Clinical Medical Research Award
Interview by Emily Senay
Emily Senay, a correspondent with CBS News, interviews Robert Edwards, whose work on in vitro fertilization revolutionized the treatment of infertility.
Date of interview: September 20, 2001
Senay: Welcome. I'm Dr. Emily Senay of CBS News. Joining me is Robert Edwards, Professor Emeritus at Cambridge University. We're talking today about his amazing scientific career and how so many of the things he worked on early on have led to amazing breakthroughs, and potentially even more amazing breakthroughs as time goes on.
But I want to go back to the very early days when you first were working on IVF. So much of that was controversial. How much of the controversy that's going on today brings you back to that time? Is it almost like a flashback for you when you hear about the controversy today in this country over things like stem cell research, human cloning, that sort of thing?
Edwards: In relation to President Bush's dilemma about stem cells, the decision about the ethics of making stem cells actually arose in my clinic in a different form. The clinic was called Bourn Hall, in Cambridge, where we were growing human embryos for infertility care. We were taking one or two spare embryos for making stem cells or for using methods to diagnose genetic disease in those embryos. We decided we could not use embryos from our patients for research. The embryos were not chattels; no one could give them away. No one, really. At the time, there was no law for or against using embryos without penalty, which is how every advance in reproductive medicine since then has proceeded. We had to make up our own mind, and we decided the embryos belonged to their parents.
To do work such as making stem cells, the people in the laboratory—myself or many American, British or other investigators—have to make their own individual decision to go ahead. That is the basic of the ethics of scientific research. And we felt, all of us, that we could not take embryos from our patients to do this research.
Senay: Do you still feel that way?
Edwards: I still have these complex ethical difficulties within me. I don't usually formulate them because with time we've passed many of them, of course. IVF is very well established by now. Pre-implantation genetic diagnosis of diseases is now expanding wonderfully and into new forms of family treatments. Arguments about it we're having now are about the late-onset diseases such as Huntington's disease and mutations of tumor suppressor genes, which result in the carrier becoming exposed to numerous tumors. Since all these things have now entered practice, the ethical decisions are beginning to be formulated and discussed, and some are already well passed by now. But the ethics of embryo research still lives with me, I'm afraid to say.
Senay: Did you support President Bush's decision or did you think it was not the right thing?
Edwards: I think it was a compromise. I think we understood the compromise because he had made clear his opinions about abortion, a related issue. In assessing the ethics of stem cell research, we are talking about the value of fetal human life. This is the fundamental question that faced us the very first day when we added sperm to eggs to fertilize them, and then later transferred embryos to the mothers' uterus. How do you value the human embryo? How do you value the human fetus? Trying to solve this ethical dilemma has, of course, divided nations, including yours and mine. So inevitably these problems are still there.
In the end your President has agreed to purchase stem cell lines from abroad or from private clinics in the USA. I think that should relieve the immediate problem for the research. It's an ethical compromise. He relies on other people taking the personal decision to go ahead and make the cells and compromise their own ethical situation. Then he pays to get them. It's not a happy position, and I hope one day he will go the full way and say we must do embryo research. I hope he can go that far. And buying stem cells assumes that the scientists making them knew how to select the best embryo for making stem cells.
Senay: How does it feel to be really at the beginning of so many things that have led to so much positive treatment of infertility and yet so much moral and ethical conflict? They call you the father of in vitro fertilization; without your early research and your manipulation of embryos in the laboratories, we certainly wouldn't be talking about stem cells or pre-implantation genetic diagnosis or any of these things. How does that feel as a scientist?
Edwards: I think I live in a permanent high state of excitement. It's a nuisance, because when I get home it doesn't go out of my head and it dominates life. I'm not the only one; I'm sure the other winners of the Lasker Awards are exactly the same. When we started these ideas back in the 1960s, by chance my career and my PhD had led me to work on mice. On mice reproduction in order to try to change the number of chromosomes in their embryos. That was my introduction to genetics research. And from that time onwards, I've been in those three fields: genetics, reproduction, and ethics. My professor in Edinburough taught us ethics of science; he was wonderful. When he was teaching me these ideas, I had in mind that everything he taught me would be valuable later, and it's proved right.
