PCGUIA 10/PC Guia 10.iso/database/body/cu169.txt

Text File | 1996-03-13 | 42KB | 905 lines

1.5
Steptoe's initial pioneering work was with laparoscopy, a
method for examining the abdomen. This led, in 1968, to his
collaboration with Robert Edwards on infertility problems.
Their work culminated in the first successful birth of a baby
from in vitro fertilisation (IVF). Edwards showed how
immature eggs could be ripened and then fertilised in a dish
by adding sperm. Steptoe's laparoscopy enabled eggs to be
collected from the ovary. The fertilised eggs seemed to
develop into normal embryos. But they found support for
their work hard to come by. There was resistance to work on
human embryos, and they were conscious of the ethical
problems. When they tried to replace the artificially
fertilised embryos in the mothers, they had only one success
between 1971 and 1975 and that was an ectopic pregnancy.
They then tried freezing eggs and embryos and modifying
the hormonal treatment of the mothers. Embryos were
replaced in mothers during their natural menstrual cycle.
Lesley Brown became pregnant with this procedure. The
birth of Louise Brown, the first "test-tube baby", in 1978 was
Steptoe's moment of glory. With Edwards, Steptoe established
a private clinic at Bourn Hall and, a few weeks before his
death, the 1000th baby conceived in vitro was born there.
Their techniques are now used worldwide
@
2.3
The new method of fertilization being pioneered at Oldham
General Hospital is another example of doctors' ingenuity in
helping childless women to become pregnant.

The method was first outlined last year  in the report of an
experiment in which human eggs were fertilized outside the
body.

The basis of the method is to remove an egg from an ovary,
fertilize it outside the body with the husband's sperm, and
replace it in the womb.  If the method proves viable it will
help to treat the form of infertility in which the Fallopian
tubes are blocked.  This is the commonest single cause of
infertility in women.

The method has been made possible by two advances
reported in Nature last year by R.G. Edwards and B.D.
Bavister, of the Physiological Laboratory at Cambridge
University, and P.C. Steptoe, of Oldham General Hospital.

One advance is the clinical technique for removing the egg
cells from the ovary by manipulations made through three
small slits in the abdomen wall.  This is an operation in which
Mr. Steptoe, senior consultant in obstetrics and gynaecology
at Oldham, is a leading expert.

The second advance is the technique for fertilizing human
eggs outside the body.  This was done some years ago for
other mammals such as the hamster but it has taken until
now to devise a reliable way of fertilizing human eggs.  The
trick is to find a mixture of chemicals that mimics the natural
body environment in which the sperm and egg cells mature
and become ready for fertilization.

The fertilized egg is replaced in the womb and there follows
the natural course of events, the first of which is
implantation in the wall of the uterus.

One of the possible hazards of the technique is that the test-
tube fertilization may not go exactly according to the rules
and an abnormal embryo may be created.  This is a natural
hazard but many of the many abnormal embryos that arise
naturally are screened out by some correcting mechanism.

The various animal experiments that have been conducted do
not really give any guide to the chances of an abnormal
embryo being created by the test-tube technique.  But these
must inevitably be slightly higher than with the normal
method.

The Oldham doctors have undoubtedly taken this possibility
into account and an obvious safety measure available to
them is to withdraw a few foetal cells during the third month
of pregnancy and test that the chromosomes are normal.

The fertility treatment at Oldham is unlikely to be successful
at the first attempt.  Several operations may be necessary for
the fertilized embryo to have a good chance of implantation
in the womb.  Not only must the egg be implanted at the
right stage in the menstrual cycle-and judging the right stage
is a matter of guess-work-but it will be subject, like any
other egg, to natural waste.

One estimate is that between a half and a third of all
fertilized eggs fail to implant in the uterus and many of those
that do so prove to be abnormal embryos that are quickly
weeded out.

In the Oldham operation it is planned to super-ovulate the
infertile patients with a dose of gonadotrophin hormones.
This will allow several eggs to be retrieved.

If the technique proves successful it will not only afford
treatment for the commonest kind of infertility but should
allow artificial insemination between couples where the
woman, not the man, is the infertile partner.  An egg
supplied by an anonymous donor could be fertilized by the
husband's sperm and implanted in his wife's uterus.

All the Oldham technique consists of is fertilizing human eggs
in a test tube instead of in the Fallopian tubes.  After that
they are reinserted in the uterus to implant in the usual way.

