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Fiction

The greater good

Not everyone can be a winner

Rebecca Nesbit 28 November 2017

www.lablit.com/article/934

I imagine this camera seeking out the soul of my unborn child, still waiting as an egg in my over-stimulated ovaries

Editor's note: We are pleased to present the sixth installment in our series, The League of Imaginary Cats. Read more about the Series in our accompanying editorial, and use the navigation links at the top right to catch up.

A red VW Golf crawls up the drive of Bourn Hall Clinic, its tyres crunching on the gravel. Incongruous next to the Jacobean manor house, the car has a number plate obscured by a layer of grime and a painful scratch running down the passenger door. I focus on the contrast between house and car to keep me from contemplating the even greater anachronisms within. Today, in this building full of carvings, portraits and stags’ heads, a fine needle will inject my husband’s sperm into my egg and our first child will be conceived.

I spot a film crew, their camera focussed on its arrival. An assistant, about the same age as me, is huddled against the cold. When she sees me coming she breathes on her hands and smiles.

“What are you filming?” I ask.

“It’s for the Nobel Prize documentaries. We’re making a film about Professor Edwards. The house is full of people celebrating his prize with a tea party.”

“Then why the car?”

“We’re filming a patient’s journey, and showing how much things have changed since Bob founded Bourn Hall. The car is like them arriving.”

The cameraman straightens up, nodding in satisfaction with his shot. “We could film you walking in, as the next stage of the journey, would you mind?”

I shrug. “Why not?” My husband and I walk towards the ancient wooden door and I feel the camera on my back. Just as Berber women believe a camera can steal their souls, I imagine this one seeking out the soul of my unborn child, still waiting as an egg in my over-stimulated ovaries.

At the reception desk my husband announces we are here for an egg collection, his voice calm and natural. I picture a child reaching under a chicken to see if she’s laid any eggs, still not wanting to believe they are really talking about me and the eggs in my body.

Next to us a young boy clings to the leg of a lady with permed blonde hair.

“Are you leaving, Louise?” The receptionist goes round to hug the lady and her son, and my husband stoops to whisper in my ear.

“That’s Louise Brown!”

I frown, and shake my head to show I have no idea what he is talking about.

“Louise Brown, miracle child, the baby of the 20th century, first IVF girl, born in 1978.”

“I was born in the ‘80s.” It’s my stock answer to justify why I know less than him.

Elaborate goodbyes over, the receptionist returns her attention to us. “Do you want a drink? There are lots of new mothers in the canteen for the celebration, but don’t worry, you can still go in.”

My husband heads straight for the coffee machine, but two years of infertility have taught me not to allow myself to be surrounded by mothers and their babies. Instead I slip into the toilets. The egg collection might rob me of my last shred of dignity, but I can still look good for it.

I pull out a lipstick from my handbag and as I add ‘radiant plum’ to my lips the lady next to me smiles in the mirror. She has a mother’s smile, caring and wise. She’s about the same age as my mother, although my mother’s smile has been dulled by the realization she may never be a grandmother, that the daughter she produced is defective in the reproduction department.

“Are you one of the mothers here for the party?” the lady asks in a lilting Scottish accent.

“Not yet. I’m here for my egg collection. Are you here for the party?”

“I’m here with my Alistair, the second IVF baby after Louise.”

“You were the second person to have IVF?”

“The second person to have an IVF child, but lots of women were there trying with me. I was just the lucky one.”

So this lady went through the same thing as I am, before anyone knew it would ever work.

“What was it like?” I ask.

Her smile doesn’t waver; there is no shuddering at the horror of the experience, just an invitation to see the photos. Out in the hall she flicks through the pages of a scrapbook. “Alistair and Louise were born at Oldham Hospital – Bob didn’t found Bourn Hall until a few years later.” She stopped at a black and white photo of portacabins in the snow.

“Patients lived in portacabins?” I don’t want to sound like I’m doubting her, but the cabins make it feel a bit like reproduction in Brave New World.

“This building was pretty much in ruins when Bob and Patrick Steptoe bought it, so all the ladies lived in the cabins while they were going through treatment. All of us in the early days felt such a bond, living together while we worked towards the same dream.”

I feel calmed by this auburn-haired lady who kept trying when nobody had yet succeeded; her words sound more genuine than reassurance from doctors, experiences shared in internet chat rooms, or the kind words from my family.

My husband arrives just as we turn the page to see the newspaper announcing Louise Brown’s birth, a tiny face under the headline ‘The Lovely Louise’. I read the fading print.

