23 June 2010
30th Anniversary of IVF in Australia
Today marks 30 years since the birth of Australia's first IVF baby Candice Reed. On this special day, pioneering embryologist Alex Lopata reflects on a brief history of IVF.
In Melbourne, the history of IVF began in 1971 when Professor Carl Wood, the head of Obstetrics and Gynaecology, at Monash University, appointed me to start an IVF program at the Queen Victoria Medical Centre. Before the end of 1971 we started collecting eggs from women and made our first attempts to fertilize human ova in a laboratory set up at the back of my office.
Carl Wood and Dr John Leeton began to admit patients who required surgical procedures to treat their infertility. These patients were asked whether they would consent to have eggs removed from their ovaries during the surgery. The women were told that we were starting an IVF program for treating infertility but also that no one had ever succeeded so far. It was heart-warming to discover how much these women wanted to contribute to the new research. These patients were pioneers in the early days of IVF and their participation in the project was critical to its further progress.
Despite our enthusiasm we had very few patients in the early days, usually no more than two per week, and progress was slow. In 1972 I asked Carl Wood whether the patient numbers could be increased by linking up with Dr Ian Johnston, who was working with infertile patients at the Royal Women’s Hospital. Carl Wood agreed with my proposal.
Dr Johnston had recently returned from an International Fertility Conference where he heard an enthusiastic lecture by Dr Robert Edwards about IVF and its potential for treating infertility. Ian Johnston was fired up about this exciting new potential for treating infertile women. When I told Ian my idea of starting IVF at RWH, the first thing he said was “How the hell did you know what was on my mind for the last few weeks?” and before I could answer he followed up with “What miraculous wind blew you into this clinic at this terrific time?” We decided that an IVF laboratory should be set up as close as possible to an operating theatre where eggs would be collected. Ian had introduced laparoscopy to the hospital and this instrument would be used for collecting eggs from the ovaries, rather than surgery that required opening the abdomen.
A janitor’s storeroom, a few steps from an operating theatre, was converted into my second IVF laboratory. When this room was equipped with two benches and a sink it had space for two people. But this small outfit started to handle the eggs from four times as many patients as my office lab at the QVMC.
We knew that Dr Robert Edwards, working in Cambridge, linked up with Dr Patrick Steptoe in Oldham Hospital, and that they started working on IVF in 1965. They had been working together for 7 years before we set up our program. Moreover Steptoe was a pioneer in using laparoscopy for collecting eggs from infertile patients. We knew we had to accelerate our work to catch up with the English group. Combined with Professor Jim Brown’s fertility hormone treatments we started to obtain the large number of eggs needed for establishing IVF in Melbourne.
My tiny lab at the RWH and my office lab at the QVMC became hives of activity for 7 days per week. By the beginning of 1973 we began to fertilize eggs and grow human embryos that we thought were healthy and ready for transfer to patients. At first, none of the embryos that were placed in the uterus in about 15 patients, were able to establish pregnancies. But before 1973 was over, an encouraging early pregnancy was established when an embryo, grown for 3 days in my lab at the QVMC, was transferred into the uterus of one of Dr John Leeton’s patients.
This patient was infertile because she had damaged fallopian tubes. She was admitted to the QVMC for surgical repair of her blocked tubes. Her eggs were collected during the laparotomy (abdominal surgery), matured in the lab for 24 hours and after in vitro insemination one of the eggs produced a normal looking embryo. When the embryo developed to the 8-cell stage, by the third day, it was transferred into the patient’s uterus while she was recovering from her surgery. Pregnancy tests showed that the embryo was viable and had implanted in her uterus. Unfortunately a few days later her surgical wound burst open, she went into shock and had to be returned to the operating theatre to repair her abdomen. The patient recovered well but unfortunately her pregnancy was lost after the second surgery.
Despite this tragic loss of an early pregnancy, its occurrence indicated that some of the embryos were capable of producing pregnancies. This idea was recorded in a publication in The Lancet. It is also worth noting that the lead author in this article was Professor David de Kretzer, the current Governor of Victoria. His laboratory was responsible for the pregnancy tests that confirmed the viability of the implanted embryo.
After 1975 there was an influx of infertility specialists into the RWH. Professor Roger Pepperell was appointed head of Obstetrics and Gynaecology, and he had the insight to appoint three young specialists. Dr John McBain who began working with fertility drugs, and Dr Hugh Robinson and Dr Colm O’Herlihy who applied ultrasound to study the ovaries of women being treated for infertility. Their work led to careful studies on ovulation and enabled us to collect better quality eggs from our patients.
A development at the QVMC at around the same period of time was the appointment of Dr Alan Trounson. Initially Alan and I worked together but in 1978 Carl Wood decided that Alan Trounson and I should work as separate teams and compete with one another, based on the idea that competition would speed up our progress. The main outcome was that we no longer shared information and that it gave me much more time to work at the RWH.
In 1978 the Steptoe-Edwards group announced the birth of Louis Brown at Oldham Hospital. The RWH invited Patrick Steptoe to give a lecture on how they succeeded. Steptoe talked in general terms and provided no information about the details of their methods. He suggested that we should go to lectures that will be presented by him and Dr Edwards at the Royal College of Obstetrics and Gynaecology. Alan Trounson and I travelled to London and attended their lectures. We were again disappointed because the information on how the English group succeeded was not provided. However, Dr Edwards stressed that working with women who were having natural menstrual cycles was an important first step.
Many of us from Melbourne began to wonder whether Edwards and Steptoe really knew how they had succeeded. We also realised that we had to establish pregnancies without their help. It did not take long for us to achieve this and in1979 we obtained Australia’s first IVF pregnancy at the RWH.
It is of interest that Professor Ian Craft from London was watching the embryo transfer procedure that resulted in the birth of Candice Reed. Professor Craft was setting up an IVF clinic at the Royal Free Hospital in London, but could not obtain any helpful information from his English colleagues.
The birth of Candice Reed at the RWH attracted worldwide attention not only because of the media publicity, but also because the procedures that we used were published in detail in the medical journal Fertility and Sterility in 1980. The birth of Candice acted like an IVF beacon that attracted infertility specialists to Melbourne. All of the international specialists who visited us obtained information that enabled them to establish successful IVF clinics. The first ones were in France, USA, Germany, Austria, England, Japan and Israel.