October 2010 eNews
Nobel Laureate Robert G. Edwards, PhD -
A Personal Appreciation by the Genetics & IVF Institute Founder, Joseph D. Schulman, MD
This special issue of the Genetics & IVF eNews focuses on the recent awarding of the Nobel Prize in Physiology or Medicine to Robert Edwards, PhD, of Great Britain for his pioneering leadership in developing the technology of human IVF (in vitro fertilization). The author of this lead article knows Professor Edwards well as both mentor and friend, and worked alongside him in England for an entire year in the 1970s in the effort to create the first successful IVF methods. Dr. Schulman, the Genetics & IVF Institute Founder, is the only American scientist or physician to have had the privilege of such participation.
At last, after long delay, Bob Edwards has received the Nobel Prize which he so fully deserves. Louise Brown, the very first IVF baby, was conceived through Bob's scientific achievements in 1977. Since then, several million healthy IVF babies have been born around the world. The Genetics & IVF Institute was directly inspired by Bob's example, and was started as one the very first IVF centers in the United States. From its inception, like Bob's original IVF center at Bourn Hall in England, we have not just provided highest quality clinical services to our patients, but we have also led in the field of human reproduction through important scientific advances. Our Institute is well known for innovations including the introduction into the United States of non-surgical ultrasound guided egg retrieval, the first U.S. births from ICSI (intracytoplasmic sperm injection), the development of non-surgical testicular sperm aspiration, the invention of non-disclosing preimplantation genetic testing (the world's first effective technique for the prevention of Huntington Disease), and of course the development by Dr. Lawrence Johnson and Institute scientists of MicroSort® sperm separation for preconceptual gender selection in humans. Our Institute has also introduced new methods of reproductive treatment outside the United States, and at Shanghai created the first modern IVF center in all of China.
Bob Edwards was the world's pre-eminent reproductive scientist. He was also a friend to me, and a consistent source of enlightenment and encouragement. He greatly admired the work being done at our Institute and on three separate occasions crossed the Atlantic specifically to participate as keynote speaker in the Institute's conferences for medical professionals. He visited the Institute itself and engaged in discussions of science and medicine with our scientists and physicians. He invited my participation and that of some other senior Institute staff as reviewers and authors in the two leading reproductive medical journals he edited, "Human Reproduction," and the more recent electronic "RBMOnline." He was particularly enthusiastic about MicroSort®, and told me he considered it one of the most important breakthroughs ever achieved in the field of human reproduction; he encouraged articles about MicroSort® in his journals, and strongly advocated its utilization in Great Britain. In 2008, our Institute was in the process of organizing with Bob a major international conference on reproductive bioethics here in Washington, DC, but this effort was halted after he tragically became incapacitated by a rapidly progressive dementia.
Given the hugely important benefits that IVF has made possible for so many patients, benefits that were apparent to many in the field of medical science by the mid-1980s, why was the award of the Nobel Prize delayed until Bob Edwards' principal IVF collaborator, surgeon Patrick Steptoe, was dead and Bob so ill that his wife, Ruth, had to take the call from Stockholm because he was unable to do so? This question has been overlooked in most media reports on the Prize, but a few of the most perceptive reporters like Nicolas Wade in the New York Times and Ron Bailey in Reason magazine did touch upon it.
The fundamental reason the Nobel Prize award was delayed for decades was because Bob was a consistent fighter for reproductive innovation of many types. Indeed, it is not an exaggeration to call him the world's most important leader in this effort. In the course of these activities, which ended only with his current illness, he faced much opposition and made powerful enemies. Bob led the fight against those who would restrict medical progress and inhibit personal reproductive freedoms. The original IVF research with human embryos which Bob pioneered in the 1970s was bitterly attacked by numerous scientists, religious leaders, politicians, bureaucrats, and members of the press. Cambridge Professor Martin Johnson, one of the first graduate students of Bob's in the 1970s, described in 2009 how he was intimidated from any participation in IVF research: "We didn’t want to get too involved in it. The reasons for that were sheer level of hostility to the work........People were saying he really shouldn't be doing this kind of thing.......We were in this sort of little ghetto at the top of [the] Physiology [laboratory], which was ringed with prejudice and hostility and antagonism." Opponents of Bob's IVF work were influential enough to block support for the research from Britain's Medical Research Council. Scientific opposition was widespread, and included the Nobel Laureate Max Perutz. The Ford Foundation provided early support for Bob's IVF research, then backed away. The antagonism and lack of external funding nearly stopped the IVF work before it became successful. After it was a scientific success, the nationalized British health care system refused to make it available to patients, and Bob was forced to find investors and open Bourn Hall with private funding. Only those who lived through these early years of IVF research can fully appreciate the immense determination - the sheer toughness - of Bob and Patrick, aided to some degree by their few allies including Bob's department head at Cambridge, C.R. ("Bunny") Austin, the dedicated nurse Jean Purdy, and myself. It all very nearly failed. As the Duke of Wellington was reported to have said after winning the Battle of Waterloo, "It was the nearest-run thing you ever saw in your life." Without exaggeration, that statement could be accurately applied to the attainment of success with IVF.
The label of "controversial" continued to surround Bob Edwards for the rest of his life. In his later years he passionately advocated the value of stem cell research, including research using embryonic cells. He strongly supported MicroSort® in England, organized a conference at the Royal Society which included it, and was delighted that a Parliamentary committee reported favorably on it. His tragically delayed Nobel award is one of the prices he paid for such determined and publicly visible efforts.