The technique has very little to do with what is commonly
meant by the "test-tube baby".  This term implies an embryo
that has grown to full term outside the body.  This will
remain a remote possibility until progress is made in growing
a placenta as well as the embryo outside the body.

Moreover, growing a test-tube baby, should that prove
possible, is a different proposition from grown numerous
replicas of the same individual out of his body cells.

Several American doctors are working on infertility and birth
difficulties.  One of the leading researchers is Dr. Warren
Zapol at the National Institute of Health in Bethesda,
Maryland.

He is, as he puts it, working "from the other end".  His
experiments are aimed at removing partially-formed
foetuses from women who have managed to conceive but
who are unlikely to be able to give birth.

The foetuses are then mechanically incubated, using artificial
placentas.  So far, in experiments with sheep, the foetuses
have all died after a few days because of infection.

Dr. Zapol said that the best thing about Dr. Steptoe's
experiment was that it made use of the mother's placenta.
"It's probably a lot more soundly based than the difficult
stuff we are doing here," he said.  It was far better to make
use of the mother's placenta.

Among the views on the experiment last night were:-  The
Royal College of Obstetricians and Gynaecologists said that
although there had been no official discussion they were
confident that it rested at the moment in the hands of ethical,
professional people who would be motivated to reflect the
human situation.  It was a development for the relief of a
particular kind of problem in an infertile couple.

The main concern was that it gave an opportunity for
scientists to do something outside the fundamental attitude
of reproduction in the relationship between a married couple.
It was emphasized that there would have to be some sort of
safeguard at some stage if it looked as if the experiment
might pass out of the hands of those dealing with the whole
problem.

On the possibility of an abnormal baby resulting-put by one
of the doctors concerned as extremely small-it was thought
that the development was so new that it was impossible to
say.  An infertile couple deeply concerned with the
possibility of having a child of their own, would obviously
accept risks greater than those acceptable to a normal couple.

Dr. Derek Stevenson, secretary of the British Medical
Association, said that like organ transplantation the
announcement carried with it difficult ethical problems that
called for careful thought by doctors and others.  The public
would need reassurance on a number of points.  The
association would be examining the implications for society
as a long-term measure.

The Church of England Information Office said the
development would need careful assessment on moral, social
and legal grounds.  Because it might be technically possible it
did not mean necessarily that it should be done.  Such
matters were usually considered by the church's board for
social responsibility, and a group from the board might be
asked to consider the matter and make recommendations.

Father John McDonald, formerly Professor of Moral Theology
at St. Edmund's Roman Catholic College, Ware, Hertfordshire,
said the marriage contract did not give marriage partners the
right to children, but the right to natural sexual intercourse
from which children might result.  Pope Pius XII had stated
the principle that the marital act, by nature's design,
consisted of a personal cooperation which the husband and
wife exchanged as a right.  Artificial insemination lacked the
personal, natural element that should be there.  Another
point on which Catholics would have further objections was
the way in which the husband's semen was obtained.

The Methodist Church said that, provided there were
adequate medical safeguards and that fresh developments
took place within the framework of marriage, it was hard to
find moral objections to what was being planned.

Dr. Douglas Bevis, of Sheffield Jessop hospital, who with his
colleague Dr. Earle Wilson has been doing "test-tube" baby
research for 18 months, said the publicity would give false
hope to thousands of childless couples.

It was wrong to claim that the medical profession was ready
to produce "test-tube" babies at will because of major
difficulties yet to be overcome.

A great obstacle to be surmounted was the way to prepare
the mother's womb artificially to receive the fertilized egg.

Mr. St. John-Stevas, Conservative M.P. for Chelmsford, who
raised in the House the question of "test-tube" babies when
news of the possibility was made public a year ago, and who
opposed the Abortion Bill, said he thought the proposed
operation would be legitimate in cases where the woman's
own egg was used, fertilized by her husband's sperm and
where it was impossible for her to have a baby without the
operation.  This was equivalent to artificial insemination by
the husband.
@
2.4
A Lancashire woman, aged 34, has agreed to attempt a new
method for overcoming infertility.  On the B.B.C. television
programme Horizon last night, she was seen interviewed by
the consultant gynaecologist who proposed the treatment.

