Lord Robert Winston introduces Reproduction special issue on IVF



hello I'm Robert Winston emeritus professor of fertility studies at Imperial College London and is a huge privilege for me to introduce this special edition of reproduction the 40th anniversary of the birth of Louise Brown the first test-tube baby back in Oldham by Patrick Steptoe Andromeda was a great achievement an achievement which has contributed to the happiness of literally millions of people with the birth of babies all around the world but the history of the vitro fertilization goes a long way and the first account I can find is that of lazzaro spallanzani who around about 1780 noticed the male frogs in his pond climbed onto the backs of the females and then they then produced eggs and subsequently tadpoles and he wondered what the role of the male's was so he priced them off the back of the females fitted them with very tight-fitting taffeta white front shorts and then having waxed the inside of them put them back on the frogs and of course they produced eggs the females but they didn't fertilize so he did the proof of principle experiment he took the shorts off he took the seminal fluid from the inside of those shorts and then he inseminated the eggs and he got tadpoles the first IVF about 100 years later mammalian IVF by shrink in rabbits seemed to produce some cleaved eggs but it's very unclear exactly what happened there and in 1930 or there abouts Rock a mention of course in America managed to fertilize a large number of eggs perhaps as many as 150 160 of them but it's not clear whether they were generally fertilized or whether the cleavage they observed was either due to agglomeration of eggs or possibly of course part of the genetic cleavage but of course it is also important to note that there are one or two very great names in IVF well before the first human baby MC Chang stands out a Chinese emigres who went to Edinburgh and then on to Cambridge to his PhD and ended up at the Worcester foundation in Massachusetts he understood the capacitation of sperm he worked on the hormonal environment needed the implant and above all he did the first in vitro fertilization and a mammal that was in a rabbit and subsequently used for other species and got repeated in vitro fertilization which gradually led the way of course to that achievement in 1978 of the first life baby in a human but although this is a moment for great celebration it is also a moment for considerable reflection it was the truth is in 40 years the success rate of in vitro fertilization around the world is still very low in Britain the actual live birth rate per cycle of treatment is less than 20% in Australia it's about 18% and admittedly in America it's a bit higher it's about 26% per embryo transfer of course many people don't get to an embryo transfer but of course that high success rate is achieved by putting white back more than one embryo simultaneously in the uterus quite often resulting in a number of multiple births probably 30 percent of which of course many need special care and of course a great risk both of the baby and to some extent to the mother as well what is very clear is that we should be able to get much better than a one in five success rate per cycle and what we need of course is more research one of the problems of course is the market in in vitro fertilization which encourages young people young bright people to go understandably into the private sector rather than doing the sort of research which would improve IVF there must be ways of improving the hormonal environment so that we get less and euploid eggs the should be ways of improving male fertility so we don't need to use egg see all the time and of course above all we need to do research on implantation three key areas I think which need to be much better understood as well as understanding what makes a good embryo and being able to identify that before the table chance of actually doing the transfer of the embryo so at the moment one has to say that if we haven't improved the success rate at the 50th anniversary we ought to be extremely disappointed with ourselves this would not be a cause for great celebration but of course for really quite considerable regret we have to understand that our patients go through absolute misery to get pregnant they're desperate to get pregnant it costs them a massive emotional cost as well as financial cost and so many of them fail after opt treatment cycles this simply is not good enough and we need to understand to get back to the scientific basis for in vitro fertilization hence why I celebrate this wonderful opportunity in this edition of reproduction to point out that the scientific basis is so important let's reflect and let's see if we can do better in the next decade

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