30 years of IVF in Flanders
For three decades, scientists in Flanders have been helping couples conceive via in-vitro fertilisation.
Attitudes have changed since Belgium’s first IVF birth
Next week, on 24 October, Tina will celebrate her 30th birthday. That it’s also the 30th anniversary of in vitro fertilisation (IVF) in Belgium is no coincidence. “I had contact with her until a few years ago,” said Paul Devroey, one of the doctors responsible for bringing Tina into the world, making history in the process. “But then she decided she’d rather be out of the picture, I guess. She’d been in the public eye, on television and in the papers.”
Tina, from Opwijk, Flemish Brabant, was conceived at the university hospital in Brussels in 1983 and nine months later became the country’s first recognised birth by IVF. She was not, however, actually the first “test tube” baby in Belgium. That honour goes to the university hospital in Leuven, which had succeeded in bringing a child into the world by IVF five months earlier.
Two things stopped UZ Leuven from claiming its milestone: the family wanted no publicity and have never been identified, and the hospital found itself in a difficult situation as the procedure was forbidden according to the Papal encyclical Humanae Vitae.
At the time, the University of Leuven (KUL) was under tighter control from the Catholic church authorities; its reticence on religious-ethical grounds led it to hand over dominance in the field – not only in Belgium but across Europe – to Leuven graduate Paul Devroey and former paediatrician André Van Steirteghem of the Free University of Brussels (VUB).
"A fantastic adventure"
The two doctors had met in 1978, when Devroey convinced Van Steirteghem to turn his lab skills towards the field of artificial insemination. “I was looking for people who were interested in working with me on the culture of human embryos,” Dr Devroey tells me. “I tried to convince several people to join me, but the reaction was very negative, and they all refused because it was too sensitive; it was not well-regarded in society at that time.”
Religion is not the sole owner of ethics
In 1980, Van Steirteghem agreed to become a partner in IVF. “We spent three years preparing the lab,” says Devroey. “We went to America and Australia to different centres, to get an idea about the technology.”
Van Steirteghem, in turns out, didn’t need to be convinced at all. “I was happy that one of my colleagues from the hospital came looking for me with a very innovative project,” he said in the Canvas documentary Alles voor de wetenschap (Everything for Science). “At a certain point we clicked and decided to start out on what was to become a fantastic adventure.
Leuven’s religious objections left the door open for Brussels. “The VUB was the centre where ‘anything goes’,” Van Steirteghem explained. “From lesbian mothers to women who wished to be inseminated with the sperm of their deceased partner. But we always paid a great deal of attention to the ethical aspects of our work.”
Devroey: “Religion is not the sole owner of ethics. Ethical issues arise out of many, if not all, procedures concerning embryos. For several years I’ve been head of the Belgian National Committee on Bioethics, and I’ve also been very close to the ethical committee of the European Society of Human Reproduction and Embryology. We have produced position papers on all aspects of medical ethics in the field of fertility treatments.”
The VUB clinic also set up its own “reflection group” to address ethical concerns.
My family made the acquaintance of IVF almost exactly 20 years ago when, in 1993, my wife and I visited Devroey’s clinic. The procedure then was more onerous than it is now: daily hormone injections by a nurse to stimulate ovulation; regular temperature control to determine when ovulation was taking place, then a mad rush to the hospital in Jette to have the ova – one or more egg-cells produced with the help of the injections – “picked up” for treatment.
In the meantime, I had to provide a sperm sample. The two vital components were brought together in the laboratory, before being implanted.
The process was physically and emotionally exhausting for my wife, and the chances of a successful conception once the fertilised ova were placed in the uterus were then far less than the one-in-five chance of success now. Nevertheless, we have two fine, healthy children, aged 19 and 15.
They are just two of the estimated two million people worldwide conceived through the use of IVF, thanks in part to the advances in fertility treatments pioneered by Van Steirteghem, the lab boffin who worked away in virtual anonymity behind the scenes, and Devroey, the public face of the clinic, the consultant who picked up his phone and provided the patient-hospital interface for every patient treated there.
Both men are now retired, though they are still in demand across the world to give talks and even to consult on the work of their clinic, now under the leadership of professor Herman Tournaye. The basic procedure of IVF is attributed to Patrick Steptoe and Robert Edwards in England, with the birth of the world’s first test-tube baby, Louise Brown, in 1978, five years before Leuven’s.
The watchword needs to be: IVF if possible, ICSI if necessary
Devroey and Van Steirteghem’s contribution to the field is considered a milestone of almost equal importance – the development of intra-cytoplasmic sperm injection (ICSI), in which a single sperm cell is retrieved from the testicle and injected in the lab into a single ovum. That procedure allows even couples where the male partner has an extremely low sperm count to conceive, literally by helping the single sperm along its way.
“The importance of the technique is its simplicity,” says Devroey, “which allows it to be used all over the world.” The majority of cases of male infertility occur because the sperm produced in the testes is not able to find a passage to the outside, and Devroey, he says, had long been convinced that it would be possible to extract sperm directly from the testicles.
Now, he says, ICSI is used in 70% of cases worldwide, even when it is not required. He agrees with professor Thomas D’Hooghe of KUL, who recently expressed the view that ICSI is being used too often. “The watchword needs to be: IVF if possible, ICSI if necessary,” D’Hooghe says.
The question arises, Devroey explains, because people try to rule out every possible chance of failure of an IVF treatment. One of the main deciding factors is cost. “When people have to pay for treatment out of their own pockets, they can afford maybe one or two cycles, and so of course they want to avoid failure.”
ICSI is the most highly visible aspect of the Brussels centre’s approach, which Devroey considers the reason behind its enormous reputation. “There was a huge amount of teamwork with a lot of scientists behind us,” he says. “Many clinics in the world are performing procedures but are not innovative, and I think innovation was the most important thing in our favour – innovation based on a scientific approach. André and I were the most-cited in the entire IVF field for many years, and we still are, I guess. We published about 700 articles because we were doing a lot of research. That’s what made the difference.”
Some 2,000 patients a year came from all over the world to UZ Brussel for treatment from the world-renowned clinic. Many of them, a study found, have had treatment unsuccessfully at home, and come here for one last try. More than four out of five couples pay for the treatment from their own pocket; at one time it was common to see camper vans parked at the hospital where the couples lived during the treatment cycle.
Earlier this month, the hospital organised a get-together for some of the thousands of school-age children whose existence is directly attributable to the clinic’s work. According to some estimates, one in 12 children born now is the result of fertility treatment. There were family photos, and children were shown around the unit and learned about the processes that brought them into being. It’s a far cry from the early days of IVF 30 years ago, when even a leading university hospital considered it too shameful to speak of.
When ICSI first came to public attention, Devroey recalls, the French newspaper Le Monde headlined its article “Le viol de l’ovum” – The rape of the egg cell. “There was a really quite negative atmosphere then,” he says. “But that’s gone now because so many people have been able to have children as a result of what we were doing. That’s a fantastic feeling.”
IVF in figures
85% chance of an average couple conceiving within a year
1 in 6 couples are unable to conceive, in about 40-50% of cases because of male fertility problems
317 women over the age of 43 were treated in Belgium in 2012
81% were resident in Belgium, followed by the rest of the EU (16%)
18 fertility treatment centres in Flanders and Brussels, nine of them offering the full range of laboratory and clinical procedures
Free University of Brussels (VUB)
Master’s programmes offered
million euros in research budget in 2010
students in 2011-2012 academic year