The procedure would involve taking an egg from her ovary
by a simple operation.  This would be fertilized in a dish in
the laboratory by sperm, from her husband.  After a period
not yet determined the fertilized embryo would be
transplanted back into the woman's uterus to grow into a
baby.

Treatment for infertility was needed because of an
obstruction of the fallopian tubes which normally should
convey an ovum for fertilization to the uterus.  In a test last
November the specialist removed an egg from the woman's
ovary and successfully fertilized it in a test tube.

The doctor concerned made it clear in a B.B.C. radio interview
last night that there was more work to be done before a
transplantation could be attempted.  But he said he had
about 30 patients who were prepared to try this method of
overcoming infertility.

The work hinges on research first reported from Cambridge
last February where a team completed the first experiment
in fertilizing a human egg in a test tube.  Previous work had
been done with other animals.  It took 10 years between the
first fertilizing the egg of a rabbit in a test tube and the first
human experiment.

The difficulty has been in producing conditions in a test tube
containing biological fluid that are identical to the conditions
in the reproductive organs of a woman.

The specialist said that possible risks in producing an
abnormal baby by this procedure had to be determined
before going ahead.  However, he thought it would be
completed within the year and he was very optimistic about
the outcome.

Although not mentioned by name, the method referred to in
the programme hinges on work reported in Nature last year.
It is being carried out at Cambridge by Dr. R. G. Edwards, Dr.
B. D. Bavister and Dr. P. C. Steptoe.  Dr. Steptoe is a senior
consultant in gynaecology and obstetrics at Oldham hospital.

During the radio programme, Dr. Kit Pedlar head of a
scientific research unit at London University, spoke of the
dangers of "mass-produced people" and "biological
engineering".

If this technique were freely available, "then you have a
means...of mass-producing people without the advent of a
mother at all.  If you extend this experiment a little bit, it is a
question of biological engineering.  A general might order
100,000 troops to be produced.  This can only be stopped by
the public making some sort of objection."

Dr. Steptoe said he did not have any moral qualms but "we
do need help from public opinion".
@
2.5
MAN'S CONTROL of his own patterns of reproduction moved
a step nearer last week when Mr Patrick Steptoe revealed
plans, in collaboration with Dr Robert Edwards of Cambridge,
to implant a test-tube fertilsed embryo in the womb of a
Lancashire housewife.

When he was still developing techniques for fertilising
female eggs in the laboratory, Dr Edwards would often return
to his Cambridge research unit in the dead of night, scale the
high wall and return to his work bench just to see if his
treasured cultures were still alive.  His conscientiousness has
been more than a useful asset during his almost continuous
fight to get financial backing for his work and academic
recognition from his colleagues.

During the early 1960s he was forced to relinquish his post
with the Medical Research Council, Mill Hill, because money
for his line of research began to dry up.  His fortunes
changed by 1965 when he joined the physiological laboratory
at Cambridge University with a Ford Foundation grant.  His
first goal-fertilisation of female eggs in the test tube-though
simple in concept proved infinitely complex to achieve.

Vital clues to Edwards' dilemma came from the American
reproductive physiologist, Dr M. C. Chang, one of the co-
discoverers of the pill, who successfully fertilised hamster
eggs and later rabbits and pigs.  But Edwards' programme
was inhibited by one drawback; he could not obtain a steady
supply of female eggs.  As he explained in an interview a
year ago, "When I asked various gynaecologists if they could
let us have excised ovaries and explained what we wanted to
do they thought I was barmy.  Their eyes glazed over-you
know the sort of reaction."

His problem was solved when he made contact with Mr
Patrick Steptoe, senior consultant in obstetrics and
gynaecology, at Oldham.  Ovaries or pieces of ovaries
removed during essential medical operations at Steptoe's unit
were regularly rushed from Oldham to Edwards's laboratory
in Downing Street, Cambridge.  In their recent statements
neither of the collaborators have stated whether women are
informed that their removed ovaries are used in research.

Steptoe's work aroused bitterness among sections of the
scientific community. Dr J. F. Watkins of Oxford wrote to the
Times.  "The programme should provide an awful warning to
scientists who are tempted, for whatever reason, to come into
the market-place of public relations men, mass media,
fashion photographers and pop stars, with the result that
they are exhibited as curiosities in a rare-show."

