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Daily Mail, 26 January 1979, pp. 2–3: ‘Region 1, London. Freezing fog patches soon clearing. Sunny intervals. Occasional snow showers. Wind N.W., light to moderate. Max 0–2c’.Google Scholar

Participant note: ‘This was my assumption, as I was not able to talk to either Edwards or Steptoe immediately after the event and only interacted with them later in the day’.Google Scholar

For Steptoe’s exact words, see Chapter 3.Google Scholar

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The MRCOG examination was in two parts at that time: Part One (basic science) and Part Two (clinical).Google Scholar

Mill Road Maternity Hospital, Cambridge, UK. Opening in 1838 as the Central Union Poorhouse, it officially became a maternity hospital in 1948. It was replaced by the Rosie Maternity Unit in 1983.Google Scholar

Senior House Officer.Google Scholar

‘Martin H. Johnson interviewed by Sarah Franklin’. Interview Ref: C1324/11, Mammalian Developmental Biology Project Interviews, London, British Library, 2012.Google Scholar

Ruth Fowler, scientist and wife of Robert Edwards. For her marriage to Edwards, her professional collaborations with her husband and her contribution to some of the original IVF work, see Gosden, R. Let There Be Life: An Intimate Portrait of Robert Edwards and His IVF Revolution. Williamsburg, VA: Jamestowne Bookworks, 2019. See also, among other items,Google ScholarGoogle ScholarGoogle ScholarGoogle ScholarGoogle Scholar

Charing Cross Hospital London, originally one of the capital’s eight teaching hospitals. Elstein was a lecturer in obstetrics and gynaecology there in the 1960s. Participant note: ‘This was a Department of Obstetrics and Gynaecology meeting’.Google Scholar

Elstein refers to the work that Edwards did on sperm capacitation, during a visit to the University of North Carolina at Chapel Hill in 1966; Johnson, MH. Robert Edwards: the path to IVF. Reproductive Biomedicine Online 2011;23(2):245–62. At Chapel Hill, Edwards conducted research with women willing to use a device he invented which would enable spermatozoa to be exposed to their uterine fluids.Google ScholarGoogle ScholarGoogle Scholar

Participant note: ‘I questioned the ethics of a collaborative research proposal on human egg and sperm in utero with the possibility of a viable embryo resulting’.Google Scholar

Arnold Klopper (1922–2014) was Professor of Reproductive Endocrinology at the University of Aberdeen. Born in South Africa, he came to Aberdeen in 1956 and retired from his university post in 1987.Google Scholar

Ian Cooke, Professor of Obstetrics and Gynaecology at the University of Sheffield, 1972–2000. Now Emeritus. Sinha had worked with both Klopper and Cooke early in his career.Google Scholar

Sir Medawar, Peter Brian (1915–87), biologist who worked on the immunology of transplantation. He won the Nobel Prize in Physiology or Medicine in 1960. Medawar, Sir Peter Brian (1915–87), biologist, in Oxford Dictionary of National Biography, https://doi.org/10.1093/ref:odnb/40016, accessed 22 July 2022.Google Scholar

Eugene M. Lance, MD, PhD (1933–93). An orthopaedic surgeon from New York, he spent two years working with Peter Medawar in London at the Medical Research Council’s National Institute for Medical Research, Mill Hill, from 1966 to 1968. He returned to Cornell Medical Center, New York, then came back to London in 1971 and worked as a consultant orthopaedic surgeon in Northwick Park Hospital Harrow. In 1974 he moved to Honolulu as Professor of Orthopaedic Surgery. He was not a Fellow of a UK College of Surgeons, which was unusual for someone appointed as a consultant surgeon in the UK at the time. Together with Sir Peter Medawar, he co-authored ‘Survival of skin heterografts’; see Note 25.Google Scholar

This memory may refer to the press response to the publication of the February 1969: Edwards, RG, Bavister, BD, Steptoe, PC. Early stages of fertilization in vitro of human oocytes matured in vitro. Nature 1969;221:632–35.Google Scholar