So as my research switched to humans, we knew first of all we could probably get embryos if we could get mature eggs in vitro, then fertilize them in vitro and grow the embryos for a few days. We could probably use these embryos to diagnose genetic disease. Indeed, in the rabbit egg, we had already sexed the embryo by excising a small piece of tissue from it to use for identifying a marker for sexing the embryos. We tried to do the same with human embryos in 1971, but the marker was not expressed in human embryos and we had no DNA markers in those days. Remember, this is before Watson and Crick did their stuff.
Senay: So you could now sex embryo ...
Edwards: Well ...
Senay: Human embryos at that stage?
Edwards: At this stage, Richard Gardner, then a postgraduate student, and I did the work on the rabbit which had a small marker in its nucleus that showed it was a male or a female. The human did not, or else we'd have introduced the sexing of human embryos when we tried in 1971. This achievement took another 18 years before Alan Handyside achieved it just after we reopened our own work in this field. He is another of the young postgraduate students we worked with in Cambridge during those wonderful years of research with 20 or 30 postgraduate students. A wonderful time for a teacher, by the way. Today all these methods are working, they're all beginning to move, and stem cells are actually the last one to get started.
Senay: In your book A Matter of Life, which is the tale of how you and Steptoe got together and really worked for many, many years to perfect IVF, you say that when you first saw the human embryo dividing and forming in the Petri dish, you then went outside and looked at the moon and the stars and you saw all the wonder of this. But did you know at that time how prescient were you? Did you know stem cells at that moment? Did you know pre-implantation and IVF would all come true?
Edwards: Yes. I probably did gaze at the stars for inspiration! We grew human embryos to blastocysts at day 5 in vitro, I'm speaking from memory, in 1971 or 1972. We had produced stem cells in the rabbit in 1962, in Glasgow. Richard Gardner and I did our work on sexing the rabbit embryo in 1968. We achieved fertilization in vitro in mice about the same time, although we were not the first to do it. So we had all these techniques in animals behind us, helped in various ways by our postgraduates.
In Cambridge from 1963, I supervised many young students who were looking for research projects. Several of them helped us in some of these areas, while others chose other topics for their PhD, so we had knowledge of their ideas in related fields. The only study with ethical overtones that we did not enter was cloning, because we thought it a waste of time in those years. I used to say I've never met anybody worth cloning as my answer to that. I never bothered with cloning, and even today I think there are other things that I should be doing rather than cloning. Stem cells, preimplantation genetic diagnosis, the use of hormones to stimulate the growth of many ovarian follicles were all apparent to us in 1968 or 1969, and each of these topics were ready for further development.
Remember, too, that if you are asking about human stem cells, we could not get human blastocysts except by opening the whole field of human IVF and growing embryos in vitro. We achieved the growth of human blastocysts to day 5 in 1972, but we didn't know if they were capable of producing all body tissues. To know this, we had to replace some of those blastocysts into a mother and get babies. This took years of effort. So the birth of Louise Brown also signaled the birth of human stem cells.
Senay: Well that brings up an important question—those early attempts at IVF, many of them failed. Were they genetic abnormalities? Was it hormonal abnormality? What was it about those early attempts that that wasn't quite right? And how did you hit on it with Louise Brown?
Edwards: Our early failure in establishing human pregnancies by IVF was entirely our fault. It was due to an ethical mistake. We discovered in the 1970s that stimulating patients with hormones to encourage several follicles to grow, and then taking ripe eggs from the ovaries for fertilization, actually distorted their menstrual cycles. The second half of their cycles was abnormal and foreshortened, and it would not support a pregnancy. So we had to give hormone support to our patients to overcome this defect and sustain any pregnancies after transfer.
