October 04, 2010

Nobel season '10: Physiology or Medicine prize for in vitro fertilization

The Nobel committe at the Karolinska Institute has awarded Robert G. Edwards this year's Nobel Prize in Medicine or Physiology "for the development of in vitro fertilization".

You can't argue against the 4 million people that have been born thanks to in vitro fertilization. That if anything is of "greatest benefit on mankind", as Alfred Nobel put it in his will. So it would seem as though this year's Nobel prize in physiology or medicine premiates a technical development rather than basic biological discoveries, but as usual there is a very strong basic science core. Many important discoveries were made by Robert Edwards on the way to producing the first IVF baby and the knowledge that was gained on the way would add something to our fundamental understanding of how a living organism originates and develops.

Starting with significant findings in the reproductive cycle of mice, including the maturation and activation of oocytes (egg cells) and sperm cells, Edwards was able to take this knowledge into the study of human fertilization, discovering the differences in oocyte maturation between humans and other mammals and perhaps most importantly finding the importance of gonadotropins in this process. This gave us new knowledge in the timing of oocyte maturation, the early development of the embryo as well as the conditions that are necessary for fertilization to happen in the first place.

In addition, the technical achievements and the theoretical basis behind IVF also contributed to the development of the techniques we use today for basic genetic research in animal models as well as basic and applied research in embryonic stem cells. Two very widespread but also controversial research fields.

Here's a summary from the advanced information published on the Nobel website:

The 2010 Nobel Prize in Physiology or Medicine is awarded to Dr. Robert G. Edwards for the development of human in vitro fertilization (IVF), a medical advance that represents a paradigm shift in the treatment of many types of infertility. The inability to conceive a child is a reproductive defect that afflicts more than 10% of all couples worldwide. During the 1950s, Edwards came to realize the potential of IVF as a treatment for this medical condition. What inspired him to take on this challenge was his research on how hormones control critical ovarian functions in mice, such as oocyte maturation and ovulation. By a brilliant combination of basic and applied medical research, Edwards overcame one technical hurdle after another in his persistance to discover a method that would help to alleviate infertility. He was the first to show that human oocytes could undergo in vitro maturation, as well as fertilization in vitro. He was also the first to show that in vitro fertilized human oocytes could give rise to early stage embryos and blastocysts. All of Edwards’ accomplishments came together at 11.47 PM, on July 25 1978 with the birth of Louise Joy Brown, the worlds’ first child conceived through IVF. Dr. Robert G. Edwards’ research has completely transformed the field of reproductive medicine and today close to 4 million babies have been born thanks to the discovery of human IVF.

You could argue that the actual achievement of human IVF in itself did not advance our understanding of basic phenomena in biology. But you can't ignore that it was the result of arduous basic research, by Edwards himself, that set the stage for the whole field of reproductive physiology. The Nobel committee is very clear in that this is part of their motivation when you read the press release and the accompanying documentation. Unfortunately the researchers that headed the achievement of IVF in laboratory animals before Edwards, Gregory Pincus and Min Chueh Chang, are dead and cannot share in the prize. Pincus died in 1967 and Chang died in 1991.

Patrick Steptoe, the pioneer of laparoscopy that collaborated with Edwards in the development of the IVF procedure and started the world's first IVF clinic together with him is also diseased. Steptoe died in 1988.

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