The consultant in charge of the case, Mr Patrick Steptoe, said: "All examinations showed that the baby is quite normal. The mother's condition after delivery was also excellent.”

“She’s beautiful.” I stroke her cheek, the yellowed newspaper crisp under my finger.

“Oh she was.”

More cuttings chart the subsequent developments in IVF. Grace MacDonald and baby Alistair meet Lesley Brown and Louise for the first time (Grace’s smile as proud and gentle in the grainy image as it is now), the world’s first IVF twins are born, the first mixed race IVF baby...

“Time to go.” My husband places a hand on my back to guide me to the door that will take us to the ‘procedures’ area.

“Good luck, my love.” I feel the comfort of Grace’s smile. “It’ll be over in no time, and before you know it they’re leaving school and leading exciting lives of their own.” She looks over to where a young man is rolling his eyes at her with an indulgent smile.

I would like to have stayed to talk, to hear about the real story of one woman, not just the collective story of anonymous couples told by the official history. Even more, I would like to tell her my story. But that’s not why I am here, so I take my husband’s hand as we leave the manor house and head to the theatre. The medical facilities aren’t contained within the beautiful old building, instead housed in a functional but sympathetic extension. My phone rings and the sound is almost lost to the wind.

“Who’s calling now?”

“My mother.” My finger pauses over the screen, summoning the energy to answer.

“Don’t.”

“She’s only calling to say good luck.”

“She’s said good luck on the phone, in person, in a card, and by email. And none of it will make any difference.”

“You don’t say good luck to make a difference, you say it to make someone feel better.”

“And is it making you feel better?”

My phone beeps to announce the arrival of an answerphone message and I turn it off.
My husband slips his arm around my shoulders and kisses my forehead. “This is our day.”

I realize that it wouldn’t have been my story I shared with Grace anyway. It would have been the story of every friend, aunt and neighbour who believes they are going through this with me.

The facts so far have been very simple: nobody knows why we can’t conceive so we’re trying IVF. The version I tell is the shared story of everyone who is close to me, and some people who aren’t. It’s about my discovery through Facebook that my sister-in-law’s third child was on its way because she was too scared to tell me in person; about the holiday I didn’t go on so that I didn’t ruin my pregnant friend’s fun; about my mother’s incessant reassurances; about the delicate phone calls where I am the one who treads carefully to help my friends know what they can and can’t say; about the sighs of relief they all must breathe when the call is over; about everyone who has an emotional investment in my success here today.

“We don’t need luck anyway.”

I pull open the door and warm air engulfs us.

Next to the nurses’ reception the film crew are talking to an attractive middle-aged doctor, and I watch as he shows them the tools used in IVF today. He waves a plastic syringe with a long tube wobbling above it, and the young producer reaches out to feel it. She recoils with a giggle.

My God. That thing is going in me.

For a moment the doctor’s brown eyes meet mine. He gathers up his instruments and rings the bell for a nurse. A tiny lady with glasses too big for her face bustles up to the desk and hands us both a clipboard.

“I just need some quick details, and you to sign that you know the procedure and the legal practices.”

The words on the forms enter the haze in my mind but refuse to solidify into meaning. I look at the nurse to request an explanation, whether they are going to turn any excess eggs into experiments, or into children for that matter. But she is listening to the doctor, and probably expects me to be able to read.

Thankfully, my husband whispers: “It’s so you can’t steal my sperm when you run off with another man.”

I sign the first form and let my attention return to eavesdropping. The doctor has moved on from shocking people with his tools to shocking them with history.

“You know IVF could never be developed today.”

“How come?” The producer holds her notebook to the ready.

“Regulations wouldn’t allow us to do trials with patients. It would be seen as too risky.”

“Nobody knew Louise was going to be normal, did they?” It is the first sign that the cameraman has any interest in what’s going on. I preferred it when he was a disinterested observer, there only to operate the camera and not to pass judgement on what he saw through it.

“There were lots of people convinced she wouldn’t be, although IVF had worked in animals. Bob faced tremendous criticism, but his desire to help people meant he withstood the huge pressure from peers who believed he was doing wrong.”

“It’s kind of ironic that IVF was developed when people didn’t think it was ethical, but couldn’t be invented today now people are totally OK with it,” the producer says.

