When the first test-tube baby was born, it wasn't just the beginning of a new life but of a whole new approach to infertility. Olga Craig talks to some winners and losers in the IVF lottery and asks where do we go from here?
A single word, splashed across the front page of a national newspaper, said it all: superbabe! In a photograph below, swathed in a soft blanket, was the baby whose birth had healed the heartache of her childless parents and brought hope to millions of infertile women: Louise Joy Brown, the world's first test-tube baby, who was born in Oldham General Hospital minutes before midnight on July 25 1978.
The IVF lottery is an emotional experience
Delivered by caesarean section and weighing just 5lb 12oz, little Louise was the daughter of John and Lesley Brown, a Manchester couple. She was conceived by in vitro fertilisation, during which her mother's eggs were fertilised by her father's sperm in a test tube and she became, to her parents' delight, the first child to be born using the procedure pioneered by the British fertility experts Robert Edwards and the late Patrick Steptoe.
As she proudly showed off her day-old daughter, Mrs Brown, who, at 29, had endured nine anguished years trying to conceive naturally, described her as her 'cherished little angel'.
'Louise is, truly, a gift from God,' she told assembled television reporters, her voice breaking with emotion. 'Every woman who has yearned to hold her own child in her arms, and then been flooded with the love that only motherhood brings when that longed for dream comes true, will understand what I mean.'
Next month Louise, now herself the mother of a lively two-year-old, Cameron, who was conceived naturally, will celebrate her 30th birthday. She and husband, Wesley, live quietly in Bristol where they will hold a family birthday party. Guest of honour is likely to be Prof Edwards, the man who, all those years ago, made the dramatic breakthrough that has, for millions of women worldwide, ended the prolonged and crushing misery of childlessness. For Edwards it will be a momentous occasion.
'I'm extremely proud to have been involved in Louise's birth,' he says. 'In my many years working in this field I have seen the devastating effect infertility has on the lives of sufferers.'
Prof Edwards knows all too well, and at first hand, the misery these couples endure. In the 30 years since Louise's birth IVF has become increasingly widely available. In the mid-1980s, as doctors honed and refined their techniques, more and more couples opted for fertility treatment. By the mid-1990s about 3,000 babies were being born annually in Britain thanks to IVF.
Today that figure has more than doubled. Currently, some 8,000 babies are born annually to the 30,000 British women who opt for IVF, with the infants now making up one per cent of our annual births. While IVF's success rate is still reasonably low - even for those under 35 it is only 28 per cent - and while those who do go on to have healthy babies are likely to have undergone numerous cycles of IVF before becoming pregnant, for the three and a half million women in Britain who currently have trouble conceiving its existence can prove to be nothing short of miraculous.
We have all heard the happy-ever-after stories of countless women for whom IVF has made motherhood a possibility. But what few women realise is that IVF treatment has become increasingly aggressive: so much so that there are very real risks involved.
Take the case of Temilola Akinbolagbe. Just two days after she began fertility treatment she suffered a massive heart attack at a south London Tube station. She was rushed to hospital where, five days later, her life-support machine was switched off. She had been a healthy young woman who had simply yearned for a child. But her body reacted fatally to the drugs she was given to stimulate her ovaries.
Dr Geeta Nargund offers 'soft' IVF
Granted, such deaths are rare but the fact is that they do happen. And, worryingly, up to 10 per cent of women, particularly those under 35, react badly to the hormonal drugs they are given. They are used initially to shut down the reproductive system and then to stimulate the ovaries to produce multiple eggs instead of a single one, which can then be surgically collected and fertilised with the father's sperm.
Back in 1978, when Steptoe and Edwards carried out the treatment that led to Louise's birth, IVF was very different to the aggressive form in use today. They waited until one of her mother's eggs had ripened, collected it and then fertilised it in a test tube with her husband's sperm before replacing it in the womb.
But in the past two decades the liberal use of drugs and the practice of returning multiple embryos to the womb has been the norm in Britain. All that, however, may be about to change. At a fertility conference in London last month a revolutionary new form of IVF, which involves fewer drugs - thus reducing drastically the side effects - was hailed as the future for IVF. Known as 'soft' or 'mild' IVF, it interferes much less with the body's natural chemistry.
