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For women, the most common reason for infertility is a blockage or abnormality of the fallopian tubes. These thin, flexible structures, which convey the egg from the ovaries to the uterus, are where fertilization normally occurs. If they are blocked or damaged or frozen in place by scar tissue, the egg will be unable to complete its journey. To examine the tubes, a doctor uses X rays or a telescope-like instrument called a laparoscope, which is inserted directly into the pelvic area through a small, abdominal incision. Delicate microsurgery, and, more recently, laser surgery, sometimes can repair the damage successfully. According to Beverly Freeman, executive director of Resolve, a national infertility-counseling organization, microsurgery can restore fertility in 70% of women with minor scarring around their tubes. But for those whose tubes are completely blocked, the chance of success ranges from 20% to zero. These women are the usual candidates for in-vitro fertilization.
Much has been learned about the technique since the pioneering days of Steptoe and Edwards. When the two Englishmen first started out, they assumed that the entire process must be carried out at breakneck speed: harvesting the egg the minute it is ripe and immediately adding the sperm. This was quite a challenge, given that the collaborators spent most of their time 155 miles apart, with Edwards teaching physiology at Cambridge and Steptoe practicing obstetrics in the northwestern mill town of Oldham. Sometimes, when one of Steptoe's patients was about to ovulate, the doctor would have to summon his partner by phone. Edwards would then jump into his car and charge down the old country roads to Oldham. Once there, the two would remove the egg and mate it with sperm without wasting a moment; by the time Lesley Brown became their patient, they could perform the procedure in two minutes flat. They believed that speed was the important factor in the conception of Louise Brown.
As it happens, they were wrong. Says Gynecologist Howard Jones, who, together with his wife, Endocrinologist Georgeanna Seegar Jones, founded the first American in-vitro program at Norfolk in 1978: "It turns out that if you get the sperm to the egg quickly, most often you inhibit the process." According to Jones, the pioneers of IVF made so many wrong assumptions that "the birth of Louise Brown now seems like a fortunate coincidence."
Essential to in-vitro fertilization, of course, is retrieval of the one egg normally produced in the ovaries each month. Today in-vitro clinics help nature along by administering such drugs as Clomid and Pergonal, which can result in the development of more than one egg at a time. By using hormonal stimulants, Howard Jones "harvests" an average of 5.8 eggs per patient; it is possible to obtain as many as 17. "I felt like a pumpkin ready to burst," recalls Loretto Leyland, 33, of Melbourne, who produced eleven eggs at an Australian clinic, one of which became her daughter Zoe.