Nobel Prize to Robert Edwards

Le résumé fourni par la source

For invention, characterization and application of in-vitro fertilization with the aim to treat infertility in the human …… at last! In-vitro fertilization (IVF) was first described in an animal model in the 1950′s. The British physiologist Robert Edwards has since then with out any comparison been a leading pioneer in this field of research and he understood at an early stage the potential to apply and utilize this technique in the human. Already in 1965 Edwards worked for 6 months at the John Hopkins University in Baltimore, USA, where the gynecologist and director Howard Jones Jr. provided him with numerous human oocytes derived from follicles punctured during various abdominal surgical procedures in women. A few of these oocytes became in fact fertilized. In 1968 Dr. Edwards, who was keen on continuing his work on human material, contacted the English gynecologist Patrick Steptoe. They agreed to collaborate and Steptoe provided eggs isolated from follicles (oocyte retrieval) by use of laparoscopy. This was a new, less invasive operative technique where Steptoe himself had made major developmental innovations. According to the agreement Edwards should fertilize the eggs in vitro and Steptoe should then transfer the embryo back to the uterus. Initially the patients were stimulated with ‘fertility medication’ to obtain more growing follicles and eggs in the same cycle. This approach resulted in only one ectopic pregnancy and Edwards and Steptoe decided to return to the natural cycle. The second patient in this series of non-stimulated cycles had one mature egg which was fertilized and grown in vitro for 3 days. When the embryo had reached the 8-cell stage it was replaced into the uterine cavity with an embryo transfer catheter developed by Edwards and Steptoe. Following an uneventful pregnancy a routine cesarean section was performed at Oldham hospital on the 26 of July 1978. The birth of the world's first ‘test-tube baby’ (Louise Brown) was a fact. This event also became the starting point for clinical application of IVF worldwide. Alan Trounson's group at Monash University in Melbourne, Australia, reported success in 1980 followed by Howard Jones' group in the USA in 1981. In the next year (1982) four countries (France, Germany, Austria, and Sweden) reported clinical success with deliveries of children. Milestones in the history of IVF beyond the first successful pregnancies are in summary these: use of gonadotrophins to increase the number of growing follicles (1981), transvaginal ultrasonography for oocyte retrieval (1983), gamete intra-Fallopian transfer (GIFT; 1984), pregnancy following cryopreservation (1984), pregnancy after human oocyte cryopreservation (1986), pregnancy after subzonal sperm insertion (SUZI; 1988), partial zona dissection (PZD; 1989), intra-cytoplasmic sperm injection (ICSI; 1992), clinical application of pre-implantation genetic diagnosis (PGD; 1992), re-introduction of single embryo transfer (1997), pregnancy after in-vitro maturation of oocytes prior to IVF (1998), clinical application of pre-implantation genetic screening (PGS; 1999). Recombinant gonadotrophins also became available for clinical use. Robert Edwards was at an early stage involved in genetic aspects and genetic diagnosis of embryos, both in animals and in the human. Another important closely related field where Robert Edwards was intimately involved is an early stage concerned embryonic stem cell research. Storage of frozen gametes, embryos and gonadal tissues was another important area of research where Edwards was one of the pioneers. The possibility to store frozen gametes and embryos has become very valuable for preserving fertility for various reasons and numerous new indications have appeared over the last years. It has been estimated that approximately 15% of all couples in the Western world today are either primary or secondary infertile or subfertile. Also in the developing world the demand for assisted reproduction techniques is rapidly increasing in response to earlier traumatic delivery or infections. Now approximately 4.3 million children have been born worldwide as a result of IVF, and in high-resource Western countries approximately 2–5% of all children are being born as a result of assisted reproduction. It has also been demonstrated in several international follow-up studies that the techniques are safe and no adverse effects have been shown in the offspring. The most important adverse effect demonstrated is the high incidence of multiple pregnancy related to the replacement of many embryos in the same cycle. This was initially not recommended by Robert Edwards, and the first ‘test-tube baby’ born in 1978 was a result of a single embryo transfer in a natural, non-stimulated cycle. Robert Edwards has in a very active manner participated in the ethical and legal debate within this field. In 2004, Edwards organized the first International Conference on Ethics, Science and Moral Philosophy of Assisted Human Reproduction. This conference series has continued thereafter under the guidance of Edwards. Numerous awards have been given to Robert Edwards to acknowledge his outstanding contribution in the field of assisted reproduction and for his unique ability to combine basic research with clinical applications. In 2001, Robert Edwards was given the prestigious Lasker award. Robert Edwards is also well known as author and editor of three major textbooks in reproductive medicine. He was a co-founder of the European Society of Human Reproduction and Embryology (ESHRE) in 1985, which now has more than 7,000 members and runs annual meetings on subjects related to assisted reproduction. Robert Edwards has been instrumental in starting four distinctive international journals in this field (Human Reproduction, Molecular Human Reproduction, Human Reproduction Update and Reproductive Medicine On-Line). Few examples can be found, where a scientist during his lifetime has been responsible both for the basic research and for clinical application of a technique that has gained worldwide recognition and universal use. Because of their fundamental impact on procreation Robert Edwards' achievements have been of the utmost importance for mankind. We congratulate!

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