The funny thing about technological revolutions is that they are measured by the decreasing evidence of novelty. The mobile phone is radically transformative because it has established a new ordinary. Shopping, playing, eating – even chatting – have been utterly transformed by this hand-held device, which is powerful precisely because it facilitates what we already wanted to do.
IVF is another of the powerful transformative technologies of the twentieth century that has created a new normal. It too has been intimately integrated into everyday consciousness, and has become more powerful in direct proportion to its increasing unremarkableness. But while IVF and the alphabet soup of related technologies designed to assist human conception have become an accepted and increasingly taken-for-granted part of modern medical care around the globe, they have received far less attention as transformative social forces than the information and communication technologies with which they came of age. Possibly because of their association with the private and domestic business of making babies, and the feminised connotations of reproductive health and pregnancy, there is as yet, for example, no major academic study charting the history of in-vitro fertilisation or assisted conception technology.
Although slow to become the focus of more concerted academic research, the award of the Nobel Prize in Physiology or Medicine to Robert Edwards in 2010, followed by his death in 2013, have stimulated increasing interest in how IVF was developed in the 1960s and 1970s. Louise Brown: my life as the world’s first test-tube baby adds significantly to our understanding of this history: narrated from an intimate personal point of view, it also benefits from unparalleled access to many of the key players involved in the extraordinary rise of IVF technology over the past three-and-a-half decades. Complementing the earlier volumes authored by Edwards and Patrick Steptoe (the co-authored A Matter of Life published in 1980, and Life Before Birth published by Edwards in 1989), and the earlier account of Louise’s birth as told by her parents, Lesley and John, to journalist Sue Freeman (Our Miracle Called Louise, 1979), this new account both brings us full circle and marks the end of an era. Louise's autobiography begins in the 1950s, before she is born, and closes with her reflections on mitochondrial DNA replacement therapy, egg freezing, and stem cell research as IVF enters a new phase of its history as a core technique of bioscience and biomedicine in the twenty-first century.
Louise’s story is both her own – chronicling the unique form of celebrity she has known as the poster child of IVF (Fig. 1) – and a retelling of her parents’ journey towards, through, and then increasingly away from IVF. It is also the story of the world’s ongoing mixed reaction to a new relationship between reproduction and technology – and not only IVF, for this book reminds us on almost every page that IVF grew up with that other famous acronym – TV – as well as the airline industry, satellite technology, the Internet and the 24/7 news cycle. The sense that IVF’s initial, introductory phase has ended is accentuated by the book’s dedication to the four key people involved in her birth – all of whom have now died – Louise’s father, John, in 2006, her mother, Lesley, in 2012, and Robert Edwards in 2013 (Patrick Steptoe died in 1988). The happiness that her birth brought to her parents, and that IVF has brought to thousands – and eventually millions – of other couples, is offset by the sense of passing generations, premature mortality (Louise’s parents both died at relatively young ages), and the persistence of incurable disease (her older half-sister Sharon also died in 2013).
Fig. 1.
Louise Brown with the glass container in which she grew as an embryo. (Photograph by Si Barber, reproduced with kind permission of Louise Brown.)
Louise’s story, told in partnership with Bristol-based journalist Martin Powell, draws both on her own experiences and the extraordinary archive discovered in her mother’s wardrobe after her death, containing virtually every letter Louise or her family were ever sent, as well as a vast collection of media coverage. Lesley kept everything – including early TV talk shows and even a Hollywood movie script by Oscar winning film producer Carl Foreman. Videotapes of the The Phil Donahue Show starring baby Louise, wedding proposals to Louise from foreign admirers, congratulations from heads of state and music industry moguls, and thousands of newspaper and magazine articles offer a portrait of ‘iVF’ – the media-cultured Petri dish we all have come to take for granted. Foreman’s film script, intended to capitalise on test-tube baby fever for US television, was never produced by Universal Studios and CBS due to a writers’ strike in the summer of 1981. Had it been shot, Lynn Redgrave and Ian McShane would have recreated John and Lesley Brown’s extraordinary journey from severely deprived upbringings in South Bristol to world celebrity as the first parents of a child conceived in a glass container. Famous for his scripts for High Noon and The Bridge Over the River Kwai, Foreman’s talents would have been well chosen to televise one of the great epic stories of the twentieth century – an odyssey combining personal and professional heroism, surprising twists and turns and a spectacular happy ending.