The necessary hormone was progesterone. An American scientist had shown how this hormone would be needed for eight to ten weeks after fertilization because the ovary normally functions over that period. Since the ovary had been impaired by ovarian stimulation, it would not produce enough progesterone. This is often referred to as "luteal phase defect." To administer enough to patients, we would have to give progesterone for eight to ten weeks. It is suspended in oil and it would have to be injected into the backside every day which can cause scabbing. We decided to avoid scabbing in our patients especially since we could not yet offer them any prospect of a baby. Giving progesterone today is different, because there is a fair chance of conceiving babies. Also, there are of course improved methods for this purpose today
We chose a different hormone to give to patients to overcome their luteal phase defect. This hormone was supposed to save threatened abortions. It was called primulot depot, A Schering compound. Doctors looking at this program will know all about it. We believed this preparation was what we wanted to avoid long-term injections of progesterone and also to avoid risking scabbing. As it happened, I was growing and replacing embryos, then Patrick was injecting primulot depot, which turned out to be an abortifacient. We discovered this only after three years. A friend of mine had developed an assay for early pregnancy, measuring levels of the pregnancy hormone called human chorionic gonadotropin. I sent him some previously collected samples of blood from our patients. He wrote back to report that four or five of our patients had an early pregnancy, which then aborted. This was marvelous news. It opened my eyes to the risks of using primulot depot, after I had been testing all my methods in vitro, and could find nothing wrong. My heart was lifted!
The reason why pregnancies had not been established was a consequence of that ethical decision to avoid long-term administration of progesterone. This experience taught me a lesson: be careful about letting ethics interfere with the practical details of science and medicine. Sometimes in these fields a decision must be taken, and that decision must be followed. If it is harmful, it has to be abandoned. New treatments are essential to help more and more people, and while any risk must be avoided, lack of effort may compromise the whole of your work. I suppose in retrospect we should have gone straight to progesterone. This lesson was learned during that difficult period of successive transfer with no pregnancies, which disappointed many patients and ourselves. And all my opponents had a field day because they knew we were transferring embryos and getting no pregnancies.
Senay: When you were working on IVF in the early days, certainly there were other people out there trying to do the same thing. Did you have a sense of competition? Did you know you were working towards the crescendo of creating the first pregnancy? Was that in your mind?
Edwards: It's always been astonishing to me that Steptoe and I were almost alone in working on human IVF. I had never worked with patients in my life, and he had done very little science. Both disciplines, science and medicine, were essential for our work, so we had to team up. We had agreed before we began that we would stop if we thought any damage was being done to the mother, the father, or the child. We would not accept religious or political objections that weren't defined, or personal insults, which we got in plenty.
We kept going, mostly alone. We never hit a bad phase, except for the ethical situation I've just described. We never thought the embryos would be born abnormal, even though famous people, including Nobel Prize winners, told me that I would have to do infanticide on the babies. We have never had to do infanticide on a single child. There's no need. Of course, we have to accept the same problems in IVF as arise in normal, natural conception. Low success rates in IVF, low success rates in natural conception. On average, couples have to pass through four natural cycles to get one implantation. We can't change that, because it's a problem of the human embryo. Today I'm studying the reasons for these natural handicaps because the human embryo is related evolutionary to embryos of other species, but it's changed along the line somewhere.
Senay: Was it the work in mice and other species and the success in that that gave you the confidence to say that you wouldn't run into those problems that so many of your critics were quickly leaping on you at the time?
Edwards: I had done many transfers myself of mouse embryos. I was in touch with others who had done transfers in rats, rabbits, farm animals. Nevertheless, we did have some shocks on the way. One arose when we were developing techniques for diagnosing genetic diseases, using the rabbit embryo preparatory to human studies. We found one fetus was what we call anencephalic. We were surprised to find it, and assumed it was possible we had caused this damage by dissecting the embryo. A close examination of the strain of rabbits we were using, examining many litters, revealed that the cause was a gene segregating in that rabbit population, and causing anencephaly. So we were in the clear, and could carry on dissections small pieces of tissue from blastocysts.