“It wasn’t just the worry about whether it would produce normal children, it was what the women had to go through. Now patients give themselves hormone injections at home to stimulate ovulation, but when I arrived in 1980 they were in-patients for weeks. It was pretty invasive back then – they had to collect urine through the night and hand it over in a plastic milk jug the next morning. It was a constant stream of injections and tests.”

The producer keeps glancing over to me, and I wonder what part she wants me to play in her film. I’m a woman, not a patient. Unlike Grace, I’m not a hero.

“But they all did it out of choice,” she says.

“True, though remember that the openness about science and medicine you take for granted hasn’t always been the way things work. Bob was really criticized for being open with the media – it just wasn’t the done thing.”

“Still, even if they didn’t understand everything, it doesn’t necessarily mean they wouldn’t have done it.”

This seems to be a question rather than a statement, and I’m better placed than the doctor to answer it. “Of course it was right. The ladies thought it was worth the risk just for themselves, not to mention all the people who came after them.”

“The world was different back then, we can’t judge it by today’s standards.” The doctor gives me a diplomatic smile.

If fate had landed me with the curse of infertility when IVF was simply ‘playing-God’, a bold idea from a man keen to improve the lives of people like me, I would have volunteered to be part of the trial. I would have joined Alistair’s mother or her friends in portacabins and sacrificed dignity for motherhood and science.

My husband takes the clipboard from me and the film crew moves on. “Come on, we don’t want to teach our child to be late.”

I follow him and the nurse to the silent ward. It is a relief to be away from the camera crew and the camera, even if its lens is covered. Like a disarmed gun, you know it is no threat but can’t quite relax when you’re around it.

The nurse ushers me into a hospital gown. Not a uniform that you are proud to wear, but a dress code to strip you of your identity. When you are in the gown you obey the nurses’ wishes.

My husband lets go of my hand, a symbolic handing over to the nurses’ care. His job today is not to comfort me; it involves a sterile pot and some 90s porn.

The nurse who wheels me on my trolley into the egg collection room is young and pretty. When I’m inside she moves back and leaves me in the charge of a larger lady in maroon scrubs. Her smile is so warm I feel like asking for a hug, but I can’t forget the conversation I had with the doctor. As someone who soothes ladies during the invasions which bring us closer to motherhood, she seems entitled to her opinions, so I ask: “If Professor Edwards had the same regulations as today, would he have been able to develop IVF?”

“I don’t know, dear. Can you lean right back again for me?”

“Four million babies born through IVF, don’t you think it was worth it, all they did for us?”

“Four million babies is certainly a fine thing.”

A plastic mask is placed over my face and a calming wooziness overtakes me as the gasses used for sedation infiltrate my body. It’s not so much that I can’t see the nurses preparing to suck the eggs from my ovaries, it’s more that I can’t summon the willpower to care.

Moments later (or hours, who knows?) the task begins. A nurse carries a small dish through the open door to the lab, and I see a hand come out and take it.

An expectant pause.

“Only granules!” It’s a man’s voice, and even through the blur of the sedation my body tenses in the knowledge a man is waiting for samples extracted from within me.

Undeterred, the nurse concentrates on a black-and-white monitor. It shows a grainy image of my insides, where they are probing for an egg. I don’t think it is just the sedation which means the image looks as clear as an un-tuned television.

Another dish goes through to the lab. “Grannies again!”

And again...

I shake my head in disappointment (or is it the room that is shaking around me?). The next dish is passed through to the lab.

“More grannies.”

“It’s alright, just keep still.” The younger nurse squeezes my shoulder. Another sample is handed to the disembodied male voice.

“An egg!”

The next thing I know I am lying in the ward and my husband is watching me.

“Hello sleepyhead.”

My lips move but I don’t think any sound comes out.

“You did well,” he says. “Five eggs.”

My voice returns with my smile. “And how did you do?”

“I think I made more sperm than that.”

**********

Five days later the most promising embryo is returned to its rightful place. It is still only a ball, a blastocyst. The cells that will grow into the child are together in a tight clump, surrounded by a ring of protective cells that will nurture it as the placenta.

This time I return home with the child inside me, and wait. When the time for the pregnancy test arrives it feels strange that the world remains oblivious. Little of what has led to this has been a private process, but now I am alone. I can hear the traffic outside, and the dog next door asking to be let out.

The sickness and hot flushing associated with pregnancy visit me while I wait the allocated two minutes.

But that’s not what they are. It is just nerves. My body has no reason to call for special treatment.

