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BOOK REVIEW

A life of egalitarian principle and dogged determination

Published 23 August 2019

Our knowledge of Robert Edwards comes from a mix of anecdote, brief encounters, autobiographical snatches and occasional scholarly research. Now, his former student Roger Gosden has completed the first authorised biography of ESHRE's founder, reviewed here by Simon Brown, editor of Focus on Reproduction.

Hagiography is the occupational hazard of the authorised biographer, and this book, Let There Be Life, is indeed the authorised biography of Robert Edwards, IVF pioneer, hobby farmer, and joint-founder of ESHRE. Its author, Professor Roger Gosden, was a graduate student under Edwards's supervision in Cambridge, but, while such intimacy may open up the topsy-turvy world of the university's Marshall Laboratory, it also raises the risk 'of letting objectivity slacken' and 'sliding into sentiment from familiarity and fondness'.

Happily for the biographer of a man whose life must surely have been one of the richest and most influential of modern times, Gosden does not fall into that sentimental trap. For this is not a sanitised biography of selective omissions and soft platitudes, but one built on expert witness and hard work. By my count Gosden interviewed or sought information from more than 60 sources, many of them luminaries in their own right in the history of IVF. The book's declared aim, however, was not just another scholarly reference in that history (as evident in the painstaking research of Martin Johnson and Kay Elder(1,2)) but was rather the broad range of readers 'who want an accessible story' about IVF and those who made it possible. So this is a book where background is as much in the foreground as Edwards himself, and where the personal domestic life of its subject gently overlaps with the breathless frenzy of life in the lab.

Thus, Gosden's backstory to IVF does not lie simply with Edwards and his relentless experiments in oocyte maturation but rather begins with Rock, Pincus and Chang in the USA. Pincus, Gosden notes, kept rabbit embryos alive in culture fluid and 'even tried IVF', while by 1959 Chang had evidence of healthy rabbit pups born to surrogate mothers after transferring eggs fertilised in vitro. Thus, Gosden proposes, if Chang and Rock had been more interested in IVF than in contraception, 'the first human IVF baby might have been born earlier, and in America'.

These transatlantic reports, he adds, were inspiration to Edwards, and the cue for a relentless sequence of trial-and error experiments ('mostly error') which would culminate in 1969 with a report in Nature in which 'human oocytes have been matured and fertilised by spermatozoa in vitro'.(3) Yet this same paper would also raise a huge cloud of scepticism over IVF and the maverick Edwards, setting in the minds of 'the men in ivory towers' the precedent for a decade of scientific doubt and grant refusals. But as Gosden now concludes, this paper was indeed 'the first authentic account of human IVF . . . a turning point not lightly achieved or without personal cost'.

It would be another nine years of painstaking study before the birth of Louise Brown, whose embryo transfer and delivery are described in remarkably dramatic detail by Gosden. Each of these phases in Edwards's life is presented in relatively self-contained chapters, in which one episode appears a cue for the next. So it's tempting to conclude from the book's build-up to 1978 and Louise's birth that Edwards's professional life thereafter was largely taken up by the establishment of Bourn Hall, the private clinic which he and Steptoe would open near Cambridge, and his occupation with ESHRE and its journals, which would last from 1984 to 2000.

These ESHRE years are recalled in another self-contained chapter ('Spreading the good news') in which Gosden sees Edwards primarily as an instinctive, principled and determined editor. By the early 1990s, with the Brussels reports on ICSI exclusively published by Human Reproduction, Edwards 'had worked tirelessly to make it a leading title and a masterpiece for ESHRE'. Yet it was this same egalitarian principle and dogged determination as an editor which Gosden now sees as the wedge which would finally drive Edwards and ESHRE apart. Throughout most of the latter years of Edwards's editorship of Human Reproduction (and its two sister journals Update and Molecular) he had been irritated by the control over page planning (and profit) required by a commercial publisher. Edwards continued to favour self-publication, which would free him and ESHRE from the publisher's constraints. So when contract time with the publisher (Oxford University Press) came up again, Edwards stood firm and, as Gosden says, 'reached for the atom bomb'. It would be him or the tyranny of a commercial publisher. 'His doggedness scared the committee,' writes Gosden, 'for who could replace him?' It was indeed a painful time for many of ESHRE's senior members, many of whom - Paul Devroey, Klaus Diedrich, Arne Sunde, Basil Tarlatzis, André Van Steirteghem - had been alongside Edwards from the beginning. But heads would finally rule hearts, ESHRE would take a deep breath, and Human Reproduction would stay with a commercial publisher.

