Test Tube Babies And The Single Woman

Select Magazine — February 1983

One of the greatest 'misconceptions' of all time is that getting pregnant is as easy as falling off a log. Ten per cent of British couples have learnt the slow, cruel and harrowing lesson that conceptions are miracles and that they have been singled out never to have babies of their own. However, right now medical science offers hope to many of them and miracles CAN happen in the laboratory for some. But for whom? asks Christopher Long, who witnesses the birth of a revolutionary clinic in London.

By Christopher Long

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Why, you might well ask, should single people be concerned about getting pregnant? One answer, of course, is that a 'mistake' when you're single can be rather unfortunate. On the other hand it could be the best news ever: it proves at least that you can do it. Which 10% of us will discover we can't. We're so used to being careful, taking precautions, watching the calendar and 'crossing our fingers' that we easily assume that getting pregnant is as easy as falling off a log. The more well-informed of us know that a healthy man and woman at peak fertility, on the right day of the month and trying hard, have a one-in-four chance of a successful pregnancy. But right now, in Britain alone, there are thousands of couples who somehow have to face the fact that mother Nature has cheated them of the one thing that gives ultimate meaning to their lives.

At the Chelsea Hospital for Women, in the heart of London, the news was announced in November that a pioneering National Health Service clinic is being set up to offer an in-vitro (test-tube) pregnancy service for infertile couples. Within days of the announcement the young doctor who is leading the team was faced by a deluge of letters from desperate women. And for Mr Keith Edmonds that mountain of mail raises an equally large range of moral problems.

Look at it this way. As a single woman you have the absolute right to go to bed with whom you wish – and to get pregnant if you wish as well. Providing you're fertile nobody yet can question your right to have, and bring up, a child on your own. If you don't want to get married or you think you'd like a child now and marriage later – or even if you're lesbian – no one can stop you doing so. You also, quite rightly, under certain circumstances, can choose to terminate that pregnancy as well.

But if you are infertile and you are one of the many people whom modern medicine can help, getting pregnant is likely to depend upon someone else's approval, help and moral judgement. They may decide whether you are a suitable case for treatment.

Infertility is a word that covers a multitude of possibilities. Leaving aside psychological problems (the cause of the vast majority of male sexual problems) the most common physical cause of infertility in men is a low sperm count. While this has nothing to do with libido, or the male's ability to satisfy his partner, it may be that the 'count' can be improved by no more than hormonal drugs to improve his chances. If the count is very low, however, then at least the well-known alternative of artificial insemination from another male donor is available instead. Now in-vitro techniques can bring the egg to the sperm so that 'low count' fathers can conceive their own children. Infertility in women, however, is much more difficult to deal with in most cases.

Until recently blocked fallopian tubes have been one of the best-known and most common causes of infertility in women – largely because of the numbers of people affected and because of the irrevocable fact that if an egg could not move from the ovaries to a position where it can be successfully fertilised there was no hope whatever.

What made matters worse was that blocked fallopian tubes were, and still are, becoming increasingly common. More worrying still was the conclusion by experts that the sexual revolution might be contributing to the problem. Statistics suggest that the more partners a woman has the greater are her chances of developing the deep-rooted internal growths that result in blocked tubes, caused in many cases by salengitis which can be the result of VD, a burst appendix or which sometimes occurs naturally. Fortunately medical science offered a solution in the form of in-vitro fertilisation which simply means that an egg from a woman is taken direct from an ovary and fertilised in a culture dish in a laboratory by a male sperm and then, after a suitable period of incubation, re-introduced via the vagina into the womb where it then can develop into the foetus in the normal way.

