Human Reproduction Vol.21, No.7 pp. 1645–1650, 2006 doi:10.1093/humrep/del067 Advance Access publication April 10, 2006. OPINION A.R.T. and history, 1678–1978 Gary N.Clarke Andrology Unit, The Royal Women’s Hospital, Carlton, Victoria, Australia To whom correspondence should be addressed at: Andrology Unit, The Royal Women’s Hospital, Carlton, Victoria 3053, Australia. E-mail: [email protected] Louise Brown, the first baby conceived after IVF, was born on 25 July 1978 and turned 27 last year. From one perspective, her birth can be seen as the culmination of 300 years of medical and scientific investigation aimed at understanding the fascinating process of reproduction. This essay was written as a tribute to mark the unique contribution to assisted reproductive technology (ART) which resulted from the collaboration of a scientist, Bob Edwards, and a clinician, Patrick Steptoe, who pioneered the successful clinical use of IVF. This article was not intended to be a conventional history of science, but instead has primarily focused on those early discoveries which in the author’s opinion were critical to our current understanding of mammalian reproduction. There are some digressions and many omissions necessitated by attempting to cover 300 years in a relatively short essay. In particular, there is no mention of endocrinology because this area has been covered in numerous reviews and books. The main sources of historical information for this article were the authoritative books of Professor Cole (1930), Dr Elizabeth Gasking (1967), Professor John Farley (1982), Dr Fielding H. Garrison (1929) and the Philosophical Transactions of The Royal Society or Letters collated from the latter. Introduction The process of reproduction has long fascinated mankind, particularly from philosophical and scientific perspectives. For example, Aristotle devoted a considerable amount of his time to study the process of reproduction, and William Harvey (1578–1657) performed exacting trials on the King’s herd of deer and wrote a major treatise on the subject (‘De generatione animalium’, 1651) which contains in the frontispiece a drawing of Jove releasing a plethora of creatures from an egg on which is inscribed his famous dictum: Ex ovo omnia The meaning of Harvey’s dictum was expressed poetically by his friend Martin Lluelyn: That both the hen and housewife are so matcht, That her son born, is only her son hatcht, That when her teeming hopes have prosp’rous been, Yet to conceive, is but to lay within. Harvey’s work is often regarded by historians of science as defining the boundary between the early era which relied heavily on folklore, superstition and casual observation, and the recent period during which experimentation and more exacting observations of nature became the modus operandi for many scientists and natural philosophers. However, although it was obvious to most people that many creatures were hatched from eggs and that the male was essential for sexual reproduction, the discovery and experimental study of spermatozoa and mammalian oocytes required a new scientific instrument, albeit initially a very crude one. One of the first microscopists was Antonj van Leeuwenhoek (1632–1723) who, amongst his many other discoveries, was the first to conduct rigorous observations on human spermatozoa. The discovery of spermatozoa and the doctrine of preformation They are formed of a transparent substance, their movements are very brisk and their shape is similar to that of frogs before their limbs are formed. This discovery, which was made in Holland for the first time, seems very important, and should give employment to those interested in the generation of animals. This is an extract from a letter written by Christiaan Huygens in 1678 and published in Paris in the Journal des Savants (see Gasking, 1967). It was the first published description of spermatozoa following van Leeuwenhoek’s original observations of the microscopic tadpole-like creatures in human semen which were known at the time as ‘animalcules’ or ‘spermatick worms’. Antonj van Leeuwenhoek had previously conveyed his observations in a letter to the Royal Society in 1677, which was eventually published in the Philosophical Transactions in 1679 (Leeuwenhoek, 1941). The Fellows were very interested in the ‘living creatures’ in semen and consequently the Secretary wrote back to van Leeuwenhoek with a request that he examine the semen of other species. There was a subsequent dispute over priority with Nicolas Hartsoeker, who had also reported his observations on rooster semen later in 1678, subsequently claiming that he had first discovered the animalcules © The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: [email protected] 1645 G.N.Clarke (see Gasking, 1967). There is strong circumstantial evidence, though, that both Huygens and Hartsoeker had seen Leeuwenhoek’s letter prior to publishing their own letters (Cole, 1930). However, it was Johan Ham, a medical student at Leiden whose observations on spermatozoa apparently antedated those of both van Leeuwenhoek and Hartsoeker, but although van Leeuwenhoek referred to Ham in his letter to The Royal Society, the young student never published his own observations (Figures 1 and 2). The discovery of the vast numbers of motile creatures in semen stimulated a lot of debate as to their origin