Louise Brown (1978): The First IVF 'Test-Tube Baby'

Louise Brown, born in Oldham, England, on 25 July 1978, was the first human being conceived by in vitro fertilisation (IVF), the joining of egg and sperm outside the body. Her birth was the result of a decade of work by the Cambridge physiologist Robert Edwards, the Oldham gynaecologist Patrick Steptoe and the nurse and embryologist Jean Purdy. Hailed by the press as the world’s first “test-tube baby”, it began a medical revolution that has since helped millions of people to have children.

Background: the problem of infertility

In the 1970s many women could not conceive because their fallopian tubes, which carry eggs from the ovaries to the womb, were blocked or damaged. Surgery rarely helped. IVF offered a way around the problem: collect an egg, fertilise it in the laboratory and place the resulting embryo directly in the womb.

Scientists had achieved IVF in animals, notably rabbits, decades earlier, but human eggs proved hard to work with. Robert Edwards spent the 1960s studying how human eggs mature, and in 1969 he and his colleagues reported in the journal Nature that they had fertilised human eggs in the laboratory.

Edwards, Steptoe and Purdy

Edwards needed a way to collect eggs at the right moment. He found it through Patrick Steptoe, a gynaecologist at Oldham who was a pioneer of laparoscopy, a technique that uses a thin telescope inserted through a small cut to see and reach the ovaries. They began working together in 1968.

Jean Purdy, a trained nurse, joined Edwards as his laboratory assistant the same year and became central to the project. She managed the culture of eggs and embryos and the care of patients, and she travelled with Edwards on the long journeys between Cambridge and Oldham, more than 150 miles (240 kilometres) apart.

The work was difficult and controversial. In 1971 the Medical Research Council declined to fund the clinical research, citing ethical and safety concerns, and the team relied on other sources of support. Over the following years they treated many women, with a number of failures and an ectopic pregnancy in 1976 that had to be ended.

How IVF works

In vitro is Latin for “in glass”, and the method replaces the first steps of natural conception with laboratory work. In its basic form, a doctor collects one or more mature eggs from the ovaries just before they would be released. In the laboratory the eggs are placed in a dish with sperm and a nutrient solution kept at body temperature.

If an egg is fertilised, it begins to divide, forming an early embryo of a few cells. After two to five days it is transferred through the cervix into the womb, where it must implant in the lining for a pregnancy to begin. Every one of these steps posed problems in the 1970s: timing the egg collection, finding the right culture fluids and judging when to transfer the embryo. Much of the team’s decade of work went into solving them.

The Brown family and the pregnancy

Lesley and John Brown, a couple from Bristol, had tried to have a child for about nine years. Lesley Brown’s fallopian tubes were blocked, and she was referred to Steptoe.

Instead of using fertility drugs to stimulate the ovaries, which had given poor results, the team followed Lesley Brown’s natural monthly cycle. In November 1977 Steptoe collected a single mature egg by laparoscopy. Edwards and Purdy fertilised it in a dish, and about two and a half days later the embryo, then at the eight-cell stage, was placed in her womb. The pregnancy took hold and was closely monitored.

The birth

Because of concerns over the mother’s health late in the pregnancy, Steptoe delivered the baby by caesarean section shortly before midnight on 25 July 1978 at Oldham and District General Hospital. Louise Joy Brown weighed 5 pounds 12 ounces (about 2.6 kilograms) and was healthy.

The birth caused a worldwide sensation. Journalists had besieged the hospital for weeks, and the family sold exclusive rights to their story to a national newspaper to help manage the intense attention. Steptoe and Edwards announced the result in The Lancet on 12 August 1978.

Controversy and debate

The news was welcomed by many as a triumph for couples who could not have children. Others were deeply uneasy. Some religious leaders objected to conception outside the body, and some scientists and commentators warned of risks to the child or of a slide towards “designer babies” and genetic manipulation. Edwards took part in public debates on these questions throughout his career.

In the United Kingdom the debate led to the government’s Warnock inquiry, whose 1984 report recommended regulating IVF and embryo research. This was followed by the Human Fertilisation and Embryology Act 1990, which created a national regulator for fertility treatment.

IVF spreads around the world

The second baby born through the Edwards-Steptoe method was a boy delivered in Glasgow in January 1979. In India, the physician Subhash Mukhopadhyay announced the birth in Kolkata of a girl conceived by IVF on 3 October 1978, about ten weeks after Louise Brown; his claim was doubted by officials at the time and recognised only after his death in 1981. Australia’s first IVF baby was born in 1980 and the United States’ first in 1981.

In 1980 Steptoe, Edwards and Purdy opened Bourn Hall Clinic near Cambridge, the world’s first dedicated IVF clinic.

The team’s later lives

Jean Purdy died of cancer in 1985, aged 39, and Patrick Steptoe died in 1988. Edwards long argued that Purdy deserved equal recognition, and in recent years her role has been much more widely acknowledged. In 2010 Robert Edwards received the Nobel Prize in Physiology or Medicine “for the development of in vitro fertilization”. He died in 2013.

By the numbers

Timeline

• 1968: Robert Edwards and Patrick Steptoe begin working together; Jean Purdy joins Edwards’ laboratory.
• 1969: Edwards and colleagues report the fertilisation of human eggs in the laboratory in Nature.
• 1977, November: An egg is collected from Lesley Brown, fertilised and placed in her womb.
• 1978, 25 July: Louise Brown is born by caesarean section in Oldham.
• 1978, 12 August: Steptoe and Edwards report the birth in The Lancet.
• 1980: Bourn Hall Clinic opens in Cambridgeshire.
• 1990: The Human Fertilisation and Embryology Act sets up UK regulation of IVF.
• 2010, October: Edwards is awarded the Nobel Prize in Physiology or Medicine.

Legacy

IVF is now a routine treatment offered in most countries. Later techniques, such as freezing embryos and injecting a single sperm into an egg, extended it to many more causes of infertility. Fertility organisations estimate that well over 10 million babies have been born through IVF and related methods since 1978. The research also fed into wider debates about embryos and genetics, from cloning to the Human Genome Project.

Why it matters

Louise Brown’s birth showed that human life could begin outside the body and still lead to a healthy child. It gave hope to millions of people facing infertility and forced societies to think carefully, and often for the first time, about how to regulate new reproductive technology.