick’s contribution then that caught Bob’s eye?

Kay - The development of what we now call keyhole surgery - laparoscopy - which is now commonly used in all different fields of medicine. But in the 1960’s, it was yet to be developed and Patrick heard about this technique that was being pioneered and he developed his own expertise by practicing in the postmortem room.

Chris - So he’s developing this technique to look inside tummies. What’s the relevance of that to fertility treatment and fertility research?

Kay - Patrick could see by looking inside tummies what the problem was. Some women had tubes that were blocked so that the egg could not pass into the womb. He could see abnormalities in the pelvis, he could see if there were bits of fibrous tissue adhesions.

Chris - Why was Bob interested in that?

Kay - Because he had spent many years working on looking at the development of eggs. They decided to start collaborating. Patrick was based up in Oldham near Manchester. Bob was based at his lab in the University of Cambridge. When Patrick was ready to do a laparoscopy, Bob and Jean would load up the car with microscopes, test tubes, culture medium, and drive up there. And when Patrick was able to recover eggs they put them into culture, looked at them under the microscope and watched to see if an embryo would develop eventually.

Chris - The patients who were undergoing this - what was then an experimental procedure - these were women who were hoping that they would have a baby through this sort of approach?

Kay - Definitely.

Chris - So they were willing to take part in these sorts of studies. So what did they then do in order to achieve in-vitro fertilisation?

Kay - They had to work out how to recover the eggs. They had to work out how to manage them, how to look after them, how to nurture them. What kind of culture conditions, the temperature, the gas. And once they were certain that the eggs appeared to be normal they started fertilising them.

Chris - But that’s still eight years before these headlines we have on these newspaper cuttings in front of us. So what happened over eight years? Why did it take so long from having embryos to having a baby?

Kay - Really everything that’s now taken for granted in IVF treatment they had to work out from scratch. Getting the hormones exactly right at the time that the eggs were collected and when the embryos were put back.

Chris - Looking at some of these other cuttings the reception wasn’t all positive though was it? Again, this is a Daily Mail editorial you’ve got here:

“Amid the rejoicing there are those who shiver involuntarily, where, they ask, is all this going to end?”

Kay - The teams themselves were an incredible set of extraordinary individuals. They were always very positive and very optimistic. They were quite certain that what they were doing was correct.

Chris - But you had people like James Watson. On the scientific stage, this guy has enormous credibility and he’s saying this is a bad idea?

Chris - You’d think then that having achieved this world first, things must have taken off! They must have then had people biting their arms off to do work. Is that what happened?

Kay - No. There was so much controversy and criticism that between 1978 and 1980 they had nowhere to continue working. And it took them two years to raise sufficient capital venture funding to open a private clinic because they eventually realised that this was their only option. They had hoped to have funding from the NHS, from the MRC, but the atmosphere in those days, thanks to people like James Watson and Max Perutz, was so negative, their only option was to open a private clinic.

Chris - And actually, that led to the purchasing of where we’re standing now, which in Bourn Hall. They bought that and moved in here in what, 1980?

Kay - September, 1980.

Chris - What were the other major developments along the way that have helped to keep Bourn Hall ahead and have helped to keep your success rate at what it is? Because it is one of the most successful clinics the country has.

Kay - Well, the first transition really started in 1984 when an expert ultrasonographer by the name of Jill Williams came over from California and started using ultrasound to measure the growth of the little follicles that contain the eggs.

Chris - This is physically looking inside the woman at the development of the egg that you’re going to harvest, or eggs you're going to harvest?

Kay - That’s right. Jill started by monitoring just by putting an ultrasound probe on the lady’s tummy and looking at the follicles, looking at the ovaries to see how they were doing.

And then the next thing that happened was a doctor by the name of Rajat Goswamy came in 1985 and started trying to recover eggs using ultrasound guidance instead of opening up for a big operation like laparoscopy. By 1986, we were using ultrasound guided egg collections, vaginal ultrasound, which is what everyone uses nowadays. So that was a major transition.

But another major transition was the discovery by two of our scientists here at Bourn Hall, Colin Howells and Mike Macnamee, that patients who had high levels of a particular hormone LH in their urine were less likely to get pregnant than those who had lower levels at specific times during the cycle, and this led to the use of drugs that would suppress the hormone cycle that elevates LH. That made it easier to programme and regulate when the eggs could be collected.

Chris - When did the atmosphere and the perception of the work that was being done here at Bourn Hall switch from one of being shivers going down people’s spines and scepticism to one of positive reception?

Kay - That really took quite some time. I think things started to shift when Dame Mary Warnock led a committee to look into the ethics of IVF. In fact, I think we were probably the first clinic in the world who had our own ethical committee.