̽��ֱ�� of Cambridge - infertility

̽��ֱ��archive of Professor Sir Robert Edwards, IVF pioneer, reveals his personal struggles: for recognition of an unsung female colleague and fair access to treatment for all

ehs33 — Sun, 09 Jun 2019 23:01:00 +0000

̽��ֱ��private papers of IVF pioneer, Professor Sir Robert Edwards, opened to the public at Cambridge ̽��ֱ��’s Churchill Archives Centre on Monday 10 June 2019.

Robert Edwards worked for over a decade on the research that led to the success of in vitro fertilisation to treat infertility. ̽��ֱ��big breakthrough came with the birth of the world’s first IVF baby, Louise Brown in 1978. Thereafter he established the world’s first IVF clinic, Bourn Hall in Cambridgeshire, in 1980. Throughout he worked alongside medical doctor, Patrick Steptoe, and clinical embryologist Jean Purdy. Since then it has been estimated that six million babies have been born through IVF all over the world.

Edwards was awarded the Nobel Prize in Physiology or Medicine in 2010 for the development of in vitro fertilisation, and was knighted in 2011. Neither award can be made posthumously, so acknowledgment came too late for Purdy and Steptoe who died in 1985 and 1988 respectively - but the discovery was a team effort.

Newly released letters from Edwards’ archive show his personal battle as he repeatedly fought for official recognition of Jean Purdy’s equal contribution towards the discovery of IVF. Her work as a woman in science has gone largely unrecognised when compared to Edwards and Steptoe.

In correspondence released between Edwards and Oldham Health Authority in the lead up to the unveiling of an official plaque to mark the birth of Louise Brown, Edwards argues numerous times for the inclusion of Jean Purdy’s name to sit alongside his own and that of Patrick Steptoe.

He writes arguing for fair recognition and states that Jean Purdy ‘travelled to Oldham with me for 10 years and contributed as much as I did to the project. Indeed, I regard her as an equal contributor to Patrick Steptoe and myself.’ Unfortunately his repeated appeals fell on deaf ears and Oldham Health Authority did not take on board his request and her name went unrecognised on the official plaque.

Purdy joined Edwards in 1968 and worked closely with him, travelling to California in 1969 to undertake key research on follicular fluid. She continued to be instrumental in enabling the continued trials of IVF and in locating and organizing the adaptation of Bourn Hall as the world’s first IVF clinic. Meanwhile, as letters reveal, the National Health Service repeatedly declined to support IVF work, despite the numerous ways Edwards presented the case.

In a letter dated November 1974, Edwards writes to the Department of Health pointing out, ‘Our major concern is to help the many patients who could benefit by the rapid development of this method, for it could avoid many operations now carried out, which could become unnecessary.’

Again in Oct 1981 he writes to the Local Health Authority questioning the ethics and legality of withholding treatment because of lack of financial support: ‘…these patients have paid their contribution to the NHS and, now they want treatment, they are not being allowed to receive it. I cannot allow this situation to rest as it is, especially since, at long last you have been advised that it is professionally accepted that our approach offers the only hope of conception for some women… I cannot see any excuse for excluding one group of patients from the correct form of treatment.’

Cambridgeshire Health Authority replied to Edwards’ appeals for support, ‘Our current allocation is insufficient to maintain the service that we already provide. There is, therefore, no way in which the Health Authority can meet the expense of NHS patients attending your clinic.’

With the ethics and funding of IVF and other assisted reproductive technologies still open for discussion today - such as the cut in NHS funding for IVF treatment- the Edwards archive could add valuable context to the debate.

̽��ֱ��papers will be invaluable for researchers in the history of science, but also in the history of ethics, social implications of medical developments, and political and media history. Edwards engaged with the ethics of IVF and there is a wealth of information in the archive on these matters.

̽��ֱ��cataloguing of the Edwards' papers has been generously funded by Wellcome.

Sir Robert Edwards' archive catalogue is available online

Researchers can book an appointment at Churchill Archives Centre to view the papers.

Robert Edwards Archive

IVF trio with Louise Brown and her mother at 1st Birthday

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Male infertility is ‘culturally invisible’, finds research

fpjl2 — Thu, 01 May 2014 09:13:38 +0000

Even though male infertility is responsible for half of all cases of infertile couples, decades of misogynistic limelight on infertile women has left a ‘categorical hole’ in medical systems, with very few male fertility specialists and no official board certification for practitioners in the US, says a medical sociologist.

Some men seeking treatment end up further damaged by malpractice – prescribed testosterone, for example, which arrests sperm production – resulting from treatment by specialists in the wrong areas, such as a general urologist or their wife’s doctor.

And those that do manage to engage with male infertility specialists are often fed information about their disorder through metaphors that mask infertility – frequently involving traditional male activities such as plumbing, sport or car mechanics – to the point where two thirds of infertile men interviewed for the study simply didn’t consider themselves infertile.