and function because at the time it was far from obvious that they might be the agents of conception. Many scientists were convinced that they must be parasites; some speculated that they were essential for conception, whilst others thought that they were a normal component of semen, but that they performed a secondary role such as mixing the other seminal components. The arguments about the role of spermatozoa may be somewhat astonishing Figure 1. Microscope made by van Leeuwenhoek in 1673. when viewed retrospectively, but it is important to remember that the discovery of the mammalian oocyte was not reported until 1827 by Carl Ernst von Baer and that Edouard van Beneden first observed fertilization in mammals in 1875. Consequently, many scientists up until around 1850 continued to regard spermatozoa as parasites (the name spermatozoa was first used by von Baer in 1827 and obviously reflects this view). Thus, in 1835 the anatomist Richard Owen classified spermatozoa as parasites and relegated them to the Entozoa (order Prothelmintha). Subsequently, the investigations of the Swiss scientist, Albert von Kolliker (1841) were pivotal in demonstrating that spermatozoa were not parasites, but motile autologous cells which developed from testicular cells by the process of histogenesis. In his words, sperm were: organized parts of the seminal fluid, elementary parts analogous to the blood corpuscles Even though the exact role of the spermatozoa in generation was a controversial topic which was vigorously debated for many years, their discovery did open a new front in the ongoing philosophical/scientific debate over preformation (the doctrine that the complete, preformed embryo was present in the generative organs of either the male or the female parent), which was often coupled with emboitement (the doctrine that the complete minature organism has always been encapsulated within its own parent, analogous to the Russian Babushka dolls which are made progressively smaller so they fit one inside the other). The ovists argued that the preformed germ or embryo came from the female, whilst their protagonists asserted that it came from the seminal contribution. On the basis of his recent discovery of spermatozoa or animalcules as they were then known, in 1683 van Leeuwenhoek proposed the animalculist version of the preformation theory which contended that the spermatozoa contributed the essential germ to be nurtured by the female. Although fascinating historically, particularly from a philosophical standpoint (see Wilson, 1995; for in-depth discussion), from our current perspective, this was a pointless debate, so we can shortly return to some of the crucial experimental work which ultimately clarified the role of spermatozoa and oocytes in the process of generation or fecundation. Before doing so, it is worth digressing to discuss the often quoted and misquoted homunculus story. The homonculus According to Cole (1930), the first author to publish a representation of a preformed fetus in the sperm head was Hartsoeker (1694) in his Essay de Dioptrique. However, Hartsoeker did not pretend that he had actually seen the homunculus, in the text he stated: if we could see the little animal through the skin which hides it we might possibly see it as it is represented in the illustration Figure 2. Van Leeuwenhoek’s drawings of spermatozoa. 1646 The homunculus gained credibility with the report by Dalenpatius (1699), wherein he stated explicitly that he had observed a minute human form inside the sperm head. Unusually, his letter was published simultaneously in Amsterdam, London and Edinburgh, which Cole (1930) considered was indicative of it A.R.T. and history, 1678–1978 being ‘an organized and serious attempt to deceive the public’. The real identity of Dalenpatius was eventually revealed by Jean Astruc in 1740 in his book on venereal diseases. Astruc had been a friend of a man by the name of Plantade who was ‘given to jesting’ and had composed the letter in order to amuse himself, and that the assumed name was an anagram of Plantadeius which was the latinized form of his real name (see Cole, 1930). Unfortunately, many bona fide natural philosophers believed his report of the homunculus, which was then discussed seriously in various publications. Thus the homunculus acquired a degree of currency in the literature before the hoax was eventually uncovered. In 1749 George-Louis de Buffon referred to Dalenpatius observations as: repugnant to the repeated experience and observation of all those who have hitherto made enquiries into this subject. It is quite possible that Plantade was satirizing the beliefs held by some of the preformationists in the animalculist school in an attempt to ridicule and discredit them (Cole, 1930). Whatever his intentions, however, once unleashed the homunculus had various reincarnations over the next 150 years. Thus, as late as 1750, possibly as another hoax, Gautier d’Agoty reported and figured a mal-proportioned fetus in human semen (see Cole, 1930) (Figure 3). Figure 3. A Dutch draper with a passion for the microscopic study of nature, van Leeuwenhoek made around 247 microscopes with which he made many exciting discoveries which he communicated to The Royal Society in some 375 letters during his long life. He was elected a Fellow of The Royal Society (FRS) in 1680. He