And so it was that in 2000 Edwards took his leave of ESHRE to grasp the nettle of self-publication, with the introduction of Reproductive Biomedicine Online, a journal which would hopefully harness the emerging potential of digital publishing and in which, says Gosden, he would be 'David against Goliath'. By then Bourn Hall too had exercised Edwards's commercial foresight, and the speed of change in the clinical model of IVF soon 'took the directors by surprise'. Moreover, three young embryologists recruited at the outset - notably Edwards's former students Simon Fishel and Jacques Cohen - quit in 1985. Cohen would move to the USA, but never severed his association with Edwards, supporting the foundation of RBMO after Edwards's split from ESHRE and taking over some editorial duties after his death in 2013.

The early death of Jean Purdy in 1985 also proved a serious setback for Edwards and Bourn Hall. Purdy, notes Gosden, was involved in the conception of more than 500 babies at Bourn Hall - as well as Louise Brown in Oldham (Steptoe's hospital) - and her death at the age of 39 was a heartfelt blow to Edwards and Steptoe. Just three years later Steptoe himself had passed away and it was not long before it was announced that Bourn Hall - dubbed 'heartbreak hall' by Gosden - had been bought by the drug company Ares-Serono, to be jointly managed by the Hallam Clinic. And when the Hallam Clinic itself closed, later to rise from the ashes as the London Women's Clinic, Bourn Hall was yet again put up for sale.

Yet before this dénouement Gosden reminds us that Edwards had predicted many of the developments in ART that we are only now beginning to accept - chromosomal studies of rabbit blastocysts as the precursor of PGT, embryonic stem cells as a forerunner of regenerative medicine - and even by 1984 Bourn Hall had seen delivery from its first frozen embryo transfer. So here too is the visionary, as well as the stubborn, determined scientist from whom ideas poured 'like newsprint off a press'. And a man too, we find, who was ever sensitive to the ethical questions raised by assisted reproduction.

Roger Gosden will be known to many ESHRE members for his landmark work in the restoration of fertility in sterilised sheep following ovarian tissue freezing and transplantation, and later with Sherman Silber for their reports of similar human success in a series of monozygotic twins of whom one had premature ovarian failure. More recently Gosden has described himself as a writer and blogger, and it's with not a little irony (or simply following a precedent?) that Let There Be Life is a self-published book from Gosden's own Jamestowne Bookworks venture. 'The loss of marketing muscle in an independent press,' the publisher writes, 'is compensated for by greater freedom for authors. Bob would understand, as he was a man who chose his own path.' The result is a most readable, enjoyable and informative book, which for many ESHRE members will give added meaning to their membership in reviving the determination and struggle it took to make reproductive medicine what it is in everyday life today.*

1. Johnson MH. Robert Edwards: the path to IVF. Reprod Biomed Online 2011; 23: 245-262,

2. Elder K, Johnson MH. The Oldham Notebooks: an analysis of the development of IVF 1969–1978. I. Introduction, materials and methods. Reprod Biomed Online 2015; 1: 3-6.

3. Edwards RG, Bavister BD, Steptoe PC. Early stages of fertilization in vitro of human oocytes matured in vitro. Nature 1969; 221: 632–635.

* One or two of those members may be a little disappointed to see ESHRE twice referred to in this book as the European Society for Human Reproduction and Embryology, and not of, a common error but one which is easily avoided.

*** Let There Be Life, by Roger Gosden, Jamestowne Bookworks, Williamsburg, Virginia, USA, available via Amazon.