Medicine: The Baby Maker

About 15% of all women who want to bear children fail to conceive, many of them because of defects in their fallopian tubes. In England last week there was a flurry of optimism about a successful treatment for some of these would-be mothers. A respected, pioneering obstetrician-gynecologist reported that in three cases a ripe egg cell had been removed from a wife and fertilized in a laboratory by sperm from her husband; then the resulting conceptus had been implanted in the wife's womb and she had given birth to a normal child. The three babies thus conceived are now from twelve to 18 months old. But optimism faded fast with the news that the doctor had failed in 30 other attempts to duplicate his successes, and was giving up the work.

What first disturbed medical scientists was the way in which this possibly historic development was announced. Dr. Douglas C.A. Bevis, 55, of the University of Leeds was about to address the British Medical Association on "Embryo Implants." But before he did so, he handed out a press release reporting the three lab-assisted pregnancies, which he did not mention in his formal paper. He refused to admit that he had made the implants himself, although it seemed evident that he had, or had directed them. He did say that he knew one baby "is well and developing normally as far as I can tell."

Bevis had long been preparing for implantations. Early in 1972 he said he was looking for the right patient. "When I find her, I am in a position to go ahead, but we cannot guarantee that this will be a success the first time." The reason for his doubt was that no one knows precisely what physiological mechanisms prepare the uterus to receive the conceptus and retain it.

Normally a woman of childbearing age ovulates once every lunar month, an average of 14 days before the expected onset of menstruation. Her ovaries then expel one or more egg cells, ripe for fertilization. An individual egg (ovum) is drawn into the fallopian tube (oviduct) to begin a four-day journey toward the uterus. After intercourse, the husband's spermatozoa swim upstream through the uterus into the fallopian tubes, and if one sperm succeeds in penetrating an ovum, conception has occurred. The conceptus, repeatedly doubling the number of its cells, enters the uterus and imbeds itself in the lining for the remainder of the nine months' gestation.

Common causes of infertility are blockage or surgical removal of the oviducts so that the egg cannot meet the sperm. Bevis and several other investigators on both sides of the Atlantic reasoned that this roadblock might be bypassed if: 1) ripe ova were removed through a small surgical incision in the abdomen, 2) one was fertilized by the husband's sperm (obtained by masturbation), 3) the conceptus was kept alive and subdividing in glassware for a few days, and finally 4) it was implanted in the wife's uterus. Bevis succeeded in keeping the conceptus alive in what he calls "a complicated cocktail of nutrients and antibiotics," with as many as 40 ingredients.