The Medical Research Council. This body awarded grants to doctors and scientists for research. Much of the MRC’s work has been conducted in two major establishments. One was the National Institute for Medical Research at Mill Hill London. This closed in 2015 when the Francis Crick Institute opened at King’s Cross, London. The other was the Clinical Research Centre, established in 1967 at Northwick Park Hospital Harrow Greater London. This eventually moved to Hammersmith Hospital London in 1999. http://discovery.nationalarchives.gov.uk/details/record?catid=121&catln=1, accessed 22 July 2022. Landsborough, A, Thomson, A. Half a Century of Medical Research. 2 vols. London: Medical Research Council, 1973–75.Google Scholar

Sinha was a Reproductive Immunology Research Fellow at the MRC for two years before finding an appointment in Aberdeen. Peter Medawar was head of the transplantation section of the MRC’s Clinical Research Centre, Northwick Park Hospital Harrow.Google Scholar

Thirty-five projects in the section of the MRC laboratory where Sinha was given a desk.Google Scholar

‘Edinburgh’ in original.Google Scholar

‘B. M. Cooper’ in original.Google Scholar

Lance, EM, Medawar, PB. Survival of skin heterografts under treatment with antilymphocytic serum. The Lancet 1968;291:1174–76.Google Scholar

Sinha’s project was to find out if there was any immunological cause of infertility, especially due to local immune response. He was involved with several materno-fetal immunology projects, one of which was his MD thesis.Google Scholar

Johnson, MH, Franklin, SB, Cottingham, M, Hopwood, N. Why the Medical Research Council refused Robert Edwards and Patrick Steptoe support for research on human conception in 1971. Human Reproduction 2010;25(9):2157–74.Google Scholar

Presumably Patrick Steptoe.Google Scholar

See Note 17.Google Scholar

Simpson Memorial Maternity Pavilion, Edinburgh, which opened in 1939 as part of the Royal Infirmary. It closed in 2002.Google Scholar

Terry Baker (1936–2006), born in Coventry, was a lecturer in Edinburgh before being appointed Professor of Biomedical Sciences, then Dean, then Pro-Vice-Chancellor at the University of Bradford.Google Scholar

Baker, TG, Neal, P. Oogenesis in human fetal ovaries maintained in organ culture. Journal of Anatomy 1974;117;591–604;Google ScholarGoogle Scholar

The birth of the first test-tube baby was filmed by the Central Office of Information for the Department of Health and Social Security. A copy is available in the Library. Wellcome Institute for the History of Medicine. Test Tube Baby: The First Birth. Narrated by Steptoe P. 1978. https://wellcomelibrary.org/item/b16763762, accessed 3 February 2021. See also Archives Centre, Churchill College, University of Cambridge GBR/0014/EDWS AS 3/1, ‘Test-Tube Baby, the First Birth, August 1978’, narrated by Patrick Steptoe for the Department of Health and Social Security on the birth of Louise Brown.Google Scholar

Participant note: ‘A group met in the Windsor Castle Pub … behind the RCOG and continued discussion about their belief that this was not “real” success’.Google Scholar

For patient numbers of pregnancies during the experimental period in Oldham, 1969–78, see E&J.Google Scholar

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Participant note: ‘I think a lot had to do with the transfer of the embryos. At that time Patrick did all the embryo transfers using the sheath of a Venflon catheter which were usually used for giving intravenous infusions. It was in the early days at Bourn Hall when, because Patrick was not in the best of health, I started doing all the transfers. I found the Venflon sheath to be unsatisfactory so I contacted Harry Wallace who made catheters and explained what I wanted and he came up with a beautiful catheter which I understand is now used worldwide. Incidentally Bob put his name to the catheter, it became known as the Edwards–Wallace catheter and it was a couple of years later that Patrick, much to his annoyance, found out that he was also receiving a royalty on these despite having had no input whatsoever in the design’.Google Scholar

Participant note: ‘Bob thought that the gonadotrophin were shortening the luteal phase and used HCG and bromocriptine, if I remember correctly, in an attempt to correct this. I don’t think pure progesterone products were available then’.Google Scholar

Participant note: ‘Chatting with Robert Edwards and Martin Johnson, an early graduate student of Bob’s’.Google Scholar

Jones, HW. In vitro fertilization comes to America. In Memoir of a Medical Breakthrough. Williamsburg, VA: Jamestowne Bookworks, 2014;Google ScholarGoogle ScholarGoogle Scholar