Given its high tech pedigree and costly price-tag, John and Lesley Brown were unlikely candidates for their starring role as IVF’s first happy couple – both having had, as Louise puts it, ‘pretty tough upbringings in some of the roughest parts of Bristol’. John had already married and fathered two daughters by the time he met Lesley at the age of 21. Lesley, who spent time in care as a child, and left school at 14 to work in a garment factory, was six years younger than John and a rebellious teenager when they met in a local pub. On the first night of their elopement the couple slept in an abandoned railway carriage, and for the next several weeks they drank and drifted, unemployed and homeless, until eventually, in the autumn of 1960, John found a job as a bus conductor and they moved into a rented basement flat on City Road in St Pauls.
For sixteen years John and Lesley tried to have a child together and it was not until several previous interventions to remedy her infertility had failed that a Bristol clinician, Dr Rosalin Hinton, wrote to Patrick Steptoe in Oldham about the experimental work that to her as well as many other people sounded like science fiction. It was a ‘million to one chance’ of success, she cautioned Lesley. But like generations of hopeful IVF patients after her, Lesley Brown preferred any chance to none, and took it, making the expensive and time-consuming 180 mile trip from Bristol to Manchester for an appointment at Mr P. C. Steptoe’s private office on John Street in 1976. She proved an ideal patient for the new procedure: Lesley’s blocked tubes ensured she could not possibly become pregnant non-surgically, her husband was of proven fertility, and according to Steptoe’s notes she appeared ‘quietly determined, strong in resolve, [and] unlikely to panic’. Steptoe accurately predicted that she ‘would likely suffer whatever was necessary with stoicism’, and he took Lesley on as his patient.
More demanding surgical investigations followed in the spring of 1977, further confirming Lesley’s suitability for the new IVF procedure – but there was a catch: the price tag was enormous, and far beyond the couple’s reach. With prophetic luck, John Brown won the football pools later that summer, fortuitously securing the £750 necessary for treatment to proceed. Within weeks Lesley Brown had joined the small community of IVF pioneers at John Kershaw Hospital in Oldham – and the rest, as they say, is history (Fig. 2).
Fig. 2.
John and Lesley Brown with their two daughters born via IVF, Louise and Natalie. (Photograph reproduced with kind permission of Louise Brown.)
As Martin Johnson and Kay Elder revealed in the launch issue of this journal, the clinical and scientific work undertaken at Oldham was more exhausting, meticulous and difficult than previously known. The number of patients undergoing experimental treatment is also larger than previously recognised: in total, 457 unsuccessful IVF cycles were undertaken in 282 patients between 1969 and 1978. Although human eggs had been successfully fertilised in vitro in Edwards’ Cambridge lab in 1969, the translation of scientific success into clinical practice had eluded Edwards, Steptoe and their teams for nearly a decade by the time Lesley Brown came under their care in Oldham. Working without state funding (the Medical Research Council had declined to fund Edwards’ and Steptoe’s work as early as 1971), they had minimal support services (many of which were provided for free by nursing, medical and technical staff who became dedicated to the IVF project). Behind the scenes, and unbeknownst to any but their closest colleagues, a wealthy American television station owner anonymously bankrolled much of Edwards’ and Steptoe’s research. Contributing the equivalent in today’s currency of half a million pounds over the course of the crucial decade between 1968 and 1978, the modest Californian philanthropist Lillian Lincoln Howell (1921-2014) is as responsible for the birth of Louise Brown as Steptoe or Edwards.
As Johnson and Elder have also shown in their analysis of notebooks discovered after Edwards’ death, the challenges of early clinical IVF were so numerous and technically difficult the odds were more like 5 million to one that it would ever work. In the end, persistence and teamwork won out: Louise was born into a media maelstrom and pictures of her and her parents appeared in media reports around the world confirming one of the most remarkable technological achievements of the twentieth century.