also sent 27 letters to the French Academy of Sciences. He was the first to describe spermatozoa, the striped appearance of voluntary muscle, the structure of the crystalline lens, and he also observed the capillaries linking the veins and arteries, thus completing what Harvey had started. The portrait shown and the biographical information above were derived from Garrison (1929). (Visit Brian Ford’s website www.sciences. demon.co.uk/∼bjford.htm for a wealth of information on Leeuwenhoek, his original specimens sent to The Royal Society and the performance of his simple microscopes.) Elucidation of the role of spermatozoa in fertilization The Italian scientist Lazaro Spallanzani (1729–1799) was a very good experimentalist who turned his attention to semen in the 1770s. He examined semen from mammals, fish and amphibians and confirmed the presence of spermatozoa. In experiments with frogs, he was able to show that oocytes would only develop into tadpoles after contact with semen, possibly the first example of IVF. He also successfully artificially inseminated a spaniel bitch of which he wrote: The success of this experiment gave me more pleasure than I have ever felt in any of my other scientific researches. In subsequent experiments, Spallanzani found that the fertilizing ability of semen was destroyed by dessication or heat or by mixing it with certain amounts of vinegar, salt or spirits. He also observed that filtration of semen could remove the fertilizing capacity, but that if the material collected onto the filter was immediately redissolved in water, then fertilization could occur. Unfortunately, because of the prevailing dogma of ovist preformation, the results of Spallanzani’s elegant experiments were misinterpreted both by himself and by the wider scientific community (see Gasking, 1967). In essence, because Spallanzani believed that spermatozoa were parasites, he assumed that some other component of the seminal fluid which had also been retained on the filters must be the fecundating agent. In the early part of the nineteenth century, the Swiss physician, Jean-Louis Prevost and the French scientist, Jean-Baptiste Dumas made a major contribution to the field with their exhaustive comparative investigations showing that spermatozoa were present in the testes of many different animals (see Gasking, 1967). They concluded that the spermatozoa must be produced in the testes. Their work was heavily criticized at the time because it was perceived as a reversion to the outdated animalculist theories of the eighteenth century, but in the longer term it lent significant weight to the mounting evidence for the importance of the spermatozoal contribution to the reproductive process. Most of their research work was published in the Annales des Sciences Naturelles in the period 1821–30. Contrary to the generally accepted view, they asserted that spermatozoa were not parasites but instead were the ‘result of a true secretory action and the active principle of fecundation’. The reason for the conflict with most of their scientific peers was summarized by Farley (1982): only the animalculists and pollenists of the seventeenth and eighteenth centuries believed that the sperm and pollen grains played any role in generation. According to them, the sperm and pollen contained a preformed embryo which needed to be implanted inside the egg in order for development to begin. These theories were viewed as historical relics by naturalists of the early nineteenth century. By then fecundation was seen as either the dynamic interaction of male and female fluids or the interaction of a male fluid with a preformed egg. Both theories explicitly denied that spermatic animalcules or pollen particles had any role to play in the reproductive process. In further experiments Prevost and Dumas demonstrated convincingly that motile spermatozoa were essential for the fertilization of frog oocytes. Their working hypothesis was that each 1647 G.N.Clarke spermatozoon fertilized a single oocyte. They accumulated significant evidence to support their hypothesis in a series of experiments wherein they added a known number of spermatozoa to a known, but always greater number of oocytes. They observed that the number of oocytes which underwent development was always lower than the number of spermatozoa added. Prevost and Dumas also repeated Spallanzani’s filtration experiments, but because they were open to the possibility that the spermatozoa were the fecundating agent, they concluded that filtration prevented fertilization by removing them from the seminal fluid. Final confirmation of the necessity for sperm–oocyte fusion during sexual reproduction was the result of key observations in a number of species over several decades (see Farley, 1982). As early as 1852, Henry Nelson had reported observing that the sperm of Ascaris entered the completely transparent ovule, and he claimed that his investigation was: the first in which the act of the penetration of the spermatozoa into the ovum has been distinctly seen and clearly established. George Newport (1853) subsequently reported seeing fertilization in amphibians, and then Edouard van Beneden (1875) and Oscar Hertwig (1876) reported their respective observations of mammalian fertilization. Herman Fol, who, like Hertwig, had trained under Ernst Haeckel at Jena, reported