“Test-Tube Babies” @40

Forty years ago, on July 25, 1978, an English baby of ordinary working-class parentage was delivered by caesarian section. At 11:47 p.m., her mother, obstetrician Patrick Steptoe, Cambridge embryologist Robert Edwards, and a large medical team, together with a BBC film crew, had secretly gathered in the operating theater of Oldham Hospital in Manchester. Admitted under the pseudonym Rita Ferguson, the mother had for weeks been kept away from all other patients and even the windows because scores of reporters had heard a rumor that Steptoe and Edwards had at last succeeded with a revolutionary fertility procedure.

Once the newborn had been pronounced healthy, Steptoe and Edwards alerted the press. Within hours, Louise Joy Brown became the most famous baby in the world, after the release of revolutionary news: she had been conceived in a “test tube.” Baby Louise—and then Louise at every imaginable milestone—was and has remained a global tabloid staple. In adulthood, she’s become a spokesperson for assisted reproductive technology (ART), particularly in Eastern Europe, where infertile couples face social stigma and scant financial support.¹ As for Steptoe and Edwards, they became scientific heroes, with the latter being awarded the Nobel Prize in Medicine in 2010.

Louise’s birth was made possible by in vitro fertilization (IVF), a delicate procedure that had been previously attempted not only by Steptoe and Edwards but also by other research teams across the globe. In this case, mother Lesley Brown’s hormone levels were monitored multiple times a day so that the doctors would be able to harvest a perfectly ripe ovum, which was extracted laparoscopically. The egg was placed in a glass apparatus with her husband’s semen and microscopically monitored as conception occurred and the resulting blastocyst divided from one to two to four to eight cells over three days; then it was implanted in the mother’s uterus. At that point, Lesley Brown had already gotten further than many of the other 282 women from whom Steptoe and Edwards had extracted ova since 1969. She was one of only five to achieve a clinical pregnancy and the first to produce a living child.²

IVF ultimately transformed reproductive possibilities for the millions who wished to become biological parents but could not because of blocked or damaged fallopian tubes. It took a few years, into the early 1980s, for IVF successes to be replicated in sizable numbers, but now, 40 years later, seven million individuals have been born as a result of this medical intervention. As one scholar has concluded, IVF “may be the most important medical advance of the twentieth century to have taken place without substantial support, financial or otherwise, from either corporations or governments.”³

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As a story of individual, institutionally marginalized research teams working alone and against the odds, Steptoe and Edwards’s success was recounted at the time as the triumph of heroic male science. Contemporaries rarely mentioned the female scientists and technicians long involved in ART research and procedures.⁴ In the case of Louise’s conception, Steptoe and Edwards were not the only two responsible. There was a third member of the team: lab technician and nurse Jean Purdy, who was involved in every step of patient care and monitored the entire process of fertilization and cell division through the microscope. Although Steptoe and Edwards always described her as instrumental to the success of IVF and included her as a coauthor of articles published in Nature and elsewhere, journalists and even the Browns themselves ignored her important contribution.⁵

This is not surprising given how infertility, the family, and science were discussed in the 1970s: as a simple but dramatic story of helpless women and brilliant men able to fix their problems and make babies for them. As news about IVF was disseminated in Louise Brown’s day, it was framed in traditional views about gender and the ideal middle-class nuclear family. Typically journalists described valiant male scientists alleviating the suffering of heartbroken women unable to have biological children. This rhetorical dynamic was decades, if not centuries old.⁶ But this was a paradoxical decade for such polarized gender stereotypes.

The pill, the IUD, and legal access to abortion (in Britain from 1967 and the United States from 1973) gave women newfound control over their reproductive bodies, an issue intertwined with modern feminism. But not all women applauded these transformations; some traditional housewives, for instance, felt left behind. Those who wanted children lamented that the contemporary focus was on preventing and terminating pregnancies instead of helping them become mothers. As one woman with blocked fallopian tubes complained, “Adoption is usually recommended. [But] for the average couple … the wait is many years. … Because of liberal abortion laws, effective birth control and the increase of unwed mothers keeping their babies, hardly any children under the age of seven are available.”⁷

Abortion often hovered behind these stories of infertility as ruining the option of adoption. One fertility researcher, Landrum Shettles of Columbia University, however, was more cheerful about it all. He claimed that the process of very early vacuum extraction of aborted fetuses “often does them no damage” and believed they could actually be prenatally adopted.⁸

many among the public linked IVF to the darkest dystopian visions in fiction, including, of course, Aldous Huxley’s “Brave New World.”

