BABY MAKER IVF PIONEER LOOKS BACK
EARLY IN his career, Dr Simon Fishel asked his rabbi about working on Shabbat. His job was all encompassing, with no set hours. “I said there’s no way of controlling this. He replied: ‘Well if it becomes absolutely necessary, giving life is more important than almost anything in Judaism’.”
Giving life is one way of putting it. In 1980, aged 27, Fishel began working directly with Robert Edwards and Patrick Steptoe in their private clinic at Bourn Hall. Just two years earlier the pair had pioneered the birth of the world’s first IVF baby, Louise Brown. Despite this breakthrough, only two other IVF babies had been born since. It was frontier science and Fishel, a former head boy of King David in Liverpool, jumped at the chance to join a tiny team dedicated to making babies.
In a new memoir, he describes those early years when there was no way of stopping ovulation, so women came in for ten-day stints, and transfers could happen at any time, day or night. Extracting one egg could take 20 minutes; a far cry from today’s speedy procedure. Patients came from the world over; sheikhs, stars, and people who mortgaged their houses to pay for this then-experimental procedure. There were
24-hour shifts, with new discoveries almost daily.
“It was frenetic, it was full on, stretching our minds to the limit,” he recalls.
“It was almost in the scientific trenches. You knew outside the world was watching and waiting for you to trip up but it didn’t matter because inside we were learning something new every day, gaining ground, and slowly and steadily making more children.”
Forty years on, IVF is largely viewed without controversy, but back then opposition was ferocious, from politicians, academics and religious groups. Fishel and his colleagues received hate mail and were lambasted in the media, especially in the years when failure was more common than success.
“Some was quite vitriolic. I got one letter once saying ‘If God doesn’t get you I will’,” he recalls. But the criticism was “drowned in the welter of people asking for help.” His only fear was that the opponents would succeed in stopping the work.
Having mucked up his A Levels but keen to avoid becoming a tailor like his father, Fishel studied at night school before going onto Salford University to do biochemistry and physiology. There he had a lightbulb moment about his love of learning. On completing his PhD at Cambridge, where he focused on reproductive science in animals, he met Edwards. “He said, ‘I need a sidekick, will you join me?’” Against the advice of academics who warned him against playing God, Fishel did just that.
“People ask what drove you to get into this field —it didn’t exist, that’s what drove me,” says Dr Fishel. “Although everybody said this was work of the devil, I believed in it.” Having just become a father — now he has four children, and one grandchild — he understood the importance of children to a couple’s wellbeing.
“We had never thought for one minute when we were having our first that there would be a problem, as people don’t”.
More than that, however, was “the utter wonderment to think that what was previously hidden to understanding and what some still believe should be divine providence, is that we can put a sperm and egg together and see two cells divide that miraculously become 50 trillion cells and a baby nine months later”. He was in awe of the science.
“To be able not just to look at this not just in a laboratory or study it an ivory tower, but to do this to give couples the chance of family life, was something I couldn’t get enough of. It was miraculous.”
At the time he was fairly observant. Did he feel any spiritual component to his work? “What I felt at the time and still believe is we are extending the opportunity of medical science through the God-given gift of our intellect and what we can achieve,” he says. “But I felt it was incongruous to treat this as anything different to what was done in medicine to improve people’s lives. That’s what mattered.”
He has no problem with those who believe IVF has a divine influence “as long as it’s not used against those suffering from infertility”. In the book he recalls an early meeting with Lord Jakobovits, who had been asked to contribute to the Warnock Commission, an inquiry into human festilisation and embryology. The then Chief Rabbi expressed reservations but said he could see the scientists’ good intentions. “One of the things I love about Judaism is
that from the word go it was positive, it never had any doubts that what we were doing was a medical process,” says Fishel.
It took until 1990 for the law on IVF to change and the Human Fertilisation and Embryology Authority was set up to inspect and licence clinics offering IVF. “To go from the battle to the routine was a revelation. Even though it was tough, it was utterly intellectually and emotionally satisfying.”
By then, Fishel had formed his own clinic in Nottingham. In the early 1990s he established an academic unit at the University of Nottingham, going on to create the world’s first IVF degree — coined “the first degree course in making babies” — partly because he had seen so many people practicing IVF poorly and felt it needed to be taught properly. In 1997 he set up what has become the CARE Fertility Group, the UK’s leading fertility clinic group. He still lives in Nottingham. He writes that in regulated countries like Britain, IVF couldn’t be invented today, because the research approval process is slow and turgid, with authorisations for treatments often coming too late for those who need them most. There were more than 450 failed cycles in the lead up to Brown’s birth.
“You wouldn’t even get to 100 today before somebody would say this isn’t working and we can’t allow you to carry on,” he sighs. He rejects the suggestion that IVF is overused, when other fertility treatments might work instead. “That is pretty glib,” he says. “Nobody wants to put a couple through IVF unnecessarily — it’s about balance.” He points out that one of the great obstacles to success is a woman’s age. “How long do you keep investigating and trying other things?” he asks. “After several years of NHS testing, she might be 38 and the biggest barrier now is her age rather than the fact that she had another condition that could’ve been treated effectively by
IVF.” He also points out that IVF itself can be diagnostic.
“The other problem is people tend to say they’ve achieved success when a woman has a baby, and that’s naturally what you’d think but not every couple wants just one child. If it’s taken them until 38 it’s going to be a lot harder to have number two.”
A self-described libertarian, he is relaxed about more controversial advances in genetic screening and embryo selection, unless an “obvious calamity” would be caused.
“For 40 years all I’ve heard is IVF is a slippery slope, IVF is going to create havoc and I’m yet to see it,” he says. “With huge numbers worldwide, I have only ever seen positivity. The armageddon the detractors have spoken about just hasn’t happened. It’s just people having babies like other people have babies — sometimes it works out, sometimes it doesn’t, but it’s just like any other natural conception.
“I have a great problem in wondering who it is who says something shouldn’t be done. All along the line the regulator has said no and then eventually yes OK, and people have missed out along the way. To me, unless it’s a matter of national security I’m not sure your neighbour should be telling you how to procreate.”
Among those he helped bring into the world was Louise Brown’s sister Natalie, who later became the first IVF baby to give birth herself. There have been so many patients since —he stopped counting at 10,000 about 15 years ago — but he remains as passionate about the technology as he was in those toddler days.
He finds it enormously positive that infertility is far less of a taboo. “I love that there is much more openness,” he says. “One of the things IVF has done, whether people like it or not, is changed the way we look at family life. It’s a lifeline, and more than that it’s also a future, in the sense that it has allowed those that felt there would be no children to have generations that live on after them.”
While most medicine focuses on cure or pain relief, IVF does something more. “That’s what is wonderful things about this. We’re not just trying to help a couple. What we are also doing is creating the opportunity for family life to exist in the first place, and then
to continue.”
Breakthrough Babies is published this week by Practical Inspiration, £14.99