his observations on fertilization in starfish in 1879. He described the penetration of a single sperm into the oocyte to form the male pronucleus, which moved within the oocyte cytoplasm to fuse with the female pronucleus. In addition, van Beneden (1879) described the reduction in chromosome number in the gametes of Ascaris and then proposed that the chromosome must be the physical vehicle of inheritance (1883). corpus luteum. In 1794, William Hunter noted that there were two corpora lutea associated with several cases of twins which he investigated versus only one with a number of singleton pregnancies (Short, 1977). During the early nineteenth century, Prevost and Dumas made vital contributions in this area with their work on rabbits and dogs during which they carefully observed the ovaries both before and after coitus. Having noted significant alterations in the Graafian follicles and the formation of the corpus luteum, a few days later they observed tiny ovoid bodies in the oviducts. They subsequently speculated that mammalian oocytes were probably fertilized in the oviducts. Another very important contributor to our knowledge of the reproductive process was Carl Ernst von Baer, an embryologist par excellence. In 1826 he identified the mammalian oocyte during his studies on the ovary of a bitch. This discovery was reported in his classic monograph of 1827, ‘De ovi mammalium et homonis genesi’ published in Leipzig (see Poynter, 1968). The descriptions of his work were both lucid and prescriptive so that fellow scientists could readily confirm his observations. In exhaustive comparative studies, he catalogued the early stages of embryonic development and in so doing he laid solid foundations for later investigators to integrate them with the cell theory of Mathias Schleiden and Theodor Schwann (1838) (Figure 4). Artificial insemination Because the subject was shrouded in secrecy, it is impossible to accurately document when artificial insemination was first The discovery of the mammalian oocyte and early embryological studies According to Short (1977), Soranus of Ephesus (ca. 50 AD) was the first anatomist to publish a detailed description of ovaries or didymi (paired organs), as he called them. The first authoritative description of ovarian follicles and the corpus luteum was made by Vesalius in 1555, whilst his student Fallopius described the Fallopian tubes in 1562 and made further observations on the ovaries (Short, 1977). Fabricius (1533–1619) studied under Fallopius and subsequently became a great anatomist who published a superbly illustrated book (‘De Formato Foetu’, 1604) on the comparative anatomy of the female reproductive tract. Fabricius in turn was the teacher of William Harvey (1578–1657) who published the results of his studies on reproduction in 1651 in ‘De Generatione Animalium’. Although Harvey’s motto was ‘ex ovo omnia’, as mentioned in the ‘Introduction’, he wrongly believed that the oocyte was the product of conception. He was also unable to find any evidence that the ovaries played a significant role in reproduction (Short, 1977). In 1667, Niels Stensen proposed that the ‘female testes’ contained oocytes and were analogous to the ovaries of oviparous animals. Another significant contributor was the Dutchman, Regnier de Graaf after whom the Graafian follicles are named, but who also gave the first detailed account of the 1648 Figure 4. The father of modern embryology who developed the germ-layer theory and made exacting studies of organogenesis and morphogenesis. Considering the relatively crude microscopes and the fact that he did not have a microtome, the results obtained by von Baer were astounding. He reported his discovery of the mammalian oocyte in 1827 and described the notochord. This great scientist conducted extensive investigations into comparative anatomy which culminated in his classification of animals into four main groups—Radiata, Mollusca, Articulata and Vertebrata. The portrait shown and the biographical information above were derived from Garrison (1929). A.R.T. and history, 1678–1978 used by medical practioners. Dr John Hunter has often been cited as having performed the first documented artificial insemination in about 1790. However, in an article by Poynter (1968) on the history of artificial insemination, it was stated that Hunter’s case was published after his death by his executor Sir Everard Home in 1799. Apparently, in about 1776, a linen draper suffering from infertility associated with hypospadias became a patient of Dr Hunter’s. After instructions from the doctor, he successfully inseminated his wife at home using a syringe. The first published account of a successful human artificial insemination actually performed by a doctor concerned a treatment performed on 5 June 1838 in France by Dr Girault. His patient, a young countess, gave birth to a normal son on 1 March 1839. This case was the first in a series of 12, which were recorded in a paper published in 1868 (L’Abeille Medicale, volume 25, pages 409–17; cited in Poynter, 1968). In 1866, the renowned American gynaecologist Dr James Marion Sims (1813–1883) published his book on sterility which included a chapter on artificial insemination. This book stimulated an extremely vigorous debate around the medical, moral and ethical issues surrounding artificial insemination. As