Before Louise: the history of infertility.

Abstract

With gender equality and the ‘modern family’, the pace for advances in artificial reproductive technology is fast-moving. Louise Brown was the world's first ‘test tube baby’, born in 1978 (Steptoe & Edwards. Lancet 1978;2:366) (Figure 1). However, infertility and reproductive medicine have featured heavily in ancient mythology of many cultures, reflecting their long-standing value in human society. The Hippocratic Corpus from the 5th and 4th centuries BCE include three chapters on gynaecology and infertility, where infertility had become a medicalised concept and treatment options were proposed. Coxe's translation lists five causes of infertility: ‘the os uteri wrongly situated and firmly closed; the lubricity of the uterus preventing the retention of the seed; ulceration of the body of the uterus consequent to other diseases; retention of the menses; and too great laxity of the orifice of the uterus, precluding the retention of the seed’. Remedies for these afflictions included instrumentation of the stenosed cervical os, a multitude of pessaries containing herbal remedies, fumigation techniques, and specific instructions regarding the timing and method of intercourse (Coxe. The Writings of Hippocrates and Galen, Lindsay & Blakiston, Philadelphia, 306–7). There is also mention of ‘somatic’ or systemic causes, including what we now know as obesity (Flemming. Bull Hist Med 2013;87:565–90). The medicalisation of infertility improved understanding of anatomy and the advent of microscopy drove significant advancements during the 17th century. In 1672, Regnier de Graaf described the ovarian follicles now named after him, at the time believed to be the embryo that migrated to the uterus (Ankum et al. Hum Reprod Update 1996;2:365–9). Spermatozoa was first described in 1677 by microbiologist Anthoni van Leeuwenhoek, who hesitantly inspected his own semen. He wrote to the Royal Society of London stating, ‘If your Lordship should consider that these observations may disgust or scandalise the learned, I earnestly beg your Lordship to regard them as private and to publish or destroy them, as your Lordship sees fit’ (Philos Trans R Soc 1678;12:1040–3). William Smellie wrote on the concept of fertilisation in 1752, outlining the process of ovulation, transit of the ovum through the fallopian tube, and describing semen as ‘abounding with animalcula, that swim about in it like so many tadpoles’ (Smellie. A treatise on the theory and practice of midwifery, Balliere Tindall, London, 1974 reprint; 113–4). Spallanzani pioneered artificial insemination in 1784, achieving pregnancy in dogs, while Dr John Hunter performed the first successful artificial insemination in a human in 1790 for a man with hypospadias (Guttmacher. Ann NY Acad Sci 1962;97:623–31). Contrast this gradual development in reproductive medicine since Hippocrates with the 40 years since Louise Brown's birthday in 1978. The advances in reproductive technology – sperm and egg donors, intracytoplasmic sperm injection, frozen intravenous fertilisation cycles, surrogacy, gamete intrafallopian transfer and preimplantation genetic diagnosis – are remarkable. Improved take-home-baby rates, fewer multiple pregnancies, lower rates of ovarian hyperstimulation syndrome, and time-lapse embryology have followed. This rate of advancement likely reflects our societal drive to develop these technologies, with corresponding improvement in outcomes as described in this issue. The next 40 years are likely to be exciting. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.