A pioneer in the field traces the growth of in vitro fertilization
In 1983, Adam became the first baby that Dr. Alan H. DeCherney helped bring into this world using in vitro fertilization (IVF). Adam, only the fifth IVF baby in the United States, was born 5 years after the birth of the first “test tube baby” in Great Britain.
Dr. DeCherney is now the Director of the Program in Reproductive and Adult Endocrinology within the NICHD’s Division of Intramural Research. This program studies all aspects of human reproduction, including the egg, sperm, the embryo, and early fetal growth. His research and his medical practice have focused on infertility throughout his career.
Going to the Action
Dr. DeCherney became interested in infertility when he was a medical resident at the University of Pennsylvania. The University’s division of reproductive endocrinology and infertility was doing exciting work at that time, and he wanted to be a part of it.
After leaving the University of Pennsylvania for Yale University, Dr. DeCherney heard a presentation by the two men who achieved the first IVF birth, Dr. Patrick Steptoe and Dr. Robert Edwards. Dr. DeCherney was inspired by the talk. Dr. Edwards, who received a Nobel award in 2010 for developing IVF, died in 2013. (Dr. Steptoe died in 1988.)
“This was the future of infertility. I wanted to be involved in that.” He returned from the conference to his department at Yale and established a center to perform IVF-assisted births. The center was the fifth in the United States. That is where Adam was born.
Dr. DeCherney later went to Tufts University and the David Geffen School of Medicine of the University of California, Los Angeles, before coming to the NICHD.
“It was an exciting opportunity to try something different,” Dr. DeCherney said of his decision to come to the NICHD. “And of course, the NIH is such a fabulous place. Who could turn down an opportunity to come here?”
Patients Set Research Direction
Dr. DeCherney sat for this interview in a conference room of the NIH Clinical Center, the NIH research hospital. In this sprawling building he both sees his patients and does his research. Balancing research and clinical duties is much easier than it sounds, Dr. DeCherney said, because his research and medical practice are so closely intertwined.
Typically, Dr. DeCherney spends 10 to 15 hours each week with patients, who are all participants in studies at the Clinical Center. His patients come to him in a variety of ways; some hear about his work through word of mouth, while others contact the Clinical Center directly for an appointment. As he works with his patients, he remains alert to new questions that must be answered.
“Most of my research ideas come from seeing patients,” Dr. DeCherney said. “Patients ask questions that are difficult to answer. That prompts us to find an answer.”
A quick review of the scientific literature shows that Dr. DeCherney’s patients have asked quite a variety of questions. One of his most recent papers commented on a method to preserve fertility after an ectopic pregnancy. (An ectopic pregnancy occurs outside the uterus and threatens the life of the mother. Treatment can damage tissue along the woman’s reproductive tract, hampering fertility or in some cases causing infertility.) He has also weighed in on the search for genetic variants that may be associated with polycystic ovary syndrome, a hormone imbalance that can affect a woman’s fertility.
Dr. DeCherney heads the NICHD laboratory that studies the development of the fertilized egg in mice and non-human primates. Using these animal models, the laboratory is investigating the signals passed within and between cells that help determine whether an embryo will implant in the uterus successfully.
The laboratory also continues to work on a non-invasive method to obtain fetal cells that migrate into the cervical canal during the first trimester. Having a safer and less-invasive way to collect these cells will make it easier to identify certain problems, such as an ectopic pregnancy.
Understanding Human Development: The Role of the NICHD
Although IVF is fairly straightforward, it involves a number of delicate steps. First, drugs stimulate egg production; then, multiple eggs are carefully removed from the ovaries. The eggs are placed in a dish where they are fertilized with sperm. After the eggs are fertilized and begin to grow, the healthiest eggs are selected for implantation into the uterus.
NICHD research has advanced our understanding of the physiology of sperm, eggs, and embryos to help make this an increasingly successful process, Dr. DeCherney said. Institute studies have advanced knowledge so that doctors now have better techniques for removing eggs, fertilizing them, incubating them, and identifying the eggs that are the healthiest. The success rate, that is, the likelihood that one cycle of IVF will produce an implanted embryo, has increased from 10% in the early days of IVF to 50% now.
Long-Term Health Outcomes
IVF is no longer a novel procedure; the European Society of Human Reproduction and Embryology estimates that more than 5 million babies have been born worldwide using IVF. The oldest children born of IVF have themselves had healthy pregnancies and given birth without the assistance of IVF.
The long-term health of babies conceived using IVF has been tracked over the years, including studies in Australia and the Scandinavian countries. So far, there do not seem to be any well-defined health risks for these children, Dr. DeCherney said. Although some increased health risks have been observed, in absolute terms, the numbers are small.
For example, researchers found that a rare but serious genetic disorder, called Beckwith-Wiedemann syndrome, may occur more frequently in children conceived with IVF.
Researchers will continue studying the health outcome of infants conceived as the result of IVF, looking for ways they might differ from children conceived in a traditional way, Dr. DeCherney said.
There are many ethical questions that come up with IVF, just as there are with many other areas of medicine, Dr. DeCherney said. For example, there are issues associated with freezing the eggs of women who wish to defer starting a family until they are older. Fortunately, doctors have guidelines they can follow, he said.
In addition to his medical practice and research into all aspects of infertility, Dr. DeCherney finds time for other professional activities.
He is a past president of the American Society for Reproductive Medicine, the Society for Reproductive Endocrinology and Infertility, the Society of Reproductive Surgeons, the Society for Gynecologic Investigation, and the Society of Assisted Reproductive Technology.
He is the editor-in-chief of Fertility and Sterility; a former associate editor and editorial board member of the New England Journal of Medicine; a member of the editorial board of Obstetrics and Gynecology; and a member of the Institute of Medicine of the National Academies. He is the author of CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, a textbook now in its 11th edition. And he is a fellow of the American College of Obstetricians and Gynecologists.
An Eye Toward the Future
Dr. DeCherney’s career has taken many twists and turns since he did his first IVF. He remains in contact with the nurse and the other Yale staff who helped with the conception and delivery of Adam, in part because it was such a momentous event. “It was an exciting time, and I was thrilled to have helped bring about such a landmark birth,” he said.
He notes that ongoing research has great potential to improve and change obstetrics and reproduction. “We’re just beginning to scratch the surface,” he added.
For more information on NICHD research on fertility and infertility, including the work of the Program in Reproductive and Adult Endocrinology and the DeCherney lab, please review the following links:
A to Z Topic
- Beall, S., & DeCherney, A. H. (2012). Management of tubal ectopic pregnancy: methotrexate and salpingostomy are preferred to preserve fertility. Fertility and Sterility, 98(5), 1118-1120.
- Batcheller, A., Cardozo, E., Maguire, M., DeCherney, A. H., & Segars, J. H. (2011). Are there subtle genome-wide epigenetic alterations in normal offspring conceived by assisted reproductive technologies? Fertility and Sterility, 96(6), 1306-1311.
- Segars, J. H, & DeCherney, A. H. (2010). Is there a genetic basis for polycystic ovary syndrome? Journal of Clinical Endocrinology and Metabolism, 95(5), 2058.
- DeUgarte, C. M., Li, M., Surrey, M., Danzer, H., Hill, D., & DeCherney, A. H. (2008). Accuracy of FISH analysis in predicting chromosomal status in patients undergoing preimplantation genetic diagnosis. Fertility and Sterility, 90(4), 1049-1054.