Dr Watkins argument reflects a fairly common scientific
view.  Scientists should be allowed to get on in private with
their limited experiments and they should only become
public when the new techniques can be successfully put into
practice.  Dr Edwards himself has taken the view that
"doctors should not be asked or expected to answer all the
issues that arise from their work-that's up to society."

This is a view which is increasingly under scrutiny.  Society
has to live with the results of science, however applied: no
atomic physicist needs telling that.  The fertilisation of a
human egg outside the body and its successful implantation
in the womb is more than just a treatment for certain kinds
of infertility.  From it will-within the decade-follow a whole
series of developments which raise awkward ethical and
practical problems.

When, for example, it becomes possible to fertilise a human
egg in the test tube and to implant it successfully in the
womb of the woman from which it came, it will be almost as
easy to implant it in the womb of a different woman-to have
a baby by proxy.

This, too, can be regarded as a boon to women suffering from
certain kinds of infertility, for they might be able to find a
friend or relation willing to bear a child for them.  But how
would the proxy mother feel about parting with a baby
which every biological instinct would tell her was her own?
If she wanted to keep it would the genetic mother have any
legal rights?  Once the idea of babies by proxy became
acceptable for medical reasons how long would it be before
the rich started to pay others to have their children for them,
in order to continue their careers, preserve their looks, or
simply because they found pregnancy a bore?  Would this be
a useful service or would it be as degrading as prostitution?

Probably it will soon be possible to examine a test-tube
embryo before implantation for abnormalities in the
chromosomes of the kind that lead to mongolism or to
individuals of ambiguous sex.  Again, at first sight this looks
like an unmixed blessing.  Who would not avail themselves of
the opportunity of ensuring that their child did not suffer
from one of these conditions if they could?  But how would it
affect attitudes to the abnormal children that would continue
to be born anyway?  Could it lead to their being regarded not
as unfortunate biological accidents but as administrative
errors, for which someone was to blame?

It is already possible to remove a rabbit embryo soon after
fertilisation, determine its sex, and replace it.  It will not be
long before the same thing becomes possible with human
embryos.  The sexing procedure often damages the embryo,
so one suggestion for applying it to humans is to make the
embryo divide into two-into incipient twins-and sacrifice one
to determine the sex of the other.  That too would then be
discarded if it was not of the right sex.  The embryos would
be only microscopic bundles of cells, but how many people
would regard the whole procedure as morally repugnant?

There are compelling medical reasons for the sex
determination of children in some cases.  It might be used,
for example, virtually to eliminate certain hereditary
diseases like haemophilia.  But once it was available for
medical reasons it would be difficult to resist pressure to
make it generally available.  A recent survey in the United
States indicated that if parents were free to chose the sex of
their children in advance the ratio would be 55 boys to 45
girls.  No government would be likely to allow this, for there
would be a danger of upsetting the sex balance of the whole
population.

These developments are disturbing enough, let alone the
more instant prospect of embryos nurtured outside the body
from conception to "decanting" as Aldous Huxley called it
(animal embryos have already been grown in the test tube to
the stage where their hearts begin to beat), or the production
of exact genetic copies of individuals (already possible with
frogs).  The options are open.  Which ones do we want to take
up?

Like abortion, birth control clinics for the unmarried,
euthanasia, it is a subject inextricably bound up with people's
moral attitudes which ought to be argued out in public.  The
danger of looking at each new development in a limited
medical context is that the necessary debate will never take
place.  Step by apparently beneficial step we may arrive in a
place where we do not really want to be.

This is why it is disturbing that if the B B C Horizon
programme had not learned of the experiments, the first
babies conceived in the test tube would probably have been
born without anyone apart from those directly concerned
being any the wiser.  This shows how little communication
there is between those engaged on this kind of research and
the rest of the community and how easy it is for people to be
presented with faits accompli.

Of course there is no medico-scientific conspiracy afoot.  It is
normal scientific practice to keep quiet about experiments in
progress, and scientists who speculate about the future and
the social implications of their work invite sneers and
disapproval from the rest of the scientific community.

But Dr Edwards may care to ponder as he grows his human
embryos that opposite his laboratory is the Cavendish where
Rutherford, in 1934, said that the splitting the atom would
have no practical applications.
@
3.1
The world's first test-tube baby, a girl, was born by caesarian
section just before midnight at Oldham and District General
Hospital, Greater Manchester.  She weighed 5lb 12oz.