Senay: Nothing to do with...
Edwards: Nothing to do with IVF, nothing to do with dissecting cells from the embryo. We also heard of similar bad reports in clinics elsewhere. Defects in the eye were found after IVF in the rat. The work was done by a friend of mine, Chang, who worked in New England. He wrote later to tell me that the defect was carried in the strain of rats he was using. So that problem was also due to natural inheritance and not to IVF. We went through all these stressful periods and would have stopped our human work if we thought we were doing harm.
Senay: You've had an extraordinary career, because not that many scientists I don't think can claim to master really several disparate areas of inquiry and bring them all together to create a clinical benefit like IVF. In the very early days, did you follow things as they unfolded? Did you always have in your mind a goal? How did you take all these areas of science and bring them together? Of course, with Steptoe as well...
Edwards: Yes. A series of goals. Before meeting Steptoe, two aspects of IVF had been done. I had collected oocytes from the ovary which were not ready for fertilization; let's call them unripe. It's a pretty good description. I had to ripen them by some means in culture. That took five years. The most intense and interesting part of that period was working with Howard and Georgeanna Jones in Hopkins. Then we had to fertilize the ripe oocytes, and that took another five years. Working with another postgraduate student in Cambridge, Barry Bavister, we finally witnessed every stage of human fertilization in vitro one evening in our laboratory. What an evening!
Now it was time to move to clinical work. Patients would have to be stimulated with hormones called gonadotropins, and their eggs collected from their ovaries one hour before they ovulated. Steptoe came into the study here. With my wife, Ruth Fowler, we had used the gonadotropin hormones in mice in the 1950s, and we fully understood how the hormones worked. We were confident that they would do the same in our patients, who of course had a natural menstrual cycle. Other investigators had used these hormones in non-cyclic patients.
Senay: Were you saying to yourself, "I want to take unripe eggs and ripen them in the Petri dish, that's my next goal"?
Senay: Was it with something bigger in mind, or were you just taking each step as it came and trying to work through each problem as it presented itself?
Edwards: I was working stepwise, but knew in advance the nature of many of the problems that would emerge. From the 1960s, we knew all about stem cells, pre-implantation genetic diagnosis, and chromosomes...we knew about these in our work in animals and from published work on human beings whose fetuses were being aborted because they carried abnormal chromosomes. To begin human IVF, a different succession of targets would have to be attained. Each time a new step was taken was occasion for wonderful rejoicing. Oocyte ripening, fertilization in vitro, cleaving embryos and blastocysts were a series of high points.
I will always remember when we saw the first human blastocysts; they were beautiful in vitro, light and floating and I remember going home overjoyed after seeing them. And two or three years later, a human embryo went to day nine in vitro, past the time of implantation.
Day 9 meant we were approaching when the blood tissue probably began to form. It meant that human embryology could be studied through nine days to provide wonderful news on implantation and growth. This discovery widened the ethical dimensions of our work.
I felt strongly there was no question about growing 5-day blastocysts for transfer into the mother to attempt conceive a child. And as we discussed earlier, our first steps at transferring human embryos ended in near-disaster. But then one of our patients established pregnancy—another one of those wonderful moments. Sadly, it was ectopic, and had to be removed. It had shown me that my methods were working well, and it would now only be a matter of time to our first baby. The birth of Louise was wonderful again; at last we had everything right in my cultures and in our treatments. It was not necessarily the last step in our progress: reaching one hundred and then one thousand babies in Bourn Hall were also marvelous. These are the sorts of problems that had to be solved successively. And in Bourn Hall, all the events of IVF had to be codified in law for consent and a legal contract with our patients.
This took an immense amount of effort; every letter, every word had to be in the right place in the contract. I'm not a lawyer, but I could see this had to be done. These contracts legally tied both sides, and had to be fair to either side. Not only was research being done, since we now had to work with many patients. And this advancing science was entering ethical debate among nations all over the world.
