'The odd throuple': Accuracy and authenticity in the IVF film 'Joy'

Commercial pressure to tell an engaging story has long coloured understanding of events leading to the birth of the first 'test-tube baby' Louise Brown in July 1978. After huge global news coverage, her parents Lesley and John co-authored an instant mass-market autobiography. So did the duo who led the research, Cambridge geneticist Robert Edwards and Oldham gynaecologist Patrick Steptoe. Aiming to sell books and promote IVF, 'A Matter of Life: The Story of a Medical Breakthrough' told a tale of dogged determination and benighted obstruction culminating in a desperately wanted child.

The first feature film on the subject, the Netflix docudrama Joy: The Birth of IVF (see BioNews 1266), deploys similar tropes to dramatic effect but is new in how it credits women. We are offered not just working-class socialist and patrician pianist but 'three British scientists': James Norton as 'maverick physiologist' Edwards, Bill Nighy as 'veteran obstetrician' Steptoe and, with first billing, Thomasin McKenzie as Jean Purdy, 'the nurse-turned-lab-manager who made it all possible'. This is The Guardian's 'odd throuple of fertility science', but does the account ring true?

The three stars during their first meeting in London. (Screen capture from the film 'Joy: The Birth of IVF'.)

Thirty years ago the women's studies scholar Susan Squier critiqued 'A Matter of Life' as a chronicle of two male heroes making a pregnancy. Distrusted by insiders and revised by research, it has nevertheless remained the standard history of the science and medicine behind IVF. I recently investigated how a ghostwriter – the physician and poet Dannie Abse – imposed a consistent quest to overcome infertility. Crafting vivid scenes with characters and dialogue, Abse gave women somewhat larger roles. In his draft Edwards grudgingly acknowledged Purdy's 'ungrudging help'. After the rewrite, 'Jean's cooperation had become crucial. It was no longer just Patrick and me. We had become a threesome.' But this was still the doctors' tale.

The screenwriter of 'Joy', Jack Thorne, took 'A Matter of Life' as his 'base'. Yet having endured seven cycles of IVF, ultimately 'brutal' although successful, he and his wife Rachel Mason paid more attention to the disappointed volunteers. The film represents their heartache, sacrifices for others and camaraderie but can still only hint at their lives beyond the clinic. That is enough to put the Browns into perspective. The geneticist Ruth Fowler, Edwards' wife, does less in the film than in the book, but is shown as engaged with the science, including in a domestic scene in which her husband improbably exercises with weights.

Rachel, during her ectopic pregnancy, talks to Jean Purdy at the 'Ovum Club' outing that Purdy organised. (Screen capture from the film 'Joy: The Birth of IVF'.)

Above all, 'Joy' puts Purdy centre-stage. 'A Matter of Life' pivots around Edwards and Steptoe's meeting in 1968. Then Clare Jackson, Purdy's predecessor as Edwards' 'assistant', prepares the first reagents to take to Oldham before Purdy is hired. By contrast, 'Joy' begins in 1968 with Purdy's interview for a 'lab manager' position. By this time Edwards had committed to the project and so the narrative problem that his and Steptoe's earlier careers were mostly not devoted to alleviating infertility is solved. Next the three of them meet – the film pretends that she was present and that Steptoe needed persuading – and the collaboration starts.

In enlarging Purdy's role Thorne drew on research by Martin Johnson and Kay Elder. They concluded that during this period of travelling between Cambridge and Oldham, Purdy probably spent more time there than Edwards, to whom she was 'a major source of support'. She took responsibility for recording data and supplying the laboratory and was involved in patient care, though not clinical tasks. Her contribution was such – and progress so discouraging – that during her mother's final illness the work stopped. A friend of hers said that she then convinced Edwards to keep going, and the film runs with this.

Robert Edwards and Jean Purdy in the Oldham lab. (Screen capture from the film 'Joy: The Birth of IVF'.)

Purdy's intellectual input is hard to reconstruct. Deeply involved in the research, she saw a human blastocyst develop in a dish before anyone else. 'A Matter of Life' generally credited Edwards for ideas with Purdy as a sounding board. In the book he proposes, after their first (ectopic) pregnancy in 1976, using the patients' natural cycles rather than hormonal stimulation of ovulation, a shift the team believed crucial to their success. Consistent with her presentation as identifying with the female patients, Purdy welcomes the new protocol as easier on them.

