Book Review: Egg Cell Seeks Sperm Cell for Steady Relationship – A Brussels triumph of science over infertility

Egg Cell Seeks Sperm for Steady Relationship: A Brussels Triumph of Science over Infertility
By Professor André Van Steirteghem
Published by Borgerhoff and Lamberigts
ISBN-10: ‎9464987626, ISBN-13: 978-9464987621
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When I think of ICSI, I think of my parents who underwent several unsuccessful rounds of IVF at a time when the technique was not yet an option. It was only when ICSI became available in the UK that they had a successful pregnancy – me.

Reading 'Egg Cell Meets Sperm Cell For Steady Relationship', therefore, gave me a rather unusual perspective on a technology that I now encounter as part of my own work as a clinical embryologist. It also introduced me to the many other contributions Professor André Van Steirteghem and Professor Paul Devroey made to reproductive medicine.

Before jumping into the first chapter, it is worth reading the foreword. Professor Van Steirteghem – and those who knew him professionally – offer short but poignant reflections on the scientific and social impact of his and Professor Devroey's work. Alongside their pioneering achievements in reproductive medicine, they had an ethos of making IVF accessible to all: from being among the first to treat single women, to contributing to the development of IVF reimbursement policies. This thread runs throughout the book, and the question of who gets to benefit from advances in reproductive medicine is as relevant today as it was then.

Having established the scale of their impact, the book takes us back to where it all began: the early careers of Professor Van Steirteghem and Professor Devroey, from setting up the IVF programme at UZ Brussels Hospital to their first birth just a year later, in 1983. The description of egg collections and embryo grading didn't sound quite as antiquated as you might expect. In fact, I was struck by how similar the lab work seemed to how we do things today.

The book continues a whistle-stop tour through key scientific developments. However, I found myself wanting to stay a little longer at some moments, particularly when ICSI was discovered. The author briefly describes the 'subzonal insemination' procedure (SUZI), in which a single sperm was placed into the small space between the egg and its protective outer layer. It was a delicate technique, and occasionally the sperm would penetrate the egg itself. At the time, this was called a 'failed' SUZI attempt, but now it would be called ICSI!

Perhaps the brevity of this section reflects the uncertainty of the moment: Professor Gianpiero Palermo could not have known these seemingly unsuccessful attempts would transform the treatment of male-factor infertility. It was only with the birth of the first ICSI baby in 1992, followed by publication of the work in The Lancet and the rapid adoption of the technique internationally, that the significance of what had happened became clear.

Later, the book delves into the development of pre-implantation genetic testing (PGT). Covering everything from terminology and patient eligibility to the history and development of the techniques used, this chapter provides a useful introduction for anyone less familiar with the topic. Again, I sometimes found myself wanting more: there is plenty of detail about the science and how each technique developed, but what was it like to be there as it was happening? I wanted insight into the author's own experience and feelings. Were there disagreements, uncertainty or any difficulties along the way?

The closing chapters cover legislation and research, and I found myself comparing the Belgian approach with my experience of the UK system. The Belgian reimbursement scheme allows eligible patients to access up to six IVF/ICSI treatment cycles. This will resonate with British readers given how limited access to NHS-funded treatment is in many parts of the UK (see BioNews 1326).

The book also describes a five-year embryo storage period in Belgium, which is far more constrained than the 55 years in the UK. It left me wondering whether increasing access to treatment was enough, or whether we should also be pushing for greater patient choice and autonomy.

This sentiment was reflected in the deep sense of responsibility Van Steirteghem and Devroey showed towards the different groups their work affected. For the scientific community, this meant sharing their techniques rather than patenting ICSI, as well as contributing to the development of the European Society for Human Reproduction and Embryology. For patients, this meant involvement in policies regarding access and reimbursement, with the belief that advances in reproductive medicine should not only benefit those who could afford them.

Perhaps most importantly, there was a responsibility to the children born from these technologies, reflected in their commitment to large-scale follow-up studies to make sure that the techniques they introduced did not come at the cost of adverse outcomes in future generations.

For readers interested in life sciences and reproductive medicine, this book offers an accessible history of the developments that shaped modern IVF, ICSI and PGT, without requiring specialist knowledge. Those already working in the field may occasionally find themselves wanting to dive deeper, or desiring more of the personal stories behind the discoveries. For anyone wanting to understand how the field reached where it is today, it provides a fascinating place to start.

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