As Shettles’s optimistic statement indicates, researchers imagined many solutions to infertility and the problem of female suffering. Other teams working on IVF included Miriam Menkin and John Rock, the father of the birth control pill, at Harvard; Georgeanna and Howard Jones, the husband-and-wife team who would establish the first American fertility clinic in the 1980s; and an Australian team that was the first to achieve a human IVF pregnancy, in 1973.⁹ And, acting alone, there was the brilliant but renegade publicity hound Landrum Shettles at Columbia Presbyterian Hospital, whose work enraged his colleagues and endangered the entirety of that medical school’s NIH grants.

Shettles’s unorthodox behavior—for instance, using his own semen when fertilizing “donated” ova from gynecological surgeries—epitomizes how ART was sometimes driven by big personalities, with little heed paid to ethics. In Pandora’s Baby: How the First Test Tube Babies Sparked the Reproductive Revolution, Robin Marantz Henig highlights how wild some of these projects were; for example, the once reputable science journalist David Rorvik (Shettles’s coauthor) claimed that he had helped a millionaire named “Max” clone himself in the 1970s.

As zany as some of the stories were, there were abundant tragedies too. Working surreptitiously (without his own office, lab, or institutional permission), Shettles attempted to make the first in vitro embryo with the ovum and sperm of Doris and John Del Zio. When his department chair, Raymond Vande Wiele, discovered the test tube in an incubator, he intentionally destroyed its contents. The Del Zios eventually sued. By coincidence, their case went to trial in July 1978, just as the press pursued the mysterious woman pregnant with the world’s first IVF baby in England. Vande Wiele’s defense even argued that the Del Zios had deliberately timed their suit to coincide with Louise Brown’s birth to garner sympathy from the jury. But from the couple’s point of view, they had lost not only their chance at having a baby but also the chance to be the “first” to produce a miracle.¹⁰

Despite the portrayal of ART researchers as heroes whose research enhanced rather than undermined the traditional nuclear family, IVF posed challenging questions from the start. Although Steptoe and Edwards insisted that they were simply helping “normal” heterosexual couples be biological parents, they faced strong opposition and consequently received very little government funding.

From one side, proponents of the Zero Population Growth (ZPG) movement saw little justification in promoting additional births, considering the then four billion people straining global resources. From another side, the Catholic Church questioned the ethical and moral ramifications of any reproductive interventions. After Pope Paul VI issued the encyclical In Vitae Humanae against artificial birth control and abortion on July 25, 1968, Christian ethicists applied the Vatican’s arguments to ART. They viewed fertility technology as unethical because it could maim or kill a future child. Gruesome but unsubstantiated stories of macabre fetal experiments in the Soviet Union and Scandinavia only furthered these critiques.¹¹ And from the sidelines, some traditionalists viewed ART as serving women’s libbers who had wanted careers and foolishly delayed childbearing until their 30s, when they could only conceive artificially.¹²

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Yet one did not have to be a ZPG acolyte, a Catholic, an evangelical Protestant, or an antifeminist to question the consequences of fertility research. As letters to the editors of popular women’s magazines and the daily press showed, many among the public linked IVF to the darkest dystopian visions in fiction, including, of course, Aldous Huxley’s Brave New World (1932), with its “Central London Hatchery and Conditioning Centre,” in which babies were conceived and gestated entirely outside the human body. Brave New World and dozens of other now-forgotten novels and films depicted extreme forms of reproductive technology to critique modern science, the role of the state, and the social changes wrought by feminism.¹³

As many of these fictional works had asked, what were the consequences of playing God? In the 1970s, some researchers avoided answering this question, but Steptoe’s later remarks on the 25th anniversary of Louise Brown’s birth captured exactly what critics had feared. In 2003, Steptoe explained, “I wanted to find out exactly who was in charge, whether it was God Himself or whether it was scientists in the laboratory. … It was us.”¹⁴

Since Louise Brown’s birth, in 1978, researchers have developed many more techniques and practices, which have only exacerbated the concern that scientists try to play God and blithely meddle in life without considering the consequences. When researchers attempted less successful procedures, such as embryo transplantation, they were accused of wasting lives.¹⁵ But when they were wildly successful—for example, when they used follicular stimulating hormone therapy and were thus able to obtain 20 ova per egg extraction—they were also accused of wasting living matter.¹⁶

Today, the issues stemming from IVF and ART have only grown more thorny. Lawyers, theologians, and reproductive clinic directors, not to mention parents, face questions about what to do with the resulting extra embryos or other excess reproductive material. Because each extraction can cost thousands of dollars, doctors usually obtain as many eggs per cycle as possible. There are unknown millions of these cells in storage, many of which have been frozen, literally and figuratively, in legal and storage limbo for decades. Alongside the ethical quandaries spawned by ART, such revolutionary practices as gestational surrogacy and transgender pregnancy have raised even more complex problems than existed in 1978.

