It has been 46 years since the first in vitro fertilisation (IVF) birth, marking a transformative period in reproductive medicine.
Although the duo widely acknowledged as being the fathers of IVF are British obstetrician and gynaecologist Dr Edward Steptoe, and British physiologist Emeritus Professor Sir Robert Edwards, there were many others involved in developing and refining this life-changing technique.
Among them is Monash University Emeritus Prof Dr Alan Trounson, who was in Kuala Lumpur in May (2024).
The Australian embryologist’s pioneering work includes the development of two key reproductive techniques: the freezing of human embryos and the use of fertility drugs to help control ovulation in women.
In fact, Emeritus Prof Trounson was part of the Monash team that reported the first ever successful IVF pregnancy in 1973.
The embryo, however, miscarried soon after being transferred to their mother’s uterus.
A chance suggestion
Similar to Emeritus Prof Edwards who studied both agriculture and zoology in university, Emeritus Prof Trounson’s journey began far from the laboratories of human reproductive science.
He shares: “I was mostly interested in being a farmer when I was a young man.
“But then I ended up doing wool technology.”
He initially pursued a degree in agricultural science, followed by a Masters of Science in wool and pastoral sciences.
However, his academic path took a pivotal turn when his PhD supervisor, Prof Dr Neil Moore, was approached by obstetrician and gynaecologist Prof Dr Carl Wood in the late 1960s.
Prof Wood, who founded Monash’s Department of Obstetrics and Gynaecology, had been attempting to create artificial fallopian tubes from plastic, but this approach was unsuccessful.
“They were trying to figure out how to make a plastic tube to replace the blocked fallopian tube in women, and it wasn’t working,” says Emeritus Prof Trounson.
Prof Moore suggested exploring IVF, a technique that had already been successfully demonstrated in mice and rabbits, and was being studied in sheep at that time.
This led to the successful fertilisation of the human ovum (egg) reported in 1973.
Despite this success, and an invitation by Prof Wood to join the IVF research team, Emeritus Prof Trounson opted instead to take up a Dalgety Postdoctoral Fellowship at the Agricultural Research Centre Institute of Animal Physiology and Biochemistry in the University of Cambridge, United Kingdom.
At what was considered the world’s leading centre for animal reproductive biotechnology at the time, Emeritus Prof Trounson continued his work in animal reproductive technologies, including developing animal embryo freezing and egg maturation.
The right drugs
A few years later, Prof Wood secured a grant from the Ford Foundation and invited him to rejoin his team in Monash to continue working on human IVF.
This time, Emeritus Prof Trounson accepted the offer, motivated partly by his wife’s desire to return to Australia.
“I thought I would just work for a few years developing human IVF, and then go back to my animal interests.”
However, fate had other plans.
Back at Monash, he applied his extensive knowledge of animal embryology to human reproduction to develop embryo freezing and egg donation methods.
He worked alongside gynaecologist Dr John Leeton, and together, they developed new protocols for fertility drugs and optimising fertilisation techniques.
The fertility drug protocol was key in allowing IVF to become a practical clinical treatment, as these drugs allowed the control of ovum maturation in female patients, thus facilitating the collection of their eggs for IVF.
Their efforts resulted in a series of successful pregnancies, marking a major milestone in the field of IVF.
“By the 1980s, we suddenly produced a lot of pregnancies, with about 14 pregnancies in a row.
“That was a lot then, and there were only two or three pregnancies before that.
“We changed a lot of the things to fit what was needed in humans, and it worked,” says Emeritus Prof Trounson.
However, as a new reproductive technique, IVF faced a lot of opposition.
He notes that a rather unlikely alliance between the Roman Catholic Church and radical feminists formed a powerful front against the procedure.
“We were accused of being murderers as they believed IVF manipulated women’s bodies,” he says.
“The Roman Catholic Church in particular, was very negative about it.
“In Australia, they really had a lot of influence in the political levels.
“They made a lot of regulations and laws to slow us down, because they thought we were going too quickly.”
Thus, the researchers found their progress frequently hindered by resistance from government authorities and various bureaucratic delays.
Freeze for later
One of the main objections of the Roman Catholic Church to IVF was how the procedure’s creation of multiple embryos raised ethical concerns of treating the embryos as commodities rather than valued human beings.
The ability to obtain multiple eggs from a prospective mother resulted in the creation of multiple embryos.
The transfer of multiple embryos to the mother’s uterus helped to increase the chances of a successful pregnancy, especially in the early days of IVF when the chances of success were more uncertain.
Older mothers too, stood a better chance of getting pregnant with the transfer of multiple embryos as egg quality decreases with age, which in turn affects an embryo’s ability to implant in the uterus.
However, the chances that not all of the embryos created would be used were quite high, resulting in the objections from the Roman Catholic Church.
Emeritus Prof Trounson’s proposal to explore embryo freezing provided a solution to this problem.
He shares that although it was challenging getting approval from the Queen Victoria Hospital Ethics Committee in Melbourne where he was working, the unexpected support from two priests on the committee helped pave the way for his research to go ahead.
“There were always priests on the ethics committee, so that was challenging.
“But when I was asked to do embryo freezing, two priests supported me, because I suggested, rather than discard the embryos, we could freeze and keep them for the patients,” he shares.
The first successful pregnancy using a frozen embryo was reported in the journal Nature in October 1983 by Emeritus Prof Trounson and his colleague Dr Linda Mohr.
However, the pregnancy ended at six months due to a serious infection of the amniotic sac and uterus (i.e. amnionitis).
Instead, the first successful live birth from frozen embryos were twin girls born in the Netherlands in December 1983.
A sense of pride
Now, aged 78, Emeritus Prof Trounson looks back at the development of IVF with a mix of pride and acknowledgement of past challenges.
He notes the initial excitement over achieving a pregnancy rate of 20%, despite the primitive techniques and materials used at the time.
“We were very happy in the beginning when we had a pregnancy rate of 20%,” he recalls.
This approach, although groundbreaking, still faced significant criticism due to its low success rate.
“Eighty percent of the patients didn’t get a pregnancy every time they were treated.
“So that was considered a failure, and failure of the technology.”
Despite the criticisms and the limitations, he notes that that the scientists and doctors who believed in IVF did not give up.
“We, and all the rest of the world, persisted.”
He adds: “Criticism and observation is something that always helps us succeed in science.
“Criticism is as good as success – it just opens the question about whether we could do it better.
“Things have changed dramatically in the way we do things, and it will continue to change in the future.”
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