Killip, M. A test for detection and determination of low levels of HCG and LH. New Zealand Journal of Medical Laboratory Technology 1974;28(2):49–50;Google ScholarGoogle Scholar

Participant note: ‘LH surge’.Google Scholar

George Eliot Hospital, Nuneaton.Google Scholar

Brown, L, Brown, J. Our Miracle Called Louise: A Parents’ Story. London: Paddington Press, 1979.Google Scholar

For Edwards’ feelings about the behaviour of the British press, see ML.Google Scholar

For clarification of financial details, see Brown, L. My Life as the World’s First Test Tube Baby. Bristol, UK: Bristol Books, 2015.Google Scholar

A journal called Obstetrical and Gynecological Survey with abstracts and critical commentaries of the most significant obstetric and gynaecological literature from all over the world, including original review articles.Google Scholar

Toulson, L. Ban the test tube baby. The Sun, 25 February 1970, p. 1; see Chapter 2. Participant note: ‘I did not know Douglas Bevis’.Google Scholar

Marantz Henig, R. Pandora’s Baby: How the First Test Tube Babies Sparked the Reproductive Revolution. Woodbury, NY: Houghton Mifflin, 2006;Google ScholarGoogle Scholar

University of Southampton Medical School.Google Scholar

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Participant note: ‘Steptoe had a thriving private practice but he did not have good relations with his various colleagues’.Google Scholar

This was addressed in public by Steptoe himself in ML.Google Scholar

St George’s Hospital London. Steptoe himself addresses this question of job advancement in ML. For Steptoe’s biography, see Edwards, RG. Patrick Christopher Steptoe, C. B. E. 9 June 1913–22 March 1988. Biographical Memoirs of Fellows of the Royal Society 1996;42:434–52.Google Scholar

Francis Anthony Leopold Da Cunha (b. 1919, MRCOG 1949). He was consultant in Obstetrics and Gynaecology Oldham Lancashire and son of the Portuguese-born surgeon Frank (Francisco) Da Cunha. He published several papers and was president of the North of England Obstetrical and Gynaecological Society. Some of his personal papers are held at the University of Manchester: https://archiveshub.jisc.ac.uk/data/gb133-mmc/2a/mmc/2/dacunhafa, accessed 8 December 2021. For his work with Patrick Steptoe, see ML, p. 67.Google Scholar

Presumably the paper of 1969: Edwards, RG, Bavister, BD, Steptoe, PC. Early stages of fertilization in vitro of human oocytes matured in vitro. Nature 1969;221:632–35.Google Scholar

A cottage hospital that had formerly been used by GPs for convalescent patients; Hargreaves, GM. A History of Dr Kershaw’s Cottage Hospital, Royton: A Place to Remember. Privately published, 1999. Used by Edwards and Steptoe after June 1971.Google Scholar

For details of funding for the Oldham research, see Johnson, MH, Elder, K. The Oldham Notebooks: an analysis of the development of IVF 1969–1978. IV. Ethical aspects. Reproductive Biomedicine and Society Online 2015;1:34–45, supplementary material 1: edited transcript of interview with Noni Fallows and John Webster conducted at Bourn Hall on 19 May 2014.Google Scholar

Steptoe studied laparoscopy with Raoul Palmer in Paris and Hans Frangenheim in Germany. Steptoe, Patrick Christopher (1913–1988), gynaecologist. In Oxford Dictionary of National Biography, https://doi.org/10.1093/ref:odnb/40084, accessed 22 July 2022. He wrote a textbook: Laparoscopy in Gynaecology. Edinburgh: E. and S. Livingstone, 1967.Google Scholar

See Note 12.Google Scholar

Norman Cecil Tanner FRCS (1906–82), consultant surgeon at Charing Cross Hospital, 1953 to c. 1970, and early user of the gastroscope. https://livesonline.rcseng.ac.uk/client/en_GB/lives/search/detailnonmodal/ent:$002f$002fSD_ASSET$002f0$002fSD_ASSET:379171/one, accessed 1 February 2021.Google Scholar

Participant note: ‘Then proximal fibre lighting systems came out which did not have this problem’.Google Scholar

