Chapter 21 - Society of Laparoscopic & Robotic Surgeons

Chapter 21

The Fight for Reproductive Rights

1970s: IVF, Medicine and Media, Edwards and Steptoe, Semm
Chapter by Dave Kostiuk

Progress is a nice word. But change is its motivator. And change has its enemies.
-Robert F. Kennedy

For better or worse, it is quite hard for any of us to picture life without television. Like many aspects of our world, this seemingly immortal medium is often both a blessing and a bane simultaneously. The same electronic box that transmits mindless brain candy from The Patridge Family to American Idol also gives us all-important information regarding wars, natural disasters, and political maneuverings. Television’s broad spectrum of functionality is further complicated by corporations and other powers that be, which influence its purpose and content. Since its inception, the usefulness and uselessness of this medium has been a vast and never-clearing haze of gray.

However, innovations in media also spawned society’s most in-depth patient awareness ever. Television, then printed media about television, and then electronic media about medicine and surgery, informed those in medical need with unprecedented degree of immediacy and accuracy. The virile ontogeny of the information superhighway increasingly empowered the patient with the ability to place surgeons under scrutiny, rather than just vice-versa. Instead of asking “when” and “how much,” concerned individuals could now ask “why” and “how.”

This phenomenon and its intricate relation to the history of laparocopy is somewhat comparable to the profound effect that television had on the Vietnam war, as broadcast images rendered the acutely negative aspects of war more palpable, visceral, and immediate, therefore infusing a whole generation with the desire and data to effectuate change.

1978 – Steptoe and Edwards
One of the best examples of laparoscopy living out this prophecy of media, patient-centric care is the story of the world’s first IVF baby, achieved with the assistant of laparoscopic-assisted techniques. Perhaps too the 1970s, the post- civil rights decade, best exemplifies the medical field’s simultaneously productive and counterproductive struggle with progress, ethics, and media. In the UK, the BBC was doing its utmost to destroy the careers and reputations of two men who would eventually prove to be the authors of one of medical sciences most amazing and culture-shifting feats.

Since 1967, Dr. Patrick Edwards and Dr. Patrick Steptoe of Oldham, Great Britain had been working towards creating options for women who couldn’t conceive when they found themselves all but completely demonized by the media by 1969. The team’s publication of their working experiments with in-vitro fertilization created an immediate uproar within and without the medical community. As Kalk and Ruddock attest: “…the influential BBC produced a television program about cell fusion and in-vitro fertilization which opened with a picture of the atomic bomb explosion in Hiroshima.” Not exactly fair and balanced coverage.

Consequently, church leaders and medical associations openly denounced in- vitro fertilization as a moral abomination. The perceived unnatural aspect of the work was further heightened by the presence of its chief tool: the still widely contentious use of the laparoscope for more advanced operative procedures. Steptoe and Edwards were forced to resort to soliciting private funding, as they had no other financial support for their efforts. Morale already low (though determination was high), the duo pressed on for the majority of the 1970s, experiencing one failure after the other until one fateful day in 1978.

But before we get to that, it is crucial to note the origins of this partnership. The laparoscope brought them together! In the words of Edwards himself: “I read about this chap Steptoe… [and] his work with something called a laparoscope… He was writing about how he had managed to reach the fallopian tubes. I thought, if he can do that, he can reach the ovaries.” A melodramatic professional attraction from the start, colleagues had actually advised Edwards against working with Steptoe, who had already obtained medical infamy as a sort of radical nonconformist. Once the two men indeed joined forces, they attracted institutional hostility and dissent that was as professionally belittling as it was impulsively judgmental.

Edwards, the elder statesman of the duo, had already been thinking outside of the box for quite some time, showing interest in embroyo transplantation since 1958. The ball had already started rolling as far back as 1891, when English professor and physician Walter Heape successfully moved embroyos from an Angorian rabbit and placed them in the uterus of a Belgian rabbit, resulting in a litter of six rabbits. Much later, in 1959, M.C. Chang announced the very first successful birth following lab fertilization; this was the precedent “true in-vitro fertilization and subsequent enbroyo transfer to the uterus.” A physiologist from Cambridge, Edwards had recently joined the fray at this juncture, making his best attempts to mature the eggs of Homo sapiens well into the next decade.