My head is filled not with thoughts of the tiny embryo that will never grow into my child, but to rows of beds in the stuffy air of a portacabin. My tears have turned the bathroom into a blur, so the cold floor tiles and dusty medicine cabinet seem less real that the image of the women whose names and faces have now been forgotten. The ones who walked home empty handed.

I think of the ordeal they went through, an ordeal that allowed millions of lives to be created, which granted joy to parents, grandparents, friends and siblings. I feel their weeks of prodding, poking and pain. Their offering to parenthood and to medicine has provided me with this moment of despair.


The development of IVF

On 10th October 2010 a call came through to my office from a Swedish newspaper announcing that the winner of the Nobel Prize in Physiology or Medicine had been leaked as Professor Robert Edwards.

As PR consultants to Bourn Hall, we seemed the most likely bet for securing the first interview, but we denied all knowledge; this was genuinely the first we had heard of it. But at 09.55 a second call came from Sweden, and the journalist held up his phone so I could listen to the announcement of the winner. Though a stream of Swedish on a crackly line, I heard the name Professor Edwards.

Before I had hung up, every phone in the office was ringing (sadly we had more phones than people so every time I spoke to a journalist an incessant ringing was urging me to end the conversation as fast as I could). However, Bob was in his mid-eighties and had, understandably, retired from giving media interviews.

Along with a deluge of journalists calling to ask for interviews, we were in touch with people who had known Bob personally and were offing to speak to the media about his warmth, modesty and determination. He was a much loved man and his motivation had been to bring joy to infertile couples. And indeed he has, with over 5 million IVF children having been born worldwide (2013).

Much of the work was, however, done in the 1970s when medical regulation was very different. For better or worse, regulations are now much stricter, which may mean that techniques we now take advantage of could not be developed today.

For his PhD in the 1950s, Professor Edwards studied the developmental biology of the mouse. For his experiments he needed to manipulate the number of chromosomes in eggs, sperm and embryos. He came up against the problem that sperm were abundant and eggs were not. With the use of hormones he managed to hyper-stimulate the ovaries of mice, which would later be significant for his work on humans.

In 1959 it was discovered that aneuploidy (where an extra copy of a chromosome is present in the embryo) leads to conditions such as Down’s syndrome. To study the way that eggs ended up with an extra chromosome, Professor Edwards tried to get mouse eggs to develop in vitro. To his surprise, he found that eggs matured spontaneously when released from follicles, suggesting that in vitro fertilization was a possibility.

Teaming up with Patrick Steptoe marked a move from the study of genetic disease to the quest for human IVF. Steptoe’s skills in laparoscopy (keyhole surgery) allowed the collection of in vivo matured eggs after mild hormonal stimulation. Had Steptoe still been alive in 2010 he would have undoubtedly shared the Nobel Prize.

Initially, Professor Edwards didn’t have the same success with humans as he had with rodents. But he persevered, and as word of his hopes for IVF spread it attracted the inevitable criticism, so much so that work on human IVF was banned at the National Institute for Medical Research (NIMR) in London where he was based. He moved to Cambridge University and finally succeeded in maturing human eggs in vitro, after realizing it took 36 hours, and not the 12 hours which had been previously reported.

At the end of the 60s, clinicians still didn’t see infertility as a problem, so any research designed to alleviate it was not viewed as experimental treatment, but as using humans for experiments. This led to the Medical Research Council rejecting a grant proposal (one of the reasons given was distaste for the media exposure!). Although it was a time when scientists attracted criticism for talking with the press, Bob relished the debate and spoke regularly to the media.

On Valentine’s Day in 1969 Professor Edwards published a paper in Nature announcing that he had fertilized human eggs in vitro. Encouraged by the health of rodents born through IVF, human embryos were first transferred to their infertile mothers in the early 70s. These initial trials failed, and were followed by new approaches with different hormone injections.

These efforts resulted in the first IVF child, Louise Brown, born in the UK on 25 July 1978, following the replacement of an 8-cell embryo. She was followed 6 months later by Alastair MacDonald, the first IVF boy.

These early IVF attempts relied on the women’s natural cycle, meaning that the timing of egg recovery depended on the detection of a spontaneous surge of luteinizing hormone (LH). Egg collection could be performed at any time during the day or night.

The situation now is very different, with couples being treated as out-patients and success rates increased by techniques such as ICSI, where the sperm is injected into the egg.

Further reading:

Nobel Lecture in Honour of Robert G. Edwards

The early days of IVF outside the UK