When Unnatural Things Cause Natural People

December 14, 2007

In 1978 Louise Brown was born. Normally, a birth of a baby girl faraway in England would raise no excitement except to family and friends. But when this little girl was born, she was on the cover of Time and Newsweek, Life and the Saturday Evening Post, as well as every front page of every major newspaper in the world. Her birth was marked by marvel and disbelief. For Louise Brown was the first human being in history to have been conceived outside of the womb. She was the first "test tube" baby.

True, she had a mother and father. But there was a third person necessary in her being born, Dr. Patrick Steptoe. His team was the group of physiologists and reproductive endocrinologists who orchestrated the very complex steps needed to make the whole thing work. Together they forged a legacy that thousands of people have celebrated in making their own births possible. Today there are many, many living and thinking persons interacting with the rest of us because of this first success. Louise Brown herself came to symbolize that it's not how you're made, but that you are at all-- she broke the philosophical barriers that stood between good things and unnatural methods. Dr. Steptoe and his associates pushed the borders of the human frontier by allowing science to impact on the human existence. Now there are couples all over the world basking in the love of children who might otherwise not have been.

When I was a resident I was fortunate to attend a lecture by Dr. Steptoe himself. What I found most amazing was what his investigators had to find out by accident in trying to accomplish the first in vitro fertilization. It wasn't enough to merely mix a woman's egg and some sperm in a dish and let nature take it's course. Nature wasn't much interested in doing it naturally with the Browns, much less unnaturally in a lab. Thanks to Dr. Steptoe, complex circadian rhythms of hormones responsible for developing the egg follicles and releasing eggs were described. Failure after failure taught them something new about just how complicated the whole process is. It demonstrated just how miraculous making a baby is in contrast to how most of us take it for granted. It showed how miraculous women are. Almost all of the work in accomplishing fertilization in the laboratory involved understanding just what was going on inside a woman's body.

The Milestone

This success was a milestone, it is true; but the real success was the actual beginning of reproductive endocrinology. What we know now because of Louise Brown dwarfs what we knew before. Before, we viewed reproduction as mainly a mechanical act with hormones involved. Now we know it to be the intricate process wherein all of the tumblers must line up just so to start a living human being. And whether a troubled infertile couple today needs in vitro fertilization or something less dramatic, the events of 1977 and 1978 have affected what they experience under a modern infertility specialist's care a generation later.

The one thing I remember most about Dr. Steptoe's lecture is just how complex the road to success was. He took us on a journey, describing the failures at each step of the way, what they learned from each failure, and how they employed what they had learned for the next step. He lectured for over an hour. He was informative and charming, proud but gracious. He was such a distinguished gentleman, I almost didn't have the guts to do what I did after his lecture.

I waited my turn patiently. There were several people in line to ask him about Follicular Stimulating Hormone or Luteinizing Hormone or the role of progesterone in early gestation. He answered their questions politely and sincerely. And finally it was my turn. I shook his hand, congratulated him on a fine speech, and then I asked him if he'd autograph a couple of test tubes for me. "With pleasure," he said in his British accent, and he took out a fountain pen and scribbled his name on the adhesive tag affixed to each of the two test tubes. "That's all I wanted," I told him and then thanked him.

Louise Brown was not conceived in an actual test tube. It was more like a Petri dish. But to the layperson, the test tube became the symbol of concoctions, living or otherwise, that men and women in white coats tamper with at all hours of the reproductive night. And whether it's IVF (in vitro fertilization) or IBF (in bed fertilization), it's still a human being--her conscience and soul and life experiences being who she is, not where her genetic fusion occurred.

Louise Brown is now of reproductive age herself. Dr. Steptoe was able to see her grow up before he died in 1996. I still have one his autographed tubes. Dr. Mike Boos of Lafayette, La. got the other one after being the one to dare me to do it. I don't know if Dr. Boos has his, but I still have mine. Now when I look at it, I see the name of a man whose work made possible the entire subspecialty of modern infertility and reproductive endocrinology. I see a young woman in England who actually exists because a natural substance met a natural substance in an unnatural place. She was born, went to school like the rest of us, and now she can have a baby herself. She's a natural, and we obstetricians thank her.

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