How did in vitro fertilization (IVF) transform itself in the public mind from a morally disreputable practice to an essential medical service? In the early days of IVF research, it was stridently condemned by religious leaders, famous scientists, and politicians. Theologian Paul Ramsey argued that the research was unethical because the fetuses and babies who were created could not consent. Nobel laureate James Watson assumed that the babies born of IVF would have birth defects and would need to be euthanized. IVF researchers could not get grant money for their work. In spite of this criticism, Robert Edwards and Patrick Steptoe proceeded with their careful and controversial research in IVF, culminating in the birth of health baby Louise Brown in 1978.
Since then, IVF has had a moral makeover. It is now a standard medical practice in most academic medical centers. Perhaps the most striking example of the shift in public attitudes was the debate in Alabama after the State Supreme Court ruled that early embryos are “children.” The ruling led IVF clinics to suspend services for fear of liability. But then the state legislature stepped in and passed a law granting IVF clinics immunity from prosecution. Republican Governor Kay Ivey of Alabama supported the law, arguing that it would allow “couples in Alabama who are hoping and praying to be parents to grow their families through IVF. ” This year, Trump said he would require insurance companies to cover it. Harris argued that her support for it would be even stronger. Both were no doubt aware that over 80% of Americans think IVF should be legal and available.
Now, we are seeing dramatic and cinematic retellings of the story of IVF. In the summer of 2024, the play A Child of Science ran in London. The story is told as one of idealistic scientists persevering against narrow-minded critics. The author noted, “So many people told them that they shouldn’t and couldn’t develop this science. At different times, the forces of the tabloid media, the catholic church and the Medical Research Council were all against them, but still they persevered.” Benedict Cumberbatch is working with Louise Brown to develop a television show about IVF for the BBC. Netflix has a new movie, Joy, that offers a similar version of the story. The movie suggests that Edwards and Steptoe were surprised by the hostility they faced for their attempts to fertilize ova outside the womb. The. This is disingenuous. They both clearly knew that they were violating taboos. They both knew that prior researchers, upon whose work their own breakthrough relied, had been stigmatized or ostracized. Such stigmatization went back more than a century. Jacques Loeb achieved IVF in sea urchins in 1899 and subsequently was often approached by infertile couple who earnestly entreated him to use his science to help them have children of their own. Loeb was such a major public figure in turn-of-the-century biology that he was the model for the physician-scientist in Sinclair Lewis’ Nobel-winning novel Arrowsmith. Loeb was nominated for the Nobel Prize 78 times but never received it. Gregory Pincus, a pioneer in reproductive endocrinology who helped develop oral contraception was pilloried in the press and denied tenure at Harvard. Pincus and his collaborator John Rock could not get government support for their work and carried on only because they found a non-governmental patron, millionaire heiress Katherine McCormick. Edwards and Steptoe built upon the work of these pioneers and surely knew that any work on sexuality, reproduction, or contraception was intensely controversial and inevitably led to sensationalist press coverage and academic ostracization. The movie would have been more accurate, and maybe even more dramatic, if it acknowledged this history.
The filmmakers elide many controversies by focusing less on the two men and, instead, on Jean Purdy, the nurse who collaborated with them. She is portrayed as the dynamo who brought the men together and encouraged their work. Crucially for the story, she is infertile herself. She is a devout Christian who, in the movie, is banished from her church and abandoned by her mother for working on IVF. These are embellishments, added to make the narrative simpler. While Purdy was instrumental to the entire research program and did not, initially, get the recognition that she deserved, she was only one of many people who helped develop IVF.
A more important story highlighted by Joy is about the commitment and the suffering of the infertile women who participated in the early unsuccessful attempts at IVF. Between 1969 and 1978, 282 women participated. Only two got pregnant. Some had life-threatening complications. All knew that “there was next to no chance of success for them personally. But they willingly gave themselves so that others would benefit in the future.” The focus on these unsung heroes is also a crucial part of the story. It is a story raises questions about the importance of listening to the voices and respecting the values of research participants. While there was widespread criticism of the researchers, there was never any question but that they were respectful of the women who participated and that those women understood both the risks and unlikelihood of personal benefit.
In telling the story this way, the movie overlooks or oversimplifies two aspects of the research that led to IVF. First, it underestimates both the importance of a century of prior research that laid the groundwork and the importance of prior ethical controversies that surrounded that work. By the late 1960s, IVF had been successfully done in many other mammals. The possibilities inherent in the creation of “test-tube babies” led to widespread discussion and controversy about human chimaeras, genetic selection and modification, and even cloning. In the general press and popular literature, human IVF presaged a near-future brave new world, a science-fiction vision that Cambridge scientists had done much to promote. These concerns are pooh-poohed in the film
Another crucial element of the story that the film leaves out completely is the connection between Edwards’ work on IVF and his beliefs about eugenics. He believed that IVF would be useful not just for the treatment of infertility but also to select socially favored characteristics in babies. In 1999, he said, “Soon it will be a sin of parents to have a child that carries the heavy burden of genetic disease. We are entering a world where we have to consider the quality of our children.” This reflects a consistent and troubling underlying motivation for fertilizing ova outside the womb – it is a way of selecting certain types of people—the smart, the beautiful and those without disability, and deeming others too burdensome to be born.
Some try to distinguish (and therefore excuse) eugenic advocates like Edwards from the early eugenicists, both in the US and in Europe, who advocated for state-enforced eugenic policies, including involuntary sterilization and even euthanasia. The new eugenicists, the argument goes, hope that individuals will demand technologies like IVF in order to choose desirable traits in their babies. Edwards supported such choices. When asked about sex selection for social reasons, he said: “Go ahead and use it. Those parents have to raise those children. Why should a politician tell me what I can and can’t do?” Controversies continue to this day about the connections between IVF, eugenics, and discrimination against people with disabilities. These are crucial elements of any story about IVF.
A final element of the IVF story is particularly relevant today. Edwards and Steptoe were working in an era before biomedical research was strictly regulated. It is unlikely that today’s research regulations would permit the work that they did. Most IRBs would have found the risk-benefit ratio intolerable. If they are seen today as heroes, then we must also so those who would have stopped them as villains. But the doubters are in charge today.
Edwards and Steptoe were very careful scientists. They were also lucky. Many babies born by IVF have congenital anomalies. Louise Brown didn’t. If she had, then the story would likely have been told with a different moral. Edwards himself once said, “To have those babies being born normal . . . well, if they hadn’t been, I’d probably still be in jail.”
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