By the mid-sixties, Edwards had finally arrived at a stage where he could move from the realm of theory onto a stage of practical reality. He now knew he would have to acquire a partner who was skilled enough to retrieve human eggs to work with. Enter Patrick Steptoe, maverick gynecologist from Oldham General Hospital.

After they were ideologically ostracized from the respectable sciences and relegated to little or no funding for their work, the two pressed on for years despite constant disappointment and maddening frustration. Plenty of eggs and embryos from countless volunteer subjects moved back and forth with zero legitimate pregnancies. By 1977, Edwards was an approximate year away from retirement; ironically and admirably, he and Steptoe became more adamant and determined than ever. They embarked upon a new program that involved monitoring the menstrual cycle and implanting an embryo into the uterus. Still, pregnancies wouldn’t last more than a few weeks.

A married couple from Bristol would prove instrumental in tipping the scales in Edwards’ and Steptoe’s favor. Leslie Brown and her husband John were one of many couples who desperately wanted to remedy their disability to procreate. At age 29, Brown had an egg removed via laparoscope and replaced fertilized in Nov. of 1977. As Jennifer Rosenberg reports: “Previously, Drs. Steptoe and Edwards had waited until the fertilized egg had divided into 64 cells (about four or five days later). This time, however, they decided to place the fertilized egg back into Lesley’s uterus after just two and a half days.” Not only was she pregnant, but the pregnancy persisted.

Subsequently this pregnancy gave metaphorical birth to a shockingly high-level media frenzy. On one hand, Leslie Brown became an angelic symbol of hope to so-called barren women the world over. On the other, both physicians were deemed devils incarnate, wicked men doing wicked work. On this latter point Edwards recalled: “We were called everything under the sun– immoral, unethical, dehumanizing.” Whether a story of heroes and heroines or a tale of moral depravity at its worst, it was indeed quite a story, one that print and especially visual media salivated to document.

Bribing became the journalistic rule of the day, reporters covertly slipping hospital workers payoffs as luxurious as 5000 pounds for inside information about Brown and other patients involved in in-vitro trial work. The media traffic became so disruptive and intense that Brown’s residence was temporarily relocated to the home of Steptoe’s daughter in Suffolk. During this 1977 turmoil, Edwards was quoted as saying: “Reporters began to circle the hospital grounds with long-range cameras, long-range recorders, every modern device of intrusion.” Did the man say “modern device of intrusion?” The paradoxical irony is thick, as his partner Steptoe’s detractors abhor him for his intrusive instrument, the laparoscope.

It was now time for the doctors to file complaints. Like too eager anthropologists studying a culture in a foreign land, the media was no longer just observing but influencing circumstances, quite negatively at that. Brown’s health actually began to suffer, forcing Steptoe to file complaints with the health authority and the nation’s medical journal. Moreover, thanks to the BBC Julie Brown and the doctors became the focal point of fanatics opposed to in- vitro; a bomb threat, luckily proven to be false, was phoned in to the maternity ward in July of 1978.

That same month, the ravenous media actually affected the character of the delivery. Police and extra security staff could barely keep a lid on all of the activity, and a little more than a week before the due date, Brown was showing distinct signs of high blood pressure. Steptoe opted for a nighttime C-section. It was July 25th, and he actually went so far as to feign departure for the day, walking out of the building around 5 pm. A few hours later, he returned and slipped through a back entrance. Just before midnight, he delivered a healthy baby girl by the name of Louise Joy Brown, a blond just under six pounds.

Again, the now commonplace method of in-vitro fertilization, a godsend to so many couples otherwise incapable of conception, was physically possible thanks to the work of two brilliant pioneers using laparoscopy for what it had always been destined for; minimally invasive interventions. Laparoscopy, a subject that had been ignored for decades, had once again proven itself as safe and reliable throughout the course of Edwards’ and Steptoe’s work and studies. Like a King Arthur’s sword in battle, the laparoscope was symbolically wielded as a weapon against societal oppression, in this case the fight to control a woman’s body and her ability to exercise options in regards to it. The world was watching.