Participant note: ‘To insufflate the abdomen’.Google Scholar

Marmite – a brand of savoury spread well known for being either loved or greatly disliked by consumers.Google Scholar

Sir Norman Jeffcoate (1907–92), Professor of Obstetrics and Gynaecology, University of Liverpool, 1945–72, President of the RCOG, 1969–72. Jeffcoate, N. Principles of Gynaecology. London: Butterworth, 1957; ML, p. 70.Google Scholar

Basu was at one time working as a lecturer with Jeffcoate in Liverpool.Google Scholar

David Miller became a consultant in obstetrics and gynaecology in Sheffield. Now long retired.Google Scholar

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Participant note: ‘How to insufflate the peritoneal cavity. Initially there were no gas insufflators or bipolar diathermy. Technical breakthroughs came when a telescope, cannula and cold light source became available. Initially only diagnostic laparoscopy was done, then sterilisation using tubal diathermy’.Google Scholar

Cartoonist who invented unfeasibly complicated machines. Participant note: ‘The device was made from an unused Boyle’s anaesthetic machine for CO₂ insufflation’.Google Scholar

See Note 59.Google Scholar

Participant note: ‘I was keen to set up laparoscopy techniques in Southampton’.Google Scholar

Participant note: ‘John Hirst, a physician, asked Patrick to biopsy the liver of a nurse he was looking after … Hirst was extremely supportive and insisted that the outcome of his first attempt should not deter him from continuing to develop the technique and said he would talk to the patient and suggest she consider allowing Patrick to have another attempt … The nurse agreed to this and fortunately on this occasion the procedure was uneventful’. See ML, pp. 71–72.Google Scholar

Participant note: ‘Which is the bigger story is debatable but there’s no doubt that IVF has certainly brought more happiness to far more people than the moon landing. On the other hand, as far as I am aware, the landing on the moon didn’t upset anyone whereas IVF, or rather the failure of IVF, has caused a lot of heartache for many people’.Google Scholar

Brown, L. My Life as the World’s First Test-Tube Baby. Bristol, UK: Bristol Books, 2015.Google Scholar

Editor of the Daily Express; Jameson, Derek [Dell] (1929–2012), newspaper editor and broadcaster. In Oxford Dictionary of National Biography, https://doi.org/10.1093/ref:odnb/105557, accessed 22 July 2022.Google Scholar

Mr Ray Garry, consultant at Middlesborough General Hospital, was interested in introducing minimally invasive surgery using a TV monitor in gynaecology.Google Scholar

Participant note: ‘Guided remotely by TV monitor’.Google Scholar

The lecture was divided into three parts: see Chapter 2.Google Scholar

Four colleagues from Australia appeared on the audience list: Dr R Stanley, Dr A. Lopata, Dr A. Trounson, Dr D. M. Saunders; RCOG file E4/19 Registration List.Google Scholar

Eight colleagues from the USA appeared on the audience list: Dr Shuber, Dr Abraham, Mrs Irwin-Garrick, Professor Jones, Dr Keith, Dr Lippes, Dr Mullen, Dr Rary; RCOG file E4/19 Registration List. See Chapter 2.Google Scholar

See Chapter 2.Google Scholar

Although this was a common criticism, Edwards had produced a very detailed, comprehensive article summarising his work. Edwards RG. Early human development from the oocyte to implantation. In Philipp, EE, Barnes, J, Newton, M, eds. Scientific Foundations of Obstetrics and Gynaecology. London: Heinemann Medical, 1977; 175–252; see alsoGoogle ScholarGoogle Scholar

Participant note: ‘What was different at Bourn Hall’.Google Scholar

De Kretser, D, Dennis, P, Hudson, B, Leeton, J, Lopata, A, Talbot, J, Wood, C. Transfer of a human zygote. The Lancet 1973;7831:728–29;Google ScholarGoogle ScholarGoogle Scholar

For documentary evidence of visits made by other clinicians to Oldham to see Edwards and Steptoe, see Johnson, MH, Elder, K. The Oldham Notebooks: an analysis of the development of IVF 1969–1978. V. The role of Jean Purdy reassessed. Reproductive Biomedicine and Society Online 2015;1:45–57;Google ScholarGoogle ScholarGoogle ScholarGoogle Scholar

