Dr Kay Elder, senior research scientist at Bourn Hall, Cambridge, the world's first IVF clinic, delivered this year's Bob Edwards Memorial Lecture at the Fertility 2025 Conference in Liverpool.
It was truly inspiring to hear Dr Elder's talk entitled 'On the Shoulders of Giants: Historical Perspectives in Assisted Reproduction'. She took us through the journey of how one of the most life-changing scientific advancements of our times, IVF, was developed, from conception through to delivery (pun intended!).
Dr Elder was introduced by Professor Jackson Kirkman-Brown, chair of the Association for Reproductive and Clinical Scientists who took the opportunity to bestow honorary membership of the Association on her, in recognition of her pivotal role in creating the knowledge and standards in fertility treatment.
'A few minutes before midnight on 25 July 1978, Louise Joy Brown was delivered as the first test tube baby in the world.'
This is how Dr Elder started her talk, remembering this 'epic moment' and showing a picture of baby Louise being held by Dr Robert Edwards, Dr Patrick Steptoe and Jean Purdy, the principal team who developed IVF. Having recently watched the Netflix movie 'Joy' (see BioNews 1266), and being a scientist working on fertility myself, I found this opening quite moving.
But the journey to reach this point spanned nearly three decades, as Dr Elder promptly reminded us. Her talk was informative, full of pictures and personal memories from the time she spent working with Dr Edwards and Dr Steptoe.
But let's hit rewind.
Dr Elder set the scene by describing the backgrounds of Dr Steptoe, obstetrician and gynaecologist who pioneered the use of laparoscopic techniques, and Dr Edwards, a biologist and physiologist who trained with reproductive biologist Dr Richard Beatty and developmental biologist Dr Conrad Waddington at Edinburgh University.
It is remarkable to reflect on the fact that Dr Steptoe and Dr Edwards worked in parallel for nearly 20 years, each developing and refining skills and knowledge that would be instrumental in making IVF a reality.
Dr Edwards in particular, as Dr Elder tells us, had published more than 50 papers on reproductive biology by 1960, studying all the different aspects of gamete biology and embryo development that would ultimately be necessary for IVF.
Interesting anecdote: he was initially relying on biopsied ovaries supplied by Molly Rose, the gynaecologist who also delivered his five daughters. But he soon realised that these samples were not adequate – I suspect the chance of finding an egg near the time of ovulation would be pretty small. Dr Edwards knew he needed to study freshly ovulated eggs if he was to succeed in creating a human embryo. He had a lightbulb moment when he came across Dr Steptoe's paper on laparoscopy and later met him at a joint meeting of the Section of Endocrinology of the Royal Society of Medicine with the Society for the Study of Fertility on 28 February 1968. Dr Elder recalls that Dr Edwards was astonished that when he told Dr Steptoe about his idea of retrieving eggs from the ovaries using laparoscopy, he said immediately: 'let's get started'. It was the start of a 'powerful partnership', which by September 1968 included Jane Purdy, the nurse embryologist who was hired as lab technician by the team.
But this small group was not going to be enough. Dr Elder highlighted how this endeavour would need the dedication, energy and vision of a loyal team.
She told us about the key role played by matron Muriel Harris, the world's first IVF nurse, who set up an operating theatre and a team of volunteer nurses to look after the patients. I was glad to hear Dr Elder acknowledge the contributions of the many women who became part of this team, as well as those who supported the effort from the sidelines and made important contributions. She talked about the role that Dr Edwards' wife, Ruth Fowler Edwards, a scientist with a deep understanding of developmental biology, played in the process. She provided a stable and loving home while continuing to do research alongside Dr Edwards and publishing papers which became a very fundamental foundation to human IVF development.
One year after Dr Edwards and Dr Steptoe met, the team published the first successful attempt of human IVF in Nature. In what Dr Elder described as probably the greatest understatement of all time the paper said: 'Human oocytes have been matured and fertilised by spermatozoa in vitro. There may be certain clinical and scientific uses for human eggs fertilised by this procedure.'
It took ten more years and over 70 publications before the first successful pregnancy and the birth of baby Louise.
Dr Elder gave us an insight into what may be the reason for this delay. Following the sudden death of Dr Edwards in 2013, his family gave her several lab books and notes spanning that decade. As she took up the mammoth task of making sense of notes relative to over 450 laparoscopies spanning those ten years, it became clear that the team was very cautious about introducing any changes in the protocol and they studied each embryo carefully before implanting it. They performed 100 laparoscopies before the first implant. Lesley Brown had the 438th laparoscopy since their research began, in November 1977: finally the successful one. It was very moving to relive the excitement of that moment through the words of Dr Elder, her enthusiasm and commitment to her work really shining through.
Dr Elder described the drama and intrigue surrounding those months, as the news of Lesley's pregnancy leaked to the press, and she had to hide away until ready to give birth to baby Louise. The delivery happened during the night, and we were told that the doctors operated with torches to avoid alerting the press!
But their work was controversial, and soon after the birth of the second test tube baby – Alastair MacDonald – all major funding bodies refused to support this work any further. Dr Steptoe and Dr Edwards' dream of providing this treatment through the NHS was nipped in the bud.
The turning point, and really the only choice they had apart from giving up (which we get the sense they were not going to do that easily) came with the decision to open a private clinic.
Bourn Hall Clinic opened its doors in 1980 and welcomed the first 23 patients, two of whom delivered their babies the following summer. The clinic became a hub for training and scientific meetings, allowing doctors from all over the world to learn the technique.
During this critical time, in 1984, Dr Elder joined Bourn Hall as clinical assistant to Dr Steptoe, and head of the outpatient department, with the crucial role of managing the transition from in-patient to out-patient treatment. From 1987 she worked as senior embryologist. Although she was clearly pivotal in turning IVF into an accessible option for women around the world, her modesty prevented her from even briefly highlighting this in her presentation.
Another point I really enjoyed was when she remembered the vision that motivated Dr Edwards to develop IVF in the first place: to gain knowledge of our beginnings and to understand human embryo development. This vision, Dr Elder suggests, should be the major goal of IVF.
We must remember that, as she said, 'IVF overcomes infertility, but it does not cure it'. I think this is key and really highlights the importance of fundamental research for the advancement of human health. As Dr Edwards said: 'These cells contain mysteries that can and must be solved.'
She finished her beautiful talk by praising the power of collaboration between fundamental and clinical science for the betterment of the human condition.
Having learned more about Dr Elder's work during those early days and spoken with several conference attendees who described her as 'a legend', I can confidently say that she rightfully deserves to be regarded as one of the giants upon whose shoulders we all stand.
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