It is marvelous today to travel around the world and see how most countries have accepted our original stance and now perform IVF. We have received worldwide agreement that what we did was right, which is also marvelous news. And latest news is that there are now one million IVF babies and incredible numbers of new clinics. There are 600 in one country!
Senay: The story is told that you attended a lecture given by Dr. Steptoe, Professor Steptoe, and he was talking about the laparoscope. And this light bulb went off in your head and you met with him afterwards and that's how you two began your collaboration. How much did you lend to his side of the equation and how much did he lend to your side of the equation in the scientific pursuit of IVF?
Edwards: Well, the story you've got is not quite right.
Senay: Okay. Correct me.
Edwards: As a student and then as a young doctor in Cambridge, I always believed in reading in the libraries. At the time when successful fertilization of human eggs in vitro was near, I was searching for a clinical partner who could provide easy access to the ovary without any need for laparotomy. One day reading Lancet in the library, I found a paper by a Mr. Steptoe of Oldham in northern England who wrote that with his laparoscope, he could get access to the oviduct. If he could get access to the oviduct, then he could certainly gain access to the nearby ovary. So I phoned him about collaboration.
He was enthusiastic and promised to think carefully about it. For me there was one very big snag. It became clear I would have to work in Oldham because the patients were there; there were none in Cambridge. That was nearly 200 miles from Cambridge, and I would have to go back and forward to there from Cambridge. For six months I hesitated because I would have to take long absences from my wife and family. It demanded I would have to travel immense distances up and down the roads of England.
Finally we decided to meet in London at a conference venue. I was lecturing in one room and he was attending a different conference in another room. I lectured, and then went to his room. I heard a prestigious British gynecologist describe how he had been using the laparoscope and could not see anything at all down it. There was a sudden explosion from the back of the room and a short man stood up and said, "Nonsense, nonsense, I have photographs." His photographs of ovaries, oviducts and much else were superb. This was of course Patrick Steptoe, and we met a few minutes later. We agreed to begin, and this meant endless numbers of journeys to Oldham and back to Cambridge for me.
Could I say a word about Patrick Steptoe?
Senay: Please do. He's so important to the ...
Edwards: He's so important. Without standing up together we could not have introduced IVF, no question. His laparoscopy was essential, even if it has been superseded today. He was hounded when he introduced it into gynecological practice in the 1960s. Well-known doctors said it was dangerous. Yet when I'd met him, he'd done hundreds of cases without major disasters.
He actually established the field of endoscopy—viewing and operating on internal organs by passing "cold" light (i.e., from an external source) down carbon fibers to a small magnifying lens in the abdominal cavity. Delicate but strong and effective instruments were passed from outside through tiny holes in the abdomen wall and into the abdominal cavity to do his surgery. He was doing endoscopy in relation to gynecology. Today, surgeons do exactly the same as they pass their endoscopes into tubes, cavities, down blood vessels, into knees, elsewhere. It is called keyhole surgery, and still utilizes very fine beautifully designed instruments operated from outside the patient. And so his laparoscopic gynecology was the beginning of the breakthrough of endoscopy. Today in England, it is emptying hospital wards because you can cure people in a day, whereas before you couldn't see what was wrong and you couldn't cure them in a month. Patrick did IVF and endoscopy, and I think he should always be remembered for those two things.
Senay: It was superseded as far as IVF goes, but of course they fix a thousand things via the laparoscope now. So originally it was just for infertility or for tying tubes or something, and then...
Edwards: He once showed me a liver biopsy being done with a laparoscope. He also showed me laparoscopic treatments for endometriosis, suspension of the uterus, scoring patency in tubes. I am certain it was in his mind to go beyond infertility.
Senay: Did he help you in your thinking in the laboratory and did you help him in the clinic?