Yet despite the significance of this achievement, the passage of nearly 4 decades since Louise’s birth, and the birth of over 5 million IVF babies from this technique worldwide, we still have surprisingly little understanding of how this technology has transformed not only human reproduction, but much else besides. Like television, the older sibling ‘tube technology’ with which IVF grew up, IVF defies any simple impact model of technology. As Hannah Arendt predicted as early as 1945 in The Human Condition, the effort to create human life in vitro would fundamentally change our consciousness of ourselves and our world. And as JBS Haldane had predicted even earlier – in his 1923 address to the Heretics Society in Cambridge in which he envisaged a Cambridge scientist perfecting ‘ectogenesis’ – the ability to manipulate the human embryo would not end with IVF. As the recent Symposium IVF-Global Histories published in this journal has shown, this new technology has spread around the globe, and with it have come many redefinitions of morality, religion and citizenship.
To understand IVF, it turns out, we need to understand not only reproductive biology, but social identities, national scientific cultures, and changing family norms. As anthropologists Marilyn Strathern and Jeanette Edwards have both argued, what is fascinating about IVF is the ease with which this highly complex procedure has been so quickly normalised. This also tells us something about modern technologies, which is that their success is often directly related to their ability to facilitate social connections, and to build on the social desires and identities that make us feel ordinary.
Indeed, as Louise Brown’s story confirms, what IVF offers is not so much the sophistication of modern technology, or even its power, but something older and simpler, which is a desire to belong. The complicated hope IVF offers combines faith in scientific progress with a yearning for something beyond it, or even apart from it altogether. For many people, the hope that drives IVF is not just about babies: the child represents a desired human connection, and thus a means to connect people to their sense of themselves. Having a baby is, for some, the only way to achieve a certain kind of self. And it is precisely because this formula is so normative – the promissory appeal of having children being virtually unquestionable as a goal of human action – that IVF is so popular in spite of its numerous and well-publicised challenges.
This message, although in no way phrased as such, is at the heart of Louise Brown’s book, and she has consequently captured something both essential and elusive about IVF that many more ‘expert’ accounts have ignored – which is the desire to be ordinary. Over and over again, Louise rightly emphasises this point – an insight that is especially powerful coming from someone who is world-famous for being exceptional.
From the moment seconds-old Louise Brown was subjected to a barrage of tests to determine whether or not she was a normal baby, she has prided herself on not only being, but remaining, just that – a normal person. It might be normal today to be able to see a video of your own birth on YouTube -- but very few people born in 1978 can say this. Moreover, it’s rare to be world famous for being completely normal at birth, but this is the kind of conundrum Louise Brown has lived with all her life, and it has not only given her many startling and often comical-bordering-on-surreal stories to tell, but a very lightly worn mantle of wisdom about the human condition too.
The struggle to be normal, and the desire to be ordinary, might seem an odd pair of achievements to place at the heart of a book about one of the most significant technological achievements of the twentieth century, but what works particularly well about this combination is precisely the delay with which a seemingly casual refrain about the joys of everyday life gathers additional layers.
Louise Brown’s book is, among other things, an unusually inspiring thank you note. John and Lesley Brown’s greatest achievement, it turns out, was not their sensational triumph over seemingly hopeless odds to take home the world’s first miracle baby in 1978. Their most admirable feat, we now know, was not in beating 5 million to one odds through sheer determination to ‘think pregnant’ until they reached their goal. Louise Brown’s highly readable book movingly recognises and celebrates the legacy her parents undoubtedly valued most, which was to produce an ordinary home for her and her two sisters amidst the seemingly endless media frenzy that surrounded their family for decades. The message at the heart of Louise Brown’s book is that her very ordinary life is as much a miracle and a blessing as was her extraordinary birth. And what is especially interesting about this message – which is a timely parable for IVF in general – is how many people will agree with her.
As we get to know Louise, we also come to appreciate that the lesson she has learned over her own lifetime is how the unusual circumstances of her own birth enable her to help others. In addition to being a tribute to those who made her birth possible, and a contribution to our understanding of how IVF technology was developed, Louise’s story is about coming of age and finding a voice with which to empower other people around the world by simply being herself.