Caption: The Chelsea Hospital for Women asks us to point out that they are not yet encouraging applications for in-vitro fertilisation. Even after the first cases are taken on in the next two years they will still be highly selective so that they offer the best chance of success. When cases are handled as a matter of routine it is likely that women will be carefully screened and examined internally to be certain that it is possible to obtain an egg from the ovaries. In some cases this is extremely difficult and minor surgery is required in order to locate the ovary, while often it may prove impossible to proceed further if the infection or growth is too far advanced. The next stage involves daily visits to the clinic so that scans, blood tests and hormone measurements can be made to select the precise time of ovulation. An egg is then drawn out of the ovary and combined with 50-100,000 specially selected sperm under special laboratory conditions. After successful fertilisation and the beginnings of cell division the embryo is introduced into the womb via the vagina in a simple, painless procedure which doesn't even need an anaesthetic. Anyone wanting further information concerning in-vitro fertilisation or infertility generally should consult a general practitioner.

All of which sounds unbelievably simple! In fact the whole process is fraught with technical problems which a handful of specialists such as Mr Edmonds are still working on in the hope eventually of achieving something like a 30% success rate (i.e. slightly higher than Mother Nature herself) but which at present is running at about 10% - 14%. And it's because the technology and the processing of an individual is so time-consuming and the demand so much greater than the existing facilities can supply that the selection/moral issue results.

In this country the only National Health Service in-vitro unit in full operation is at the Hammersmith Hospital. The new unit at Chelsea and another in Manchester are still in the 'fertilisation' stage with perhaps a year to go before they take on their first case – perhaps another year before they achieve a successful pregnancy.

At the same time there are about eight million couples in the reproductive age range of whom about 10% have a fertility problem. Of these again around 15% (over 100,000) will have a problem with blocked tubes. Still more will have a sperm count that is too low for normal reproduction and more again will be unable to fertilise properly without assistance because of some as yet unidentified problem with either the egg or the sperm.

People in any of these three categories could be suitable candidates for in-vitro fertilisation and it's quite clear that only a relatively small number will be lucky enough to be chosen.

This is in no way a criticism of the doctors and clinics working in the field. Like heart transplants, the only tragedy for the doctors and medical staff involved is that there simply aren't the resources to deal with everyone.

Nevertheless, as an Australian woman continues to care for her second baby daughter after being convicted of cutting her first baby daughter's throat in the front seat of her car, one wonders whether she would have been chosen as a suitable case for treatment or whether the day will come when she can expect a pregnancy on demand. It's unlikely that Professor Cook who is the leading expert on in-vitro in this country, and who now operates a private clinic in London, will be faced with a case like that.

Nor, one hopes, will Mr Edmonds or his colleagues in Manchester. But, as the technique develops and the process becomes more widely available, it's quite possible that there will be as much moral agonising over who is 'suitable' as there was over the question of abortion.

In the past two years I myself have twice been asked whether I would be prepared to father a child. In both cases the women concerned had decided, for different reasons, to have a child on their own and to bring it up single handed. I like them both, was immensely flattered by the request and knew that if I said no there would always be someone else who would say yes. In fact, of course, I could have fathered their children without ever knowing it – so it was honest of them to have asked me first. The reason I said no was not because of any great moral dilemma as far as they and I were concerned and it wasn't because I thought I might become 'involved' with the children that resulted. What I did wonder about was what those children would have thought later on when they faced the fact that their father was a ghost who came and went. Who was he? Where is he? Did he want me? Did he love me? Does he care about me now?

So, if you're single and fertile and a woman, you can go out and get pregnant tonight and no one can stop you. If you're single or married and infertile it may well depend on someone else's judgement whether you are to be allowed that miraculous conception.

At the moment, while he still works on the practical problems of in-vitro fertilisation, Mr Edmonds very wisely says that this is all something that society is going to have to decide for itself. In the meantime, he says, he thinks he would need to be satisfied that his patients could offer 'a stable relationship' and that 'the child's environment would be normally adjusted'. Who could argue with him? But at the same time isn't it a good thing that the 90% without fertility problems don't have to satisfy a government inspector first!

N.B. This article was written in 1983 and should not be relied upon as any measure of current knowledge, statistics, facilities, etc.

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