In the film, by contrast, Purdy herself comes up with the idea of dispensing with hormones and persuades the others to give this a try. The film also plays, for no obvious reason, with the chronology and the science. When we see pregnancies achieved before the hiatus of her mother's cancer (and her brainwave) in the second half of 1974, it is harder to grasp why they almost gave up. It makes no sense to blame their failure to maintain those pregnancies on a toxic batch of liquid paraffin that Edwards described as having inhibited fertilisation for a time.

'Joy' pays more attention to Purdy's life beyond work than to Edwards' or Steptoe's hinterlands, a tall order for a private person about whom far less is known. Her Christianity appears through a fraught relationship with her mother (Joanna Scanlan), who is portrayed as a fundamentalist opponent of medical interventions in reproduction. Did she and their church really shun Purdy because of her job? They are buried in an Anglican cemetery, so one might have expected tolerant attitudes, unless they were on the conservative wing. McKenzie's character further rebels by sleeping with men but avoiding becoming attached. Lab members who knew Purdy do not remember a boyfriend, let alone such 'promiscuity', as they have described it to me. Barry Bavister, whose alkaline medium enabled fertilisation (see BioNews 1304 and 1312), has expressed disgust at 'the way they slurred Jean Purdy's memory' (see BioNews 1309).

Jean Purdy argues with her mother Gladys. (Screen capture from the film 'Joy: The Birth of IVF'.)

In the film Purdy does not just confront the unique challenge of keeping the project going in the face of antagonism within her own family. To add to her identification with the unsuccessful patients – and as a more economical alternative to following one of them – she is also made to carry a double burden as the only one of the trio to suffer from infertility. Edwards' biographer launched the speculation that Purdy had endometriosis but accepted that, if correct, she would not have wanted this revealed. The severity of her condition is implausibly diagnosed by Steptoe, the leading British practitioner of laparoscopy, in his office without equipment.

That said, 'Joy' gets right the pain of infertility, the need to argue for treatment and the team's perseverance in the face of foes and failure, not to mention those quarter of a million miles of driving between Cambridge and Oldham. It acknowledges scientific and medical advisors and witnesses including 'the second IVF mum', Grace MacDonald (see BioNews 1304 and 1313). But when Netflix tells viewers that the film is 'based on a true story', that is about right.

There are more inaccuracies. Edwards clashed with molecular biologist James Watson at a meeting in Washington DC, but not on British TV. Edwards was a Labour councillor in Cambridge but missed being selected as parliamentary candidate. A more subtle slip is that Edwards would not have seen an experiment by Landrum Shettles as hopeful, because the US gynaecologist ignored the standards of the reproductive biology in which Edwards had trained. Conversely, a Sunday-lunch discussion, including scepticism about his 1969 Nature paper, is well done.

I could go on, but historians should remember director Ridley Scott's riposte to fact-checkers of his film Napoleon: 'Get a life'. My profession must also insist, against Scott's suggestion that no one knows what happened, that much is clear and that, other things being equal, those facts might as well be correct. A historical advisor could have helped the filmmakers adjust for impact more faithfully. But accuracy does matter less than authenticity (which is where 'Napoleon' really failed). Some liberties can be taken: having a black actor (Tanya Moodie) play the white matron Muriel Harris is a straightforward bit of non-traditional casting and not such a stretch, since the NHS had appointed its first black matron, Daphne Steele, in 1964, and Steptoe's Oldham staff included a black nurse. It is nit-picking to observe that the real Harris missed Lesley Brown's delivery.

The truth of 'Joy' is that there would have been no IVF without brave, determined women in various roles. This scotches the idea, fed by early feminist histories, that men did the technique to women. It contradicts the view, promoted by a narrow focus on Edwards and Steptoe, that women were just supporting characters. But it does not ring true to have Purdy star in almost every scene (or that a shy woman is shown as so assertive). In egalitarian British labs technicians not only held things together but could also co-author papers, give talks and even earn PhDs. Yet none went everywhere a scientist could, and surely not to an interview at the Medical Research Council. Purdy's presence there is more distorting than the fiction that a face-to-face encounter occurred at all, rather than a less engrossing exchange of letters.

The fictitious interview at the Medical Research Council. (Screen capture from the film 'Joy: The Birth of IVF'.)

To pretend that all doors opened may provide an inspiring role model, but magics away real obstacles to participation in science. Since discrimination still blocks access – and social mobility is lower today – we need to see the barriers if they are ever to be removed.