“This is not some kind of deep-seated denial on the part of these men. There is an entire culture and medical system that makes it possible for men to be infertile and not even realise it,” said Dr Liberty Barnes from the ReproSoc group in the Department of Sociology, who has authored the book Conceiving Masculinity based on the research.

“Male infertility is as prevalent as female infertility, but it’s invisible in our society. While female infertility support groups, blogs, news and literature abound, male infertility is hidden from public view.

“In fact, most cases of male infertility are referred to IVF clinics – a process in which women bear the brunt. For many, male infertility is repaired in female bodies.”

Barnes spent over 100 hours shadowing doctors in five clinics in different states right across the US, as well as interviewing many of the couples involved (men and women separately).

Most infertile men, even those who do self-identify as infertile, are able to ‘intellectually reframe’ their infertility issues as a medical condition somehow separate from their self, explains Barnes.

“This separation of body and self, while rare in female infertility, is the standard coping mechanism in men – that their ‘messed-up plumbing’ is not their fault and in most cases repairable.

“Many men cling to the notion that if you have a problem that can be fixed, you don’t have a problem. Instead of telling these men they’re infertile, you hear doctors saying ‘oh, it’s just an issue with your blocked exhaust’.

“ ̽��ֱ��doctors actually provide men with the linguistic strategies to separate body from self.”

Culturally, male fertility is intrinsically bound up with ideas of virility, machismo and sexual potency because it hinges on that very essence of manliness – semen. As William, a businessman in his late thirties interviewed for the research, puts it: “Men should be able to gush sperm all over the place”.

For Barnes, the prevarication around male infertility is symptomatic of widespread cultural nervousness to expose masculinity as in any way fragile. Masculinity is equated with power; protecting and expressing power is a key function of societies and states. In the book, she cites the global media panic around a 1992 study showing sperm counts were dropping.

Male infertility hits masculine identities – from the personal to the national – right where it counts, says Barnes. One interviewee described his desire for fatherhood as “kind of the only purpose of life”. Another said his infertility led him to “doubt the toughness” of his penis.

Consequently, once a man is diagnosed, almost as much effort is taken to socially alleviate this perceived trauma to masculinity as to treat it medically. When interviewed, doctors reeled out a progressive rhetoric. But in the infertility clinics Barnes found a culture designed to enforce gender stereotypes and bolster masculinity.

“Every doctor I spoke to and medical seminar I went to, I heard time and again: we’ve got to help society move past archaic ideas that reproduction is women’s work. Then when I was in the clinics, it was complete immersion in traditional gender ideology: penis jokes, talk of balls – everything was power and virility,” said Barnes.

Diagnoses were shrouded in metaphors invoking factories/bridges/engines – technological achievement hiding biological failure. One doctor that Barnes shadowed, when prescribing hormone treatment to boost testosterone, would tell patients that side effects include “the urge to hit a ball really hard or drive really fast”. Barnes describes this claim as scientifically debatable.

̽��ֱ��assumed functionality of male sexual biology also translated to the first experience of the clinic – the collection cup. Men describe being pushed into a room or even just behind a curtain with no instruction beyond “fasten the lid tightly”.

Medical institutions assume men can masturbate under any conditions, will enjoy it, and be able to shoot semen straight into a cup, says Barnes. Some interviewees told her the semen they provided was both of particularly poor quality and limited due to stress and the amount they were able to catch. In fact, most men found this confusing and uncomfortable – especially when bluntly confronted with the choice of ‘performing’ or extraction by needle from the testicle.

Barnes found the extraordinary lack of medical professionals specialising in male infertility as opposed to those in female infertility – as well as absence of official board certification for treating male infertility – to be part of a damaging cycle:

“When I spoke to organisations about this hole in the system, they would tell me it’s because it’s not needed. Men aren’t coming forward for treatment, so there appears to be little demand. But then those that do struggle to find help, which – combined with the social stigma – means that many give up.”

There is a medical and social price to pay, she says. Research into male infertility is nowhere near as advanced as that for female infertility. And societal silence on the subject means men who want and may well be able to have children if treated are not – or being treated by the wrong people.

Among what medical specialists there are, the cultural invisibility of infertile men is inherently conflicting, says Barnes. On the one hand, male infertility doctors complain about the lack of attention the topic receives. But on the other, they realise this invisibility protects men and masculinity by suppressing the issue.

“If you promote male infertility as a label to encourage more men to come forward for treatment, you will have a harder time helping them pretend they’re not actually infertile,” she said.

Research for a new book reveals a culturally sanctioned suppression of dialogue around male infertility – despite it being equally as common as female infertility – to the extent that many infertile men receiving treatment still don’t actually consider themselves infertile.

If you promote male infertility as a label to encourage more men to come forward for treatment, you will have a harder time helping them pretend they’re not actually infertile

Liberty Barnes

Stefanie Reichelt

Illustration of sperm

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