Bourn Hall, Cambridgeshire, was the clinic established by Edwards and Steptoe in autumn 1980, after they had completed their work at Oldham. An early conference on human conception in vitro was held there on 3–5 September 1981. The proceedings of the meeting, together with a list of attendees, were later published: Edwards, RG, Purdy, JM, eds. Human Conception In Vitro: Proceedings of the First Bourn Hall Meeting. London, 1982.Google Scholar

The Fourth Serono Clinical Colloquium on Reproduction, organised by Pier Giorgio Crosignani, occurred on 24–26 October 1982. It took place in Carmel, CA, USA. Days before this, in early October, the fifth FIGO congress on reproduction occurred in San Francisco, CA. Participant note: ‘In the USA as in Europe the stars of those congresses were predominantly the Australians’. For details, see Brown S. ESHRE: the first 21 years, www.eshre.eu/Home/About-us/History.aspx, accessed 8 February 2021, pp. 18–19. Proceedings of the Serono Colloquium in Carmel were published: Crosignani, P, Rubin, BL, eds. In Vitro Fertilization and Embryo Transfer: Proceedings of the Serono Clinical Colloquia on Reproduction, no. 4. London, 1983.Google Scholar

Participant note: ‘I did not attend Carmel as I was left to look after things at Bourn Hall. Evidently it was there that Patrick confronted Robert Winston and as I understand Winston apologised for what he’d said about IVF in the past, but Patrick wouldn’t accept his apology’.Google Scholar

After the births of Louise Brown and Alastair Montgomery in the UK (25 July 1978 and 14 January 1979, respectively), ‘firsts’ for other countries were Candice Reed (23 June 1980, Australia) and Elizabeth Carr (28 December 1981, USA). Lopata, A, Johnston, I, Hoult, I, Speirs, A. Pregnancy following intrauterine implantation of an embryo obtained by in vitro fertilization of a preovulatory oocyte. Fertility and Sterility 1980;33:117–120;Google ScholarGoogle ScholarGoogle Scholar

Participant note: ‘Alan Trounson was the senior embryologist with the Monash IVF group who between 1971 and 1976 was a research fellow at the ARC Institute of Animal Physiology in Cambridge, UK, where he worked on embryo freezing and embryo transfer in farm animals’. See Leeton, J. Test Tube Revolution: The Early History of IVF. Melbourne, Australia: Monash University Publishing, 2013.Google Scholar

Participant note: ‘referring to stimulation regimes and collection of eggs’.Google Scholar

For the actual sequence of pregnancies, see Chapter 3.Google Scholar

For the sequence of four pregnancies, see Steptoe, PC, Edwards, RG, Purdy, JM. Clinical aspects of pregnancies established with embryos grown in vitro. British Journal of Obstetrics and Gynaecology 1980;87:757–68; E&J.Google Scholar

Participant note: ‘I decided not to get involved as I had other priorities’.Google Scholar

Participant note: ‘Looking back at those early days in Oldham and knowing what we know now it’s pretty obvious that the lack of success then was largely due to poor egg quality. Patrick could collect eggs and Bob could achieve fertilisation in vitro providing the egg was of good quality but the problem was in getting good quality eggs on a regular basis. Although the sequence of events occurring in the natural cycle had been known for some time Bob had no way of monitoring these, we had no scans and Bob had no ready access to rapid assays such as they were in those days and had to rely on assaying total twenty-four-hour urinary oestrogens which is … time consuming. However even after doing these he had no idea when an egg would be mature and it was much later in the early days at Bourn when treatment was offered in the natural cycle, when we found that a mature follicle produces 80–120 micrograms/millilitre of oestrogen. The early work therefore was done in stimulated cycles using gonadotrophins the thinking behind it being that it would at least improve their chances of getting some mature eggs. However although gonadotrophins had been used since the 1950s they had been used in anovulatory women but now Bob and Patrick were using them in women who were ovulating so a problem arose as regards the dosage. The big breakthrough came in 1976 when HiGonavis, an immunochemical test which could detect rising levels of LH in urine, came on the scene which allowed the timing of egg collection to be more precise following which patients were treated in the natural cycle and pregnancies started coming through. Getting back to the question of secrecy surrounding the research, we had many visitors coming to Oldham mainly to observe laparoscopy but some of these wanted to know about the research and although a few were invited to see the set-up at Kershaw’s I can’t remember anyone actually being allowed to watch the oocyte recoveries or embryo replacements. Don’t forget Patrick and I were involved in running a busy obstetrical and gynaecological unit and the research was carried out at unsocial times, early in the morning and late at night so as not to interfere with the NHS work, so we didn’t have much time to talk to visitors. I know at times Patrick got downhearted about the lack of success and talked about packing it in and I’m sure Bob on occasions had similar feelings particularly with having to drive up and down from Cambridge. I think Martin Johnson summed it up best of all when we were on the Reunion programme on Radio 4 [‘The reunion’, broadcast on BBC Radio 4, 27 July 2003] when he said, ‘It was all done on a shoestring, in true British fashion!’Google Scholar