Mr Patrick Steptoe, the consultant gynaecologist who has
pioneered test-tube baby research and who is in charge of
the case, said: "All examinations showed that the baby is
quite normal.  The mother's condition after delivery was also
excellent."

The mother, Mrs Lesley Brown, aged 29, from Bristol, was
"enjoying a well earned sleep".

The embryo was implanted in Mrs Brown's womb after being
fertilized in Mr Steptoe's laboratories last November.  He
used sperm from her husband, a railway van driver, aged 38,
who has a son from a previous marriage.

By that technique Mr Steptoe was able to by-pass Mrs
Brown's blocked fallopian tubes.

The child's financial future was assured after newspaper
rights to articles and photographs were sold by Dutch auction
to Associated Newspapers, publishers of the Daily Mail and
London Evening News.  They are believed to have paid more
than ú300,000.

More than 5,000 couples have sought help for infertility
since the work of Mr Steptoe and Dr Robert Edwards, his
partner, was first reported.
@
3.2
The personalities of Mr Patrick Steptoe and Dr Robert
Edwards, the consultant gynaecologist and the Cambridge
research physiologist involved in the test-tube birth at
Oldham on Tuesday night, are indicated in the way they
perfected the method of in vitro fertilization (conception
outside the body) against all enormous odds.  In all
probability most other people would have found them
insurmountable.

Their fields of study do not figure on the Medical Research
Council's and the Department of Health and Social Security's
priority list for the allocation of their overstretched
resources.

In fact, Dr Edwards was obliged to leave the Medical
Research Council's laboratories at Mill Hill in the early 1960s
because no money was available to continue his line of
research.  He was able to return to Cambridge as a research
fellow in 1965 with a grant from the Ford Foundation.

While he was starting his studies into the fertilization of
female eggs in the laboratory, Mr Steptoe was developing
some brilliant surgical techniques for helping infertile
patients.  But again it was a matter of stretching meagre
resources.

The two men differ markedly.  Mr Steptoe is the more
flamboyant.  Dr Edwards attempts to shun publicity, yet he
has a sensitivity to public interest in his work, which seems
to have come partly from his experience as a local councillor.

Mr Steptoe has been a popular lecturer to young doctors on
the benefits of treating infertility, and Dr Edwards has
spoken many times at scientific conferences on the
implications of research in reproductive biology, implications
that give rise to many anxieties.

He also made an important contribution to the book, Our
Future Inheritance: Chance or Choice, prepared by the British
Association for the Advancement of Science.

The book is one of the best guides published on the scientific,
social, ethical and legal implications of recent advances in
genetics and biology.  Its chapter on artificial insemination
explains clearly for the layman the procedures adopted by
Mr Steptoe and Dr Edwards at an early stage of their work.

They met through the British Fertility Society, of which Mr
Steptoe is president.  Their cooperation began when Dr
Edwards wanted to extend work on fertilization of mice and
hamster eggs in vitro to human ova.

Research in the United States, particularly that opened by Dr
M. C. Chang, an eminent reproductive physiologist, and one of
the co-discoverers of the contraceptive pill, who had also
successfully fertilized several different animals, indicated a
line of attack.

But the work at Cambridge was limited because Dr Edwards
could not obtain a steady supply of human ova.  Hence the
mutual interest of the clinician and scientist.  The eggs were
supplied from ovaries removed during essential operations at
Oldham.  They were taken to the laboratory in Downing
College, Cambridge, implanted in rabbits as carriers.

Before collaborating with Mr Steptoe 10 years ago Dr
Edwards had sought the help of other gynaecologists.  He said
some years ago: "When I asked various gynaecologists if they
could let us have ovaries and explained what we wanted to
do they thought I was barmy."

An indication of the dedication of Dr Edwards to his research
is revealed in an account of the late 1960s at Cambridge.
While he was still developing techniques for fertilizing eggs,
which showed an immense sensitivity to alterations in the
temperature of the incubators and to the composition of the
nutrients of the fluid in which they bathed, Dr Edwards
would return to his research unit at Cambridge in the small
hours, scaling a high wall to get to his bench to see if his
valuable cultures were thriving.

Mr Steptoe emphasizes the relief of personal distress of the
women who can be treated for infertility.  Dr Edwards
extends that by explaining the role that the technique can
play in sex determination of children in specific cases.