It involves only low drug dosages, and just one, single healthy embryo is replaced: thus it removes the risk of unpleasant side effects and the danger of multiple pregnancies. Who, for example, can forget the premature birth and subsequent death of Mandy Allwood's eight babies in 1996. Allwood, who decided against selectively aborting some of the babies created with fertility treatment, went into labour at just 19 weeks and lost all of them.
While many leading experts acknowledge certain advantages to the mild treatment, they stress that, with women leaving motherhood later and later, the majority come to clinics clamouring for the most aggressive treatment to increase their chances of conceiving swiftly. 'The couples we see have been using contraceptives for years and believed the woman would get pregnant within weeks of coming off the pill,' says one. 'Now in their late thirties they are experiencing problems. Thus they want to maximise their chances of a child in as short a time as possible.'
For those like Prof Bart Fauser, the head of reproductive medicine at the University Medical Centre in Utrecht in the Netherlands, however, there are more important issues, namely safety. He believes the mild option is generally safer and as successful. Consequently, he has been urging the use of mild IVF for the past three years.
In a study three years ago Prof Fauser compared the outcomes for 200 women given mild IVF and a single embryo transfer with those of 200 women who had the conventional regime and two embryos put back in the womb. Those having the mild version were given four shorter treatments, while the others had three.
Over the course of a year 45 per cent of both groups ended up with a healthy child. 'The evidence indicates that this mild approach significantly reduces risks,' he says. 'And we have shown that it is just as successful. Compared with the traditional method we had the same birth rate.'
Since almost 80 per cent of women seeking fertility treatment do so at private, and highly expensive, clinics it seems surprising then that more clinics do not opt for the mild version. The traditional mindset seems to be that more drugs mean more embryos put back in the womb - resulting in more babies and higher places in the league tables compiled by the regulator, the Human Fertilisation and Embryology Authority.
Prof Fauser believes the reality is that the huge costs charged (a single cycle of IVF costs about £3,000) has meant that there is fierce competition among the clinics. 'With all the commercial pressure and all the money involved,' he says, 'it is easy to understand. But it is not to the benefit of the patient.' With all parties desperate for results, the tendency has been to use more drugs to produce more eggs and, hopefully, more babies. Thus IVF has become a multi-million-pound industry.
A quick perusal of the finances involved speaks volumes. Last month the fact that London's most high-profile fertility doctor, Mohamed Taranissi, made £8 million in the past year was headline news. His London practice quadrupled its profits in just six years. According to its most recent accounts the company made a pre-tax profit of almost £8 million - based on charging £2,500 for a single round of treatment - and has £20 million in the bank. Mr Taranissi is far from alone. An investigation by the London Evening Standard newspaper in May revealed that quite a few fertility doctors have become millionaires.
It is cold comfort for the women desperate to conceive. As Prof Fauser points out, since the mild version is much cheaper (about £1,500) couples can afford more rounds of treatment. And because it is less severe on the body fewer women drop out after a single failed attempt. 'With the more aggressive treatment women give up because they have suffered so much,' he says.
In Britain Dr Geeta Nargund, the head of reproductive medicine at St George's Hospital in London and medical director of Create, a private clinic, is one of just a handful of doctors who offer the new treatment. 'It's safer for women to use no drugs or fewer drugs to achieve a pregnancy,' she says. 'It is safer for her own health, her eggs and any embryos that are created. Being a woman, I feel strongly that we should look after women's health. The single most serious complication of IVF cycles is ovarian hyperstimulation syndrome, which can be avoided by using mild IVF.
'I don't come from a rich family myself and I work in south London where I see a lot of couples who don't have much money and who go to the private sector,' she says. 'We have really got to stop that.'
Dr Nargund believes that mild IVF is particularly good for older mothers, who produce few eggs whatever the treatment, so subjecting them to high doses of drugs is pointless and more likely to compromise the result.
Siobhan McLernon, 40, and her fiancé, Shaun, 43, were among the couples who opted for mild IVF at the Create clinic. When McLernon discovered her fallopian tubes were blocked she initially sought help from the NHS. Shocked to discover she faced a two-year waiting list, she decided that, at their age, that was time she and Shaun didn't have.
