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Nobel prize in medicine: Implications of pioneering work are all around us

If you work at it, you can connect in some personal way with most of the scientific discoveries that lead to Nobel prizes.

If you work at it, you can connect in some personal way with most of the scientific discoveries that lead to Nobel prizes.

Take last year’s winners in the category of physiology or medicine. That team showed how chromosomes are protected by telomeres. I know that the ends of my chromosomes are more tattered as time wears on — but I have to do the research to understand the significant implications of that discovery.   

No research is needed to appreciate the achievement that earned the prize in medicine this year. Its implications are all around us.

They include the boy in my neighborhood who can leap like a pro to stop a baseball in center field. Count also the shy, tow-headed twins who come to play at my daughter’s house. Then there is the healthy baby who brought immense joy to a Wisconsin couple I know after their firstborn son died of a rare genetic disorder.

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These children were made possible by in vitro fertilization, the medical technique for joining egg and sperm outside a mother’s body.  

And now the 2010 prize in physiology and medicine has gone to Robert G. Edwards, 85, one of the British scientists who pioneered IVF therapy.

Millions of couples would have gone childless without the work Edwards started in the 1950s, seeking a treatment for infertility. The Nobel Committee says in a statementhat the medical problem afflicts more than 10 percent of all couples worldwide.

Test tube babies, multiple births, leftover embryos

While those couples can hail the award today, red-hot controversy also has surrounded Edwards’ work — beginning on July 25, 1978, with the birth of the world’s first “test tube baby.”

(Louise Brown, now a grown woman with a child of her own, reacted to the Nobel committee’s announcement on Monday by telling Reuters: “It’s fantastic news, me and mum are so glad that one of the pioneers of IVF has been given the recognition he deserves. We hold Bob in great affection and are delighted to send our personal congratulations to him and his family at this time.”

Still, controversy persists.

One thorny subject is the soaring rate of multiple births due to IVF treatments. While twins — and, even, quintuplets — can be a blessing for a family, the babies sometimes are born preterm and underweight with serious medical problems. Some also stretch the emotional and financial resources of their families.

The Nobel committee said that premature births are very rare, particularly when one egg only is inserted into the mother. And, long-term follow-up studies have shown that IVF children are as healthy as other children, it said.

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Another flashpoint over the therapy reverberates through political, medical and religious circles alike: what to do with embryos that no longer are needed by the couples who created them through IVF. Attempts to improve medicine by donating them for human embryonic stem cell research have fueled even more debate.

Finally, many critics — including, officially, the Catholic church — continue to object to the whole notion of tampering with natural conception and separating it from sexual intercourse between an man and a woman.

Four million births

Meanwhile, some four million individuals have so far been born following IVF, the Nobel committee said.

“Many of them are now adult and some have already become parents,” the committee said. “A new field of medicine has emerged, with Robert Edwards leading the process all the way from the fundamental discoveries to the current, successful IVF therapy. His contributions represent a milestone in the development of modern medicine.”

Goal: fertilization outside the body

Edwards, now a Cambridge University professor emeritus, worked systematically to discover important principles for human fertilization. Here’s how the Nobel committee summarized the progress of his work:

Beginning in the 1950s, Edwards envisioned fertilization outside the body as a possible treatment of infertility. Other scientists had shown that egg cells from rabbits could be fertilized in test tubes when sperm was added, giving rise to offspring. Edwards decided to investigate if similar methods could be used to fertilize human egg cells.

It turned out that human eggs have an entirely different life cycle than those of rabbits. In a series of experimental studies conducted together with several different co-workers, Edwards made a number of fundamental discoveries. He clarified how human eggs mature, how different hormones regulate their maturation, and at which time point the eggs are susceptible to the fertilizing sperm.

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He also determined the conditions under which sperm is activated and has the capacity to fertilize the egg. In 1969, his efforts met with success when, for the first time, a human egg was fertilized in a test tube.

In spite of this success, a major problem remained. The fertilized egg did not develop beyond a single cell division. Edwards suspected that eggs that had matured in the ovaries before they were removed for IVF would function better. So he looked for safe ways to obtain such eggs.

From experiment to clinical medicine

Edwards contacted the gynecologist Patrick Steptoe, a pioneer in laparoscopy which allows inspection of the ovaries through an optical instrument. Steptoe used the laparoscope to remove eggs from the ovaries, and Edwards put the eggs in cell culture and added sperm. The fertilized egg cells now divided several times and formed early embryos, 8 cells in size.

These early studies were promising but medical-research authorities decided not to continue funding the project. The research had become the topic of a lively ethical debate that was initiated by Edwards himself. Several religious leaders, ethicists, and scientists demanded that the project be stopped, while others gave it their support.

The historic birth of Louise Brown

A private donation eventually allowed Edwards and Steptoe to continue their research. By analyzing the patients’ hormone levels, they could determine the best time point for fertilization and maximize the chances for success. In 1978, Lesley and John Brown came to the clinic after nine years of failed attempts to have a child. IVF treatment was carried out, and when the fertilized egg had developed into an embryo with 8 cells, it was returned to Mrs. Brown.

With the birth of healthy baby, Louise Brown, IVF had moved from vision to reality and a new era in medicine had begun.

IVF refined and spread around the world

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 Edwards and Steptoe established the Bourn Hall Clinic in Cambridge, the world’s first center for IVF therapy. Steptoe was its medical director until his death in 1988, and Edwards was its head of research until his retirement. (Steptoe is not eligible to share the Nobel because the prize goes only to the living.)

Gynecologists and cell biologists from all around the world trained at Bourn Hall, where the methods of IVF were continuously refined. By 1986, 1,000 children had already been born following IVF at Bourn Hall, representing approximately half of all children born after IVF in the world at that time.

Today, IVF is an established therapy throughout the world. It has undergone several important improvements. For example, single sperm can be microinjected directly into the egg cell in the culture dish. This method has improved the treatment of male infertility by IVF.

Further, mature eggs suitable for IVF can be identified by ultrasound and removed with a fine syringe rather than through the laparoscope.

Now 20-30% of fertilized eggs lead to the birth of a child, a success rate approaching that of eggs fertilized naturally.

Not in good health

Prize committee secretary Goran Hansson said Edwards was not in good health Monday when the committee tried to reach him, the Associated Press reported

“I spoke to his wife and she was delighted and she was sure he would be delighted too,” Hansson told reporters in Stockholm after announcing the 10 million kronor ($1.5 million) award.