There are about 20,000 women in Britain with the sort of
blockage that might be circumvented by the new treatment.
What neither man can say is how the procedure can be
guaranteed to be used only for such patients, and not as
another step toward Aldous Huxley's Brave New World.
Government film made of delivery of  The birth of the
Browns' test-tube baby was recorded on film by the
Government's Central Office of Information.  It intends to sell
the film for use on television.

The Government said yesterday that the film was made as a
record of an historic medical event and to assist in the
evaluation of the baby's behaviour at birth.  It was made
with the agreement of the parents, Mr Steptoe and the
hospital authorities, and the Central Office of Information
expects it to be a "best seller".

There was apparently some dispute over the film with
Associated Newspapers, which had bought the syndication
rights to the story of the birth.  The Department of Health
and Social Security said last night: "Ministers have decided
that they cannot accept the agreement with Associated
Newspapers made last night in so far as it relates to
restrictions on the release of the film made by the Central
Office of Information.

Sir John Dewhurst, President of the Royal College of
Obstetricians and Gynaecologists, said the birth carried hope
for certain childless women, but he doubted whether the
technique would ever be easy.

Dr Anne MacLaren, director of the Medical Research Council's
mammalian development unit, said there was no evidence
that children born by the technique would run a risk of
greater deformity than children born normally.

Our Medical Correspondent writes: The birth of this baby is
the culmination of more than ten years' research by Mr
Steptoe and Dr Edwards; but while it offers some hope to
infertile couples the technique is unlikely to be used widely.
It does, however, open up the prospect of surrogate
motherhood in which a "foster-mother" could take over the
burden of pregnancy.

A test-tube baby differs from a normal conception in that the
fertilization of the ovum by the sperm takes place in a
laboratory instead of inside the mother.  Once fertilization
has occurred and the ovum begins the process of cell division
it is returned to the mother's body and grows inside the
uterus.

This method benefits only some infertile couples.  Though
one marriage in every 10 is involuntarily childless, the cause
is as likely to be in the man as in the woman.

The technique developed by Mr Steptoe and Dr Edwards
provides an alternative for women in whom surgery has
failed.  The woman is given a short course of treatment with
hormones to cause several ova to mature at the same time.
A laparascope, a narrow tube like a telescope, is then passed
into her abdomen and the ova are removed.  They are mixed
with spermatozoa from the man in a culture fluid.

One ovum or more is likely to be fertilized, and after a few
days it will have become a small ball of dividing cells, a
blastocyst.  This very early embryo can then be placed inside
the uterus so that implantation can occur.

The procedure sounds simple but in practice there have been
repeated failures.  Human ova were cultured successfully as
long ago as 1965, but since then progress has been slow.
Either the ova have stopped dividing after a few hours, or
they have failed to "take" when replaced in the uterus.  Two
years ago Mr Steptoe reported a successful pregnancy, but
the blastocyst became implanted in the lower end of the tube
instead of the uterus and the pregnancy miscarried.

A similar technique of laboratory fertilization has been used
in veterinary medicine for many years.

But veterinary experience also shows that the fertilized
ovum need not be returned to the female from which it was
taken; it can be implanted with equal chances of success in
another.  In theory, therefore, the Steptoe-Edwards
technique could be used to take ova from one woman and to
return the fertilized cell to someone else.  Doctors' hope is to
reverse sterilization  The successful birth of the test-tube
baby girl in Oldham and District General Hospital on Tuesday
night has created a new dimension in the whole medical
approach to fertility.

Dr Robert Edwards, the Cambridge scientist who collaborated
with Mr Patrick Steptoe, the Oldham gynaecologist, in work
that resulted in the birth to Mrs Lesley Brown, of Bristol,
disclosed yesterday that both men envisaged developing
their techniques with aims including the reversal of
sterilization.

Dr Edwards told a press conference at Prestwich Hospital,
Greater Manchester:  "This work may be developed in other
respects.  It may include the reversal of sterilization.  I do
not know if there is a chance of reversal, but it is certainly in
the forefront of our minds."

Earlier, Mr Steptoe said that their work may be applied to
other fertility matters, for instance to men who produce too
few spermatozoa.

The birth of the Browns' daughter, Mr Steptoe said, was
completed by Ceasarian section because the mother was
suffering from toxaemia, a condition that could cause still-
birth.  The baby was perfectly all right, he said, adding: "It
came out crying its head off.  It is a beautiful baby."