Edwards: I think what he did for me was to place me in a medical setting. Without a medical training, I just followed him around the surgery, asking questions. He was the leader. Outside the surgery, it was of course the other way round. We had our ups and downs, but he taught me by example how to handle myself in a clinical setting. How to approach and work with patients, what to say at the right time and what not to say at the wrong time. In return, I placed his work on a strict hard scientific basis. I wrote almost all of our scientific papers. He wrote in a different fashion, in reports to Lancet and BMJ. His textbook in late 1960s on laparoscopy in gynecology was a little masterpiece.
Senay: He was a practicing doctor...
Edwards: He was a practicing doctor, a first class surgeon who was trying to change the world and has indeed changed the world in his own way. And together we could change it another way, and we did that, too. I think our deal was totally fair. I have no complaints. I think it's been wonderful and I'm really sorry that he's not here today to stand and accept the Lasker with me.
Senay: In a way though...
Edwards: I really am.
Senay: Your winning the clinical award, you could probably win the basic bench scientific award, but in a way it's a tribute to him, too, because it's about clinical medicine and...
Edwards: Yes, he should be standing with me today because it is a clinical award. And I wouldn't have pursued clinical without Patrick Steptoe. I must also pay tribute to three or four other doctors in Britain who helped me in those early years. I won't mention the names, but Patrick was the one who in the end had the knowledge, the skills to carry it through.
Senay: The maelstrom when Louise was born was pretty extraordinary. Probably a lot of people, unless you were around at the time, don't remember what that was like. That was a tough time for both you and Steptoe. Personally, what was that like? And I know your father-in-law is Rutherford, is that correct?
Edwards: No, he was my wife's grandfather.
Senay: Your wife...
Edwards: Father...grandfather ...
Senay: Grandfather, okay. So he was no stranger to controversy. Did that help you at all having a...a family history...
Edwards: No, I never knew him; he died too early.
Louise's birth was indeed a maelstrom of reporters surrounding the Oldham Hospital. I believe there were a thousand or more. Patrick did the delivery by caesarian in total peace and quiet at midnight. The press thought nothing would happen that evening because we had pretended we had gone home earlier. I can only say that one telephone number of a nurse or secretary working with us was worth $500 to the press, and we were being offered almost a million pounds. We did not take the offer. Even a bomb scare at the hospital did not flush out Patrick or Mr. and Mrs. Brown. I suppose it really was a very significant moment, the birth of the first child conceived outside the body, with all that means.
Among all the controversies over IVF, the worst was in Washington in 1971, and it went exactly the same way as the cloning controversy in Washington two months ago. In 1971, I was standing up for IVF and the treatment of infertility, preimplantation genetic diagnosis, and stem cells. People who should have known better, including Nobel Prize winners, were attacking me from all sides. In the second Washington meeting recently, my friend Severino Antinori was intent on cloning human beings. The fundamental difference between Severino's case and mine was I knew IVF would be safe. In contrast, we all know—or think we know—that cloning will be dangerous to the embryos. He had a very bad wicket to play on.
The arguments about IVF were basically the same I had faced over many years, so once invited I had to go and make my points again at that conference. It was organized by Sargent Shriver so it was a big battle. By the time Louise Brown was born, many big ethical difficulties had been solved or accepted, as people got tired of arguing or some such reason. They were still there, but perhaps the fact that we utilized the single oocyte developing naturally in the natural cycle helped greatly. There was only one egg and it was replaced as an eight-cell embryo.
Senay: I think a lot of people might not realize that you were not stimulating the ovaries at that time.
Edwards: Yes, perhaps. We had not been able to disclose the pregnancy because we were trying to protect Mr. and Mrs. Brown from excess publicity. The British press did know—I believe they found out through Mrs. Brown's friends and neighbors. We asked them to keep the news quiet, and bless them they did until month eight of the pregnancy. Meanwhile in the laboratory, we had been trying all sorts of alternatives to ovarian stimulation, adding different medicines, freezing eggs and embryos, doing gift and oocyte donation. The natural cycle was the one that worked first. Many of the others are working today.
Senay: But you went on to do many IVFs without stimulating the...
Edwards: The ovary, yes.
