Nobel Prize for Robert Edwards: the controversies behind IVF

Although in vitro fertilization has brought joy to many families, the Nobel Prize for its co-developer is also a reminder of the bioethical questions raised by IVF technology.

The Nobel medicine prize committee acknowledged the role of British biologist Robert Edwards in developing in vitro fertilization, handing him on Monday the prestigious award for bringing "joy to infertile people all over the world."

Although IVF has indeed brought joy to many people, the Nobel Prize is also a reminder of the controversial arc of the technology, which has been used since the 1970s.

What began as fervent protests by the Vatican against IVF – the church sees it as a sin, partly because it takes place outside conjugation – has evolved into a more complex debate as the procedure has become commonplace. These days, supermarket tabloids herald the latest in a growing string of celebrity IVF babies.

Now, the 30-plus-year history of fertilizing human eggs in a "test tube" (actually a petri dish) can help inform debate about emerging technologies such as cloning, longevity advancements, artificial life-forms, and even "designer babies."

"The ramifications of Edwards's breakthrough have really only begun to be felt, because the race for biomedical enhancement will be in the 21st century what the space race was in the previous century," says Patrick Tucker, senior editor of The Futurist magazine in Bethesda, Md. "I don't think we'll get to the point of permanently changing the human genome, but we will be manipulating ourselves at a genetic level ... and IVF allows us to do that."

Yet Dr. Edwards' mission – and defense of IVF – was defined by the deepest of human desires. "The most important thing in life is having a child," he once said.

Between 2 and 3 percent of newborns in many developed countries are now IVF babies. And about 4 million individuals have born so far been through IVF, according to the Nobel committee. The birth of the first "test-tube baby," Louise Brown, was in 1978.

"Many of them are now adult and some have already become parents," the committee said in a press release. "His contributions represent a milestone in the development of modern medicine."

One key lesson from 32 years of commercial IVF is that many fears about the technology – that IVF kids would be seen as Frankenstein monsters or that IVF would lead to more overpopulation – were largely unfounded.

"What Louise Brown meant was, you held her up, all her parts were there, and she smiled, and that ended the ethics criticism," says Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia. "The Nobel Prize is for the work Edwards did helping the infertile, but [he could also have] unleashed the most controversial technology I can think of, which is, should we use it to design our offspring?"

According to some critics, IVF kids were perhaps seen as too normal, with society's overall acceptance of the technology speeding the way for research into gene-altering therapies.

At the same time, the prospect of scientists helping to create human life in a lab has raised vexing ethical issues. The foremost question – very real for many IVF parents – is about what happens to fertilized, but unused, embryos.

One unintended consequence of IVF includes an explosion in multiple births – as a result of parents choosing to implant multiple embryos to raise the likelihood of success for an expensive procedure.

Edwards, who developed IVF technology with the late Patrick Steptoe, fought back against critics in the Vatican and naysayers in the British government's science funding arm, which chose not to finance the research because of concerns about global overpopulation. Foreseeing many of the social implications of the work, Edwards founded an ethics committee at the Bourn Hall Clinic in Cambridge, England.

IVF research has also not received federal subsidies in the United States. This has spawned a lucrative private industry for IVF, but at the same time it has meant that many basic questions about the reasons for infertility – which could improve IVF outcomes – are still unknown.

"It has been an incredibly controversial research from the beginning. Despite the incredible promises it offers, it's also raised significant bioethical issues that divide many people in society," says Nita Farahany, a philosophy professor at Vanderbilt University in Nashville, Tenn., and a member of the Presidential Commission for the Study of Bioethical Issues. IVF "could raise issues that may be relevant to the work of the commission," she adds. [Editor's note: The last sentence and quote in this paragraph were revised to better reflect Ms. Farahany's overall comments.]

Edwards's Nobel is a nod to a clinical achievement with an appreciable and personal impact on the families of IVF babies. But what such babies will look like in the future may also help define Edwards's ultimate legacy.

Says Mr. Caplan of the University of Pennsylvania: "If you hold up a baby that was begun in a dish and designed through genetic engineering, which is taller, smarter, and healthier than its parents, will people still smile?"