Allan Templeton: How 25 years of IVF treatment changed our lives

From a talk by the infertility specialist at the Science Media Centre in London

This week, Louise Brown, the first test-tube baby, will be 25 years old. In all the publicity and hype, it will be easy to forget what her conception and birth must have meant to her infertile parents. I can still just about remember what it was like in the infertility clinic before IVF came along. For male problems, still a taboo area, donor insemination was the only viable option. For tubal disease it was surgery, usually carried out more in desperation than hope. Generally the message was - sorry, can't help, we will try to support you through this, have you thought of adoption?

But by the early Eighties, IVF as we now know it, was established in clinical practice. Initially the results were not that good, but gradually things got better, and by the time intracytoplasmic sperm injection came along in the early Nineties, most causes of infertility could now be treated using the same basic technique. All because in 1978, Patrick Steptoe and Bob Edwards finally cracked the problem of human in vitro fertilisation and demonstrated that their technique could result in a normal liveborn baby.

So life in the clinic became easier. At long last we had a viable option that could be discussed with patients. But there have been downsides. From the beginning IVF has been dogged with controversy. It has never really been accepted as an effective treatment which should be provided by a caring NHS. Thus clinical practice has evolved to a great extent in the private sector. Even in the beginning Steptoe and Edwards had huge difficulty persuading funding bodies to support their research. Because IVF developed outside the NHS, there was little fiscal control. On occasion this may have been too much of a temptation for some colleagues and might have distracted others from best practice.

There have been other problems. There have been too many multiple pregnancies. Many still believe that in order to maintain success rates it is necessary to replace numerous embryos, and some clinics even now have difficulty accepting the two-embryo limit. This is in spite of clear medical evidence that this is the right way to go, as well as knowledge of the risks associated with twin and particularly triplet pregnancy. In 2002 three London clinics were reported to have produced more than 10 sets of triplets each.

But these are the few downsides, which should not detract from 25 years of achievement and success in reproductive medicine and fertility treatment. Many have contributed and we have all benefited.