The two specialists said that after the egg removed from Mrs
Brown had been fertilized it was kept in an incubator for two
and half to three days before reimplantation.

Our Religious Affairs Correspondent writes: None of the main
churches has any official policy on in vitro fertilization, but
there was a general welcome yesterday from church
spokesmen for the first successful test-tube birth.  Only the
Roman Catholic Church appeared to be in two minds.

Cardinal Gordon Gray, Archbishop of St Andrews and
Edinburgh, said: "I have grave misgivings about the methods
and the possible implications and consequences for the
future.  However, it would be rash of me to be categorical
about the morality of a new technology."

Mgr Augustine Harris, auxiliary to the Roman Catholic
Archbishop of Liverpool and president of the English and
Welsh Bishops' social welfare commission, said: "A pro-life
expression of love is to be commended and supported."  In
this case, he added, "science can support the loving and
natural ambition of the couple to produce new life".

Mgr Harris's welcome was typical of comment in other
churches.

Mr Giles Ecclestone, secretary of the Board for Social
Responsibility of the General Synod of the Church of England,
said: "As an advance in meeting the problem of childlessness,
facing some married couples, I welcome the development in
the techniques which have now resulted in the birth of a
baby.  It is the latest of many steps by which man has taken
responsibility for shaping the conditions of his life."

He added, however, that the community faced the matter of
priorities in using scarce health resources, particularly in
view of the pressing needs of the very old or the mentally
handicapped.

"In a world setting it may well appear as simply another
example of the unjust distribution of resources between rich
and poor countries", he said.
@
3.3
Research on human embryos should not be made a criminal
offence and should be permitted beyond the fourteenth day
of development, the test-tube baby pioneers, Dr Robert
Edwards and Mr Patrick Steptoe, said yesterday.

Outlawing such research, as recommended in the Warnock
report on in vitro fertilization, is "a clumsy and inflexible
instrument of control", according to the ethical committee at
the Bourn Hall Clinic in Cambridgeshire, where Dr Edwards
and Mr Steptoe are directors.

However, the two men support most of the Warnock
recommendations.  They also agree substantially with the
views of the clinic's ethical committee, which has submitted
its views on Warnock to Mr Norman Fowler, Secretary of
State for Social Services.

Dr Edwards and Mr Steptoe said that they were worried that
making some types of embryo research illegal would inhibit
development of techniques and treatments of benefit to
mothers and children.

In one potentially controversial area, they suggested that
human embryos might be placed briefly within such animals
as sheep or rabbits in order to learn more about their
development.  But they insisted that they had no intention of
performing such work.

The two men, who delivered the world's first test-tube baby,
Louise Brown, in 1978, said that they resisted the argument
that all human embryos were entitled to protection.

"There are some embryos whose only potential is to form a
cancer that will threaten the life of the mother".

Mr Steptoe said: "Such embryos can form the most malignant
tissue that ever occurs in the human species."

They also opposed the recommended 14-day limit on embryo
research.  "To produce a criminal law which makes research
legal and worthwhile at a minute to midnight, and illegal at a
minute past is clearly wrong", Dr Edwards said.

Mr Steptoe added that a 14-day limit was arbitrary, as some
embryos developed more slowly than others.

The clinic's ethical committee said: "The requirement under
the law to dispose of all embryos in vitro punctually at the
end of day 14 seems to be impractical and self-defeating."

In the committee's view, shared by Mr Steptoe and Dr
Edwards, it would be preferable to place the legal limit at, or
close to the point at which the neural development of the
foetus might make it sentient, that is, between day 18 and
day 30.

Dr Edwards said: "Our whole emphasis is to give the husband
and wife their own child - their own normal child.  Science is
being attacked unfairly, because science is neutral."

More than 300 babies have been born as a result of
treatment of patients at Bourn Hall.
@
3.4
Mr Patrick Steptoe, CBE, FRS, the obstetrician and
gynaecologist who, together with the biologist Dr Robert
Edwards, pioneered the first in vitro ('test-tube') fertilization
procedure, died on March 21.  He was 74.

His work aroused much controversy among those concerned
with ethics.  What is undeniable, however, is that it also
brought children and immeasurable joy to many whose lives
would otherwise have remained barren.

