By Tom McLaughlin
When Louise Brown, the world’s first in vitro fertilization (IVF) baby was born, many people found it shocking that women were having babies from lab-created embryos, says Marsh daisy.
Since then, says the Rutgers – Camden University researcher, eight million IVF babies have been born worldwide, and a couple having IVF with their own sperm and eggs barely raises an eyebrow today.
However, other areas of reproductive technology are provoking debate – women who become pregnant in their 50s and 60s, paid gestational surrogacy and access issues are just a few of them. “said Marsh, professor of history at the university and Dean Emeritus of the Faculty of Arts and Sciences at Rutgers University in Camden.
Marsh and her sister Wanda Ronner, professor of clinical obstetrics and gynecology at the Perelman School of Medicine at the University of Pennsylvania, explore these challenging questions and more in their new book, The pursuit of parenthood: reproductive technology from test tube babies to uterus transplants (Johns Hopkins University Press).
The book delves into the controversial history of assisted reproduction technologies – procedures in which eggs and embryos are manipulated outside the body – to the present day, from IVF to egg and embryo donation , surrogacy and genetic modification of embryos.
Conversations with some of the pioneering physicians who developed these technologies are included in the book.
“We really understand why these men and women got involved in IVF and how technologies have advanced,” says Marsh.
A chapter of The pursuit of parenthood considers the growth of IVF in Philadelphia as an example of how assisted reproduction has developed nationally. Ronner notes that the University of Pennsylvania’s in vitro fertilization program – the seventh in the country and the sixth to have a live birth – was founded by Luigi Mastroianni Jr., a leading figure in the field and a protégé of John Rock, who was the first to report in vitro fertilization of a human egg in the 1940s.
“In many ways, the history of Philadelphia mirrors that of the IVF pathway more generally in the United States – starting in academic medical centers, then expanding into hospitals, and finally into autonomous centers. Ronner explains, noting that they were able to review fascinating materials from those early days that told the story of the early developments of Penn’s program.
The United States was not at the forefront of new technology, says Marsh. After John Rock’s early experiments, interest dragged on until the late 1960s. And when it picked up, it was researchers in England and Australia who took the lead. The British team of Robert Edwards and Patrick Steptoe were the first to succeed with the birth of Louise Brown in 1978. Australia followed closely, becoming the second country to achieve the feat, in 1980.
As British and Australian scientists progressed, Marsh says, American research in the 1970s was hampered by resistance from several groups, including those opposed to abortion.
“Inevitably, some embryos created by IVF are thrown away,” she says. “For those who believed that life begins at fertilization, destroying an embryo was like destroying human life.”
In the tense political climate following the United States Supreme Court ruling Roe vs. Wade Decision taken in 1973, which affirmed a woman’s right to have an abortion, Marsh adds, the US government has imposed a temporary moratorium on funding for IVF research until an ethics advisory committee can be created to make recommendations on the use of technology. But in 1979, when the ethics committee unanimously voted to authorize such funding, the government ignored them.
At that time, American researchers, tired of waiting, embark on private money. In 1981, the United States became the third country to pass IVF.
“It’s a good thing they didn’t wait for the end of the funding ban, because this ban still exists, with negative implications for basic and clinical research,” Marsh says. “The research has not stopped, but if it concerns human embryos, it still relies on private funding.”
In terms of clinical treatment, the Rutgers-Camden researcher notes, the market determines what is and is not acceptable – which has earned the United States a reputation as the “Wild West of reproductive medicine.”
“We are the only developed country that does not have national policies or regulations governing assisted reproductive technologies,” Marsh said, noting that one problem with the lack of federal funding is that clinical practices can be brought into play. place without the advantages of this type. independent peer-reviewed research made possible by entities such as the National Institutes of Health.
In light of this largely unregulated industry, Marsh and Ronner examine a series of ongoing – and often controversial – debates in the field, including the question “Is there a time when a woman is too old to have?” a baby ? “
A practicing gynecologist for more than 30 years, Ronner is concerned about the health risks of women in their fifties or older who become pregnant.
“There have been women who have had babies in their sixties, but is that something that should be medically allowed? ” she asks.
Researchers are also considering the use of paid surrogates – women who are paid to have a child on behalf of a stranger.
“There are a lot of wonderful parents who couldn’t have children if they didn’t have a gestational surrogate,” Marsh says. “For example, there are women who cannot medically achieve pregnancy and same-sex couples who otherwise could not have children in a biological relationship with at least one of the parents.
However, Marsh continues, there is also an inherent risk with paid surrogacy.
“It’s hard not to see this as potentially exploitation of the surrogate,” says the Rutgers-Camden researcher, noting that two countries, India and Thailand, allowed the practice, but India is now restricting it. significantly and Thailand has banned it altogether.
Another crucial question concerns the responsibility to pay for IVF treatments.
Ronner and Marsh believe healthcare is a human right and fertility care is a part of healthcare, adding that women of color and those of modest means may have difficulty accessing procedures. They argue that IVF, within reason, should be covered by health insurance. New Jersey, she notes, is one of seven states to impose medical coverage for IVF.
“In states where the procedure is covered, it doesn’t seem to add too much to the overall health care costs,” Marsh adds.
Whatever debates are going on, Marsh says, they think it’s high time the United States came together as a nation to develop policies on the future of assisted reproductive technologies.
“We think it’s important to have this national conversation and build national consensus on these issues, rather than just letting the market rule,” Marsh said.
The pursuit of parenthood is the latest volume in what the sisters call their “Infertility Trilogy”. The empty cradle: infertility in America from colonial times to the present day was their first, followed by The Fertility Doctor: John Rock and the Reproductive Revolution, which explores the life and work of the most famous physician as the co-developer of the oral contraceptive.