'The minute I heard about mild IVF I knew it was right for me,' she says. 'I didn't want to pump myself full of hormones and we also couldn't afford the £8,000 some clinics charge. Soft IVF felt like a lifeline. The process was simple. After some blood tests to check my hormone levels, I began a seven-day course of injections and didn't experience any side effects. By the second week I was convinced it hadn't worked. So when the pregnancy test was positive I couldn't believe it. I was the happiest person.'
Nine months later the couple were the delighted parents of a baby daughter, Cara-Mae. 'I just can't imagine life without her. She is an amazing gift,' she says. 'I would definitely recommend soft IVF. If we had chosen a more expensive option, we would have been under more pressure and it would have been more stressful.'
Those who support mild IVF have a firm supporter in Prof Edwards. He has never been in favour of massive doses of drugs. Even when he began working on the treatment in the early 1970s he was worried, he says, about the effect on a woman's body of hormonal drugs on top of the hormone surge that comes with ovulation. 'In those early days we were experimenting,' he says. 'We would use the lowest hormone doses we could and get four or five beautiful, ripe eggs. We always thought that was enough for one time.'
Prof Bill Ledger of Sheffield University, who heads the assisted conception unit at the NHS Royal Hallamshire hospital, worked with Prof Edwards in the late 1980s. 'If we got anybody pregnant, we all went to the pub, including the woman, her partner and the nurses - because it was a very precious thing in those days,' he says. 'The availability of IVF doctors to help people has become so much better. So now we can start looking a bit harder at safety. It is much safer for women to have mild IVF. And safer for the baby, too.'
But while more and more clinics are considering offering the option of the new treatment, not all fertility experts are convinced. Adrian Lower, a consultant gynaecologist at Barts in London who is also medical director of the Isis fertility centre in Colchester, has yet to be persuaded, although he does agree that mild IVF may be better for older women. And his argument is a powerful one in the light of the desperation felt by some infertile women.
'The fundamental problem in this country at the moment is that we feel a responsibility to the patients, most of whom are paying for treatment themselves, to give them the best chance of success. It seems the best chance of getting pregnant is having drugs.'
'IVF worked for us' Natalie Viking, 33, is a finance director. She lives in Oxfordshire with her husband, Steve, 34, a chef, and their daughter, Lucie, one
Steve had always worried he might be infertile because he's a chef - it's common among male chefs due to the heat of the kitchen. So when we hadn't conceived after six months we went to the doctor. Tests revealed that Steve had a low sperm count and that I had polycystic ovaries. I spent six months taking fertility drugs and, when they didn't work, we paid for a private cycle of IVF. The night after my treatment I woke up with a strange sense that it was working. Two weeks later I did a pregnancy test, and it was positive. The pregnancy went smoothly and Lucie was born a perfect little girl.
'We've given up trying for a baby' Clare Daynes, 44, works as a nursery-school assistant. She lives in Bedfordshire with her partner, Nick, 47, a civil servant
We didn't start trying for a baby until I was 35, and it was another three years before I tried drugs to stimulate ovulation. After 18 months without success, I found myself en route to IVF. I underwent five attempts and, after my fourth, I had counselling. My GP signed me off work for three months with depression. When I turned 42 I was running out of emotional energy and IVF had begun to feel like a punishment. We had one more attempt, which, in April 2007, also failed. I decided I had to make changes in my life. I left my job in television and found work as a nursery assistant. Being around children helps me to cope.
'We're still trying' Jess Lucas, 34, is a shop manager. She lives in Newcastle with her husband Peter, 36, who works in telecommunications
My husband's sperm are abnormally shaped and have poor motility. We started on IVF with the NHS two years ago, but after two failed attempts I had ICSI treatment [IVF in which one sperm is injected into one egg]. I produced 25 eggs, two of which were good enough to fertilise with Peter's sperm and implant into me. But within a fortnight we'd realised the embryos hadn't attached to the wall of my womb. We both cried. We've now turned to private treatment and plan on using £10,000 in savings on more attempts at ICSI. I don't want IVF to bleed us dry, financially or emotionally. The most important thing is to keep living our lives.
Case-study interviews by Natasha Courtenay-Smith. Some names have been changed.
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