Steptoe and Edwards saw their many years of painstaking
and often tedious labours bear fruit on July 25, 1978, with
the birth of Louise Brown, the world's first 'test-tube' baby.
Steptoe himself delivered the child by Caesarean section.

Patrick Christopher Steptoe was born on June 9, 1913, in the
small Oxfordshire town of Witney, one of eight children.  He
was educated at the local grammar school, and in 1939
qualified from St George's Hospital Medical School.

He immediately joined the RNVR as a surgeon-lieutenant and
served throughout the war, being captured by the Italians in
1941 and released in 1943 after the downfall of Mussolini.
From then until 1946 he was seconded to the Admiralty.

Following demobilization, he returned to St George's to study
obstetrics, and in 1949 was appointed to a senior post in the
discipline at the Oldham group of hospitals.  It was there that
he became interested in ovarian disorders and learnt how to
carry out laparoscopy, greatly helped by a visit in Paris to Dr
Raoul Palmer, who had developed the technique.

Steptoe brought an instrument back to Oldham and the town
soon became an important centre for laparoscopic training.
The investigation enables the viewer to inspect the
abdominal cavity through a small incision at the umbilicus.
The laparoscope is then introduced, the cavity inflated with
an insert gas, and hairline optical fibres are threaded through
the instrument to illuminate the contents of the ovary and
the pelvis generally.

In the 1960s, paradoxically, the chief used was to assess the
suppression of ovulation after contraceptive therapy and to
control the dose of fertility drugs used to bring about
ovulation.  Steptoe wrote a book on laparoscopy in 1967, and
it is of interest that in it there is no mention of removing
eggs for in vitro fertilization.

A year later came the turning point when Steptoe met
Edwards at a meeting of the British Fertility Society at the
Royal Society of Medicine in London.  They formed an almost
instant mutual trust.  There and then they decided to embark
upon joint research which led ten years later to the
achievement at Oldham which reverberated throughout the
world.

A centre for human reproduction was set up at Oldham and
Steptoe provided the eggs, which were collected by Edwards
and his assistant, Jean Purdy, who travelled to Oldham by
road from Cambridge - and who covered over a quarter-of-a-
million miles on these missions.

It was an emotional time, their hopes and fears being shared
by many infertile women who, supported by their husbands,
had volunteered to participate in this vital research.

In vitro fertilization was not achieved without many
problems.  The advance was painfully slow, often by trial and
error, and it eventually emerged that it was important to
implant the fertilized eggs by night.

Though fertilization by a husband's sperm was easy, after
three or four days when the developing embryos were ready
for implanting,  it was found that these microscopic babies
did not survive, a spontaneous abortion being the usual
sequence.

Using a computer, Steptoe and Edwards solved the problem
by finding that the pattern of steroids circulating in a
woman's body during her monthly reproductive cycle was a
finely-attuned body mechanism and that the technique of
super-ovulation (which they had been using) to obtain eggs
was too coarse a method.  Instead, they discovered, using a
Japanese urine hormone test, that it was possible to gauge
the time of natural ovulation, and this was the basis of the
new series of attempts beginning in November, 1977.

The following year, an eight-cell embryo was implanted into
the uterus of a patient from Bristol, and at the end of nine
months a perfect baby (Louise Brown) was produced.  Here
at last was success on the technical side; but Steptoe and
Edwards ran straight into moral and ethical problems which
they had foreseen as early as 1968, for it was then that they
first asked for ethical guidance on their work.

These ethical considerations were hotly debated during the
discussion of Enoch Powell's Bill in 1984.  At this time it was
pointed out that, if the Bill went through, an infertile couple
would have to obtain political consent to procreate, for the
Bill required that all embryos fertilized in vitro should be
replaced.  Yet this was medically unacceptable, because some
embryos are abnormal and may even be cancerous.

Steptoe had always been concerned with the relief of
personal distress, and through his death the nation has lost a
great benefactor to infertile women.

He chaired the British Fertility Society at its inception in
1973, and in 1983 founded the Centre for the Study of
Human Reproduction at Bourn Hall, near Cambridge, so that
he could continue his work after his retirement from the
National Health Service.

Despite his final illness Patrick Steptoe continued to see
patients.  He was yesterday due to have been presented with
his CBE by the Queen at Buckingham Palace, and later this
year he was due also to have received the British Medical
Association's gold medal.

His wife, Sheena, whom he married in 1943, survives him
with their son and daughter.