The struggle to bring reproductive innovation to patients, and to advance reproductive science, still continues. To this day - over 30 years after the birth of Louise Brown - our own government still prohibits the National Institutes of Health from funding any research on human IVF, and all advances in the IVF field in the United States, including those at the Genetics & IVF Institute, have been accomplished entirely without government support. The Catholic Church is still an opponent of IVF, and officially expressed its dismay at the awarding of the Nobel Prize to Dr. Edwards. Despite millions of IVF births, laboratories performing IVF have in the last few years been shut down in Italy. Despite Bob's strong support of MicroSort® and the many normal births already achieved by this method of preconceptual gender selection, MicroSort® is not today available to patients in England. And whether or not it will become widely available for patients in the United States will be influenced by the pending decisions of federal regulators.
Continued progress in the science and medicine of human reproduction is, in the long run, absolutely certain. And history has shown, as with IVF, that initially controversial medical advances ultimately become both widely adopted and wisely utilized. However, delaying such advances through restriction of research funding or denial of clinical access harms some patients irreversibly. Individuals, particularly females, have a time-limited window in which to exercise their reproductive choices. Time matters to all patients who seek reproductive assistance. That Robert G. Edwards was denied the Nobel Prize for several decades is a vivid proof of the legal truism, attributed first to William Gladstone, that "justice delayed is justice denied." With equal justice it may be said that "medical innovation delayed is medical innovation denied." As someone who has participated actively in medical progress for over forty years, I pray that the future will bring us more innovation and less denial than in the past. The combined efforts of physicians, scientists, and men and women of goodwill both inside and outside of government are required for this to happen.
Joseph D. Schulman, MD, GIVF Founder
What's New at GIVF
GIVF now offers a full service satellite office in North Bethesda, MD (across the street from White Flint Mall). Learn more about the new office here.
Preserve your fertility with Personal Egg Banking™ (also known as elective oocyte cryopreservation). Schedule a free consultation here.
Male infertility consultations are available at GIVF with a board certified urologist. Schedule a consultation here.
Have you considered using a Flexible Spending Account (FSA) to pay for infertility treatment? FSA is a common employee benefit that allows you to set aside pre-tax income for healthcare expenses not covered by insurance. Any balance left in your FSA account at the end of the year will be forfeited, so if you are considering using FSA funds for infertility treatment, now is the time to schedule a consultation with us. Speak to your employee benefits coordinator for more details about your FSA.
GIVF's Jennifer Machovina, RN, BSN is Fertility Authority's Nurse of the Month! Learn more here.
Choosing an Egg Donor - It Doesn't Have to be Scary
by Phyllis Martin, LPC
Exactly how does one go about picking an egg donor? How do you choose a woman who will donate her eggs so that you can grow your family? What is important to look for and why is the process so overwhelming?
To begin with, it is very hard to hear the news that you will need to use an egg donor. Most patients feel mixed emotions as they proceed with this type of family building. Couples often grieve the loss of the intended mother’s genetics, yet feel grateful to have another family building option that includes carrying a pregnancy. As the grief lessens and the process begins, people typically start thinking about what they want their egg donor to look like, and even about more specific qualities like family background, academic achievement, hobbies, and talents. Often times I hear from donor egg recipients that the process of looking through so many pictures of potential donors feels surreal. “I felt like I was buying a car,” or “at first it felt funny, then I started getting real picky, then I felt bad for being so picky!” are frequent comments I hear.
I recommend donor egg recipients think about nature versus nurture first. Think about your theory regarding what is “hard wired” and what is the result of upbringing. Achievements, talents, hobbies, and interests are more often a product of environment, opportunity, and nurturing, not genetics. Next, prioritize what matters to you. Similar physical appearance to you (woman) is usually desired. We typically look for some type of “new and improved” version of ourselves, and suddenly all those flaws we are used to seeing in the mirror are the very things that make us irreplaceable. So we want ourselves, but perhaps taller, thinner, prettier, and smarter!
Keep in mind that in reality you cannot find a donor who is a replica of yourself. However, you can find a donor who shares many similarities with you. Doing so will make you feel more confident in your choice. Similar build, coloring, facial features, and/or ethnicity are usually on the top five of a donor egg recipient’s list. For those who are not sure if they will disclose to their child their genetic origins, matching blood type to the mother is important.
The mental and physical health of a donor is important, but what might be considered a “deal breaker” for one couple may be a non-issue for another. Keep in mind that no donor is perfect. Imagine for a moment what your profile would look like if you were an egg donor—this will keep your expectations realistic. GIVF egg donors are tested and screened for the major diseases so you can have peace of mind that only the most healthy, best candidates are allowed to donate.
Once you have compiled a list of the traits that are important to you, compare it to your partner’s and begin looking. Get oriented with the donor search engine and see what pops out to you as you browse donor pictures and profiles. Afterwards, take a break. When you look again, narrow the profiles down to a few and then take a break again. Return with fresh eyes and look again. Remember, there is no pressure, you can proceed with the donor selection process at your own pace.
When you have your top choices, speak with your donor egg coordinator and ask questions. After all, the donor egg team has met your donor and will have a sense of her and her potential to match with you. Finally, take a breath. It is okay to think the entire process is an episode from Star Trek. The technology available to us often goes faster than our minds can comprehend. It is okay to have trepidation and excitement. Keep in mind the big picture of building a family as you proceed. Using donor egg can look different from your original family picture, but it can still make a fabulous picture.
Phyllis Martin is a Licensed Professional Counselor and Infertility Specialist available to current patients, as well as those considering infertility treatment and who have undergone treatment. Click here to view the support group meeting schedule or here to contact Ms. Martin.
The Genetics & IVF Institute (GIVF) regularly releases an informative newsletter featuring the latest infertility news and developments. The newsletter is sent electronically via email. To subscribe, click here.