Participant note: ‘Serum LH’. Killip, M. A test for detection and determination of low levels of HCG and LH. New Zealand Journal of Medical Laboratory Technology 1974;28(2):49–50;Google ScholarGoogle Scholar

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A memory possibly relating to part of a celebration of the golden jubilee of the college.Google Scholar

William Blair-Bell played a major role in establishing the RCOG in 1929; Peel J. Bell, William Blair (1871–1936), gynaecologist. In Oxford Dictionary of National Biography, https://doi.org/10.1093/ref:odnb/58525, accessed 22 July 2022. The Blair-Bell Society met at various universities around the country. Early-career trainees and lecturers would present their work at Society meetings, and more senior academics and research-minded consultants would attend.Google Scholar

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Participant note: ‘in terms of analysing the results’.Google Scholar

The first fertilisations in the Oldham programme were in 1969; E&J.Google Scholar

A reproductive clinical facility.Google Scholar

For the first meeting of Edwards and Steptoe, see Chapter 2.Google Scholar

Steptoe’s interest in Sinha was owing to the latter’s research in the immunological causes of infertility, studying local immune response in the cervix of infertile women. Sinha was also doing research in materno-fetal immunology on the placenta, on trophoblast antigen etc, all of which was key to understanding the mystery of the failure of the embryo to implant.Google Scholar

Johnson, MH, Elder, K. The Oldham Notebooks: an analysis of the development of IVF 1969–1978. V. The role of Jean Purdy reassessed. Reproductive BioMedicine and Society Online 2015;1:46–57.Google Scholar

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Sir John Dewhurst, President of the RCOG and editor of Integrated Obstetrics and Gynaecology for Postgraduates. Oxford: Blackwell Scientific, 1976. Participant note: ‘Jack Dewhurst was prepared to allow the College to have a meeting on sexuality and differently-abled people’.Google Scholar

Gary D. Hodgen (1943–2005), Head of the Section of Endocrinology, Reproductive Research Branch, National Institutes of Health, USA, 1974; later Professor of Obstetrics and Gynaecology at Eastern Virginia Medical School.Google Scholar

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Participant note: ‘The arrangement to deliver Mrs Brown had been made with some secrecy and only the essential staff were there together with the film crew of the Central Government Office for Information. The theatre porters hadn’t been notified so Patrick and myself went to pick up Lesley Brown from the Maternity Unit and this involved walking along a corridor which led from the main hospital past the theatre suite down to maternity, it was a walk of around seventy yards or so. Before he came to Oldham Patrick had applied for a consultant post at St George’s, his old alma mater, and the fact that he failed to get the job really rankled him, it was the monkey on his back, and every so often he’d bring this up’.Google Scholar

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Azim Surani was an early graduate student of Edwards; Johnson, MH. Robert Edwards: the path to IVF. Reproductive BioMedicine Online 2011;2:245–62. He has been Marshall–Walton Professor at the Wellcome Trust/Cancer Research UK Gurdon Institute at the University of Cambridge since 1992 and Director of Germline and Epigenomics Research since 2013.Google Scholar

Professor Simon Fishel joined Bob Edwards in 1975 and then worked at Care Fertility, first based in Nottingham.Google Scholar