stated by Poynter ‘The effect of the publication of Sim’s book in France was to stimulate a more open discussion in medical circles where it had been practiced with discretion for years’. The practice of artificial insemination gained acceptance quite rapidly in France and by 1888 a book by Dr Lajatre from Bordeaux was in its 10th edition (see Poynter, 1968). The first published reference to donor insemination was made by an Italian Paolo Mantegazza in 1887. With the exception of France, the wide acceptance of artificial insemination amongst the medical establishment took many decades. It was still extremely controversial in the USA in the 1940s when Dr Clair E. Folsome (1943) published his Critical Review, and donor insemination was still quite controversial in Australia in the 1970s when the first sperm banks and public hospital-based donor insemination programmes were established. Cryopreservation of reproductive tissues It is likely that the first investigations of the effects of low temperatures on spermatozoa were carried out by Lazaro Spallanzani (1776), who subjected them to: the freezing cold of winter and it’s snow The first to discuss the possible uses of sperm banks was Paolo Mantegazza, the Professor of Pathology at Pavia, who wrote in 1866: It might even be that a husband who has died on a battle-field can fecundate his own wife after he has been reduced to a corpse and produce legitimate children after his death. However, this did not become a realistic proposition until the discovery of the very effective cryoprotective properties of glycerol by Polge et al. (1949). The first human births resulting from artificial insemination of cryopreserved semen were reported by Bunge and Sherman in 1953. By 1976 approximately 1500 births had resulted from this procedure (Sherman, 1976), and initial concerns about possible genetic damage caused by the cryopreservation process were abating. Whittingham et al. (1972) reported the successful cryopreservation of mouse embryos at –196 and –269°C. The first human pregnancies resulting from the transfer of cryopreserved embryos were reported by Zeilmaker et al. (1984). Towards IVF Early attempts at IVF using animal gametes were published by Shenk (1878) and Long (1912), but these reports have dubious significance because relatively inexact criteria were used to define fertilization and also because the role of temperature changes in pathogenic activation was not identified until 1936 by Pincus and Enzmann (see Gwatkin, 1977). Perhaps 1951 could be seen as a critical boundary defining the beginning of the modern era with the independent identification of sperm capacitation by both Colin Austin (1914–2004) and M.C. Chang. Subsequently, Austin and Bishop (1958) published the first evidence for the occurrence of the acrosome reaction prior to sperm penetration of the zona pellucida. The first report of successful IVF using sperm-capacitated in vitro was made by Yanagimachi and Chang (1963). These important contributions laid the groundwork which would ultimately lead to successful human IVF (see Bavister’s, 2002 review for detailed discussion and bibliography relating to capacitation and acrosomereaction and Blandau, 1980; Wood and Trounson, 2000 for more detail on the early history of IVF). The first report on human IVF was by Edwards et al. (1969) who observed pronuclear formation in a few oocytes. In 1970 they reported that they had obtained embryonic development to the 16-cell stage (Edwards et al., 1970), and ultimately in 1978 they reported the first birth resulting from IVF (Steptoe and Edwards, 1978), with more detail presented in a paper delivered at the Scientific meeting of The Royal College of Obstetricians and Gynaecologists on 26 January 1979, entitled ‘Pregnancies following implantation of human embryos grown in culture’, followed by further publications in 1980 (Edwards et al., 1980; Steptoe et al., 1980). Their reports were followed closely by reports of successful IVF pregnancies in Melbourne (Lopata et al., 1980; Trounson et al., 1981). Postscript The enormous impact of IVF in treating infertility can be gauged by examination of the accurate data compiled by the National Perinatal Statistics Unit for Australia and New Zealand over the first two decades after its initial introduction. Thus, in 1979 there were two IVF pregnancies which grew to 1905 in 1989 and 4952 in 1999 with a total of 40 585 IVF pregnancies during that period (Hurst and Lancaster, 2001). An indication of the global impact can be obtained from the ‘World collaborative report on assisted reproductive technology, 1998’ which was presented at the 17th World Congress on Fertility and Sterility held in Melbourne, Australia in 2001 and subsequently published in the Proceedings of this meeting (Adamson et al., 2002). The global data is incomplete but were 1649 G.N.Clarke collected from 1504 clinics operating in 44 countries, who performed a total of 390 000 treatment cycles resulting in 84 594 children born from conceptions in 1998 alone. This was compared with an estimated 45 000 children born from conceptions initiated in 1995. We can extrapolate conservatively from this data to estimate that over the last 25 years between 250 000 and 500 000 children have been conceived through IVF procedures. 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