Senay: And what was your success rate without stimulating...
Edwards: When we started in Bourn Hall, we reached 22 percent with patients aged less than 38, if I recall correctly.
Senay: No different than today.
Edwards: Yes, success rates per embryo have not improved since the Oldham work. Things are changing today, though. There are major moves in Europe to transfer single, highly selected embryos. We are learning a lot about the early human embryo, which I had hoped to see over several years. We now have theories about the development of the human embryo based on scientific knowledge and comparing human embryos with those of the fruit fly, frog, nematode and mice. This understanding is enabling us to identify those characteristics in the growing embryo which help to select the best embryo for transfer. I won't bore you with the details. Some clinics are transferring a single embryo and obtaining 32 percent or more pregnancies. But this discovery also means that only a few human embryos have a high capacity for implantation, while the great majority of human embryos may not have the ability to implant.
Senay: Is that with pre-implantation genetic diagnosis?
Senay: Some other, it's a gross analysis ...
Edwards: It is a matter of watching how the embryo grows and seeing certain things. For example, how fast it cleaves to the two-cell stage.
Senay: I see, so there are things you can see ...
Senay: Morphologically that...
Edwards: Yes, several different characteristics that are all related to growth patterns. They embrace the fundamental aspects of life in the human embryo, events that take place to shape it and make it grow. We are beginning to understand these aspects of human embryology so we can now select the best embryos. Maybe there may only be one or two embryos in ten with these properties, and the others are of less value. They all have some value, but when you get to the ninth and the tenth, the chances of implantation are very remote. Selecting embryos in this way is enabling a move to single embryo transfers. I think this period is long overdue, because we must do all we can to avoid multiple pregnancies by transferring a single embryo and cryopreserving all the others. Cryopreservation is getting simpler, which should help enormously.
I am strongly against transferring several embryos. People who transfer three or four or more embryos should examine their consciences.
Senay: Well, this brings up the business nature of IVF. IVF is a huge, very lucrative business here in the states. You have feelings about this.
Edwards: I left New York for UK last Saturday and now here I'm back again! While at home, the British Sunday newspapers reported that a certain gynecologist in London was quoted as earning 2.45 million pounds per annum. If that's how IVF is developing, I think it's rather sad. I do know of course that an entire industry, a quite fantastic industry, has built around IVF. In many countries there are now hundreds of IVF clinics. There is a huge pharmaceutical back up, and many items are manufactured for clinical and scientific use. I know many gynecologists are very wealthy, whereas most scientists in the field are not. This is a bad situation since IVF is mostly scientific and getting more and more so with each passing day. I am not particularly jealous of the wealthy except for how it reflects in cost to patients. Let's face it, these rich individuals did not introduce or improve IVF. My satisfaction is that they can't take that away.
Senay: Is there satisfaction especially since you went through a very tough time when people criticized you, especially now when you're winning awards like Lasker Awards and...
Edwards: Well, I...
Senay: Or is the satisfaction in having helped so many...
Edwards: The worm began to turn, if I can phrase it that way, about ten years ago, just before Patrick died. We began receiving awards for IVF, which was wonderful. And we received joint awards. About then, people began to realize that IVF was a "fair do" as the Australians say. It was straight; it was helping the patients. There was no underhand stuff in it; it was a straightforward treatment. And then the honors and the prizes began to flow and it's culminated today in this wonderful Lasker Award, which is marvelous. And it means that the Lasker adjudicators, and I believe they are very senior figures in medicine and science, have examined all those ethical battles over many years. They must have decided that we fought a fair battle. If they did not believe this, they probably would not have awarded the prize. This is the second wonderful honor for me this summer. The other happened in Cambridge University when I was awarded an honorary DSC there. My colleagues there must have examined not only the science and the medicine, but also the ethics, and also decided we'd played a fair hand. Now that is very satisfying, isn't it?
Senay: It must be very satisfying. Thank you so much for talking today about your amazing career. Thank you very much, Professor Edwards.