The pill, the IUD, and legal access to abortion gave women newfound control over their reproductive bodies, an issue intertwined with modern feminism.

IVF has also sparked debates about what it means to be a parent and a family. While research teams’ policies of working only with married couples buttressed the assumption that the “normal” and “natural” family was composed of husband and wife, paradoxically ART has contributed to very different modern definitions of the family. Largely because governments in the United States, India, and Japan have not funded ART, fertility procedures have operated in these places as a free market with relatively few state regulations. In the United States and several (but not all) Western nations, fertility specialists have opened their doors to nearly anybody who can pay for their services. As a result, since 1978, same-sex couples, single women and men, and transgender female-to-males have been able to use ART to become biological parents.¹⁷

As reproductive technology has advanced, legal and personal conflicts that raise hard questions about parentage have multiplied. Emotionally wrenching cases that have shaped debate include the 1986 story of “Baby M,” whose biological and gestational mother, Mary Beth Whitehead, broke her surrogacy contract, and the 2015 lawsuit between actor Sofía Vergara and her former fiancé Nick Loeb for custody of their two frozen embryos. A 2005 California custody and visitation battle between separated lesbians, one of whom provided the eggs to be fertilized in vitro and then implanted in the other partner, took years to resolve legally, with the Supreme Court of California finally giving both mothers equal access to the children.¹⁸

These scenarios have created complex, emotionally intractable dilemmas that Steptoe, Edwards, and others scarcely could have predicted. These are new problems, to be sure, but they share a fundamental feature with critiques of ART in the 1960s and 1970s. That era’s discussions about infertility and IVF, emphasizing heroic scientists and sterile housewives, ultimately focused on the interests of adults, not children. Aside from the Vatican and conservative critics, organizations and individuals said relatively little about the children who might come into being (or not) and what rights they had.

That remains true today. Berkeley law school professor Mary Ann Mason and her coauthor Tom Ekman argue that the American legal system is especially ill-equipped to address not only the complex conflicts between parents but also the needs and rights of adults versus the children who result from ART. For example, because US laws protect the privacy of sperm and egg donors, children cannot exercise their right to know their biological parentage. Children created as “savior siblings,” whose cells and even organs will be used for their parents’ other children, have little say over their fate.

These situations largely result from an American emphasis on individual rights, property, and contracts—by definition only made by adults—that leaves children legally voiceless. Individual judges may take into consideration what is in the best interest of the child, but there is no overarching American framework to do this at the moment, unlike in the United Kingdom, with its Human Fertilisation and Embryology Authority.¹⁹

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When Steptoe, Edwards, Purdy, and the Browns produced the first test-tube baby, the traditional married, heterosexual, nuclear model of family drove the conversation: the egg and sperm came from a wife and husband, and the ability to carry their own pregnancy and have a biological child made them feel “normal.” Forty years later, ART has enabled same-sex and transgender parents to have a child biologically. In more progressive states and nations, they are recognized and protected as their children’s natural parents. The social and cultural changes of the last 40 years, during which the LGBT community has fought for recognition and legal parity, combined with an unregulated ART market, have helped to shift the ways we think about parents and parenting. It is no longer assumed by all that every child needs a male and a female parent, even if their biological beginnings came from a sperm and an egg.

Today, emerging technological developments such as mitochondrial replacement, which involves using a second woman’s DNA, and the possibility that two parents of the same sex will be able to provide all of their child’s DNA further push the very definition of biological parentage. We are facing a brave new world in which human reproduction—long imagined as an immutable process requiring genetic material from both one man and one woman—has, through medical technology, revolutionized our assumptions about gender, sexuality, and the family. This is the surprising legacy of Louise Brown and her parents, who simply wanted to have “just one baby of our own.”²⁰

This article was commissioned by Arianne Chernock.