Final Post 1/2: Infertility Treatments

On July 25^th, 1978, a baby girl named was born in Oldham, England to Lesley and John Brown; who would name the baby Louise. Baby Louise Brown would become known in medical circles the world over as the first child conceived by in vitro fertilization to succeed. Louise’s story, however, is not the beginning of an era, but rather the culmination of one. There are historical tales of members of the nobility of Europe divorcing their first wives, or marrying much younger women, or even fornicating quite freely in order to beget an heir. King Henry VIII married and subsequently divorced, executed, or lost to illness six wives, and Napoleon divorced his wife Josephine when she failed to produce an heir. (Ironically, Josephine went on to become the “mother” to several of Europe’s current royal families.) The inability to conceive, for those who wish to, is a tragic event still today, even as the social stigmatism attached has been removed, and from this tragedy has arisen an entire chapter of medical science and innovation through which previously barren women are now able to conceive.

            Aristotle, not the philosopher but rather a collection of writers, is quoted as having said: “When a young couple is married, they naturally desire children, and therefore use those means that Nature has appointed to that end.” Unfortunately, nature did not always grant these young couples the means to produce children. In colonial times, it was the Lord who could “choose to bless a couple with offspring.” There was not a method of medical examination to determine if a man or woman was sterile. In 1728, Philadelphian Anna Maria Boehm Miller petitioned for a divorce on the grounds that her husband was unable to procreate with her, and thus could not produce a child, as was the point of marriage. Her husband, George Miller, had what is now known as cryptorchidism, meaning he suffered from an undescended testicle, a condition which can cause sterility. Since he could still produce both an erection and semen, Anna Miller’s divorce was not granted, and the lack of children was instead deemed the Lord’s will.¹  Anna Miller’s case was one of many in which religion was turned to in place of a lacking medical treatment. With high infant mortality rates, populating the New World was a growing problem. As the century progressed, however, the source of advice began to shift from religious to medical; to be barren became being infertile, an emotionless medical condition which implied possible medical cures and treatments.

Before medical treatments were employed, women turned to close friend and relatives for advice on how to encourage the conception of a much-desired child. Early “cures” were not so much medical ones as they were changes to a lifestyle or marriage. Men were advised to avoid copulating often with their wives as “grass seldom grown in a path that is commonly trodden in.”  Women’s insensibilities or a possible “imbalance of the humors” were also cited as reasons for barrenness.² The general consensus was, despite any potential deformations of genitalia on the male’s part, if a man was not impotent, then infertility lay firmly with the woman.

As the colonial era progressed, two prominent figures in infertility studies arose. The first was a young doctor named James Graham emigrated from Scotland to the New England area in the early 1770s, bringing with him his fairly radical theory of linking sexual pleasure with electrotherapy as a cure for infertility. He also offered various remedies to be consumed, such as his “never-failing prescription for fertility”, which instructed consumers to “take one handful of red virgin sage leaves; steep them in a bottle of old red port, then drink a glassful every morning repeat it in two or three months” and then combine it with regular exercise, proper hygiene, and keeping regular hours.³ Though there is no scientific evidence that honoring this recipe would actually aid in the conception of offspring, Graham’s prescription of regular exercise and bathing were widely accepted at the time. Though he only had limited success with actually “curing” infertility, Graham did enjoy quite a bit fame and fortune from his “Temple of Health”, which featured lectures on fertility by a member of the same sex as its attendants and Graham’s famed electric baths. On the opposite end of the spectrum was James Walker, a serious young medical student who sought to change his profession’s view on infertility, but instead returned to Virginia and faded into the background of history. The only remainder of Walker was a small book, originally written as a doctoral dissertation, entitled An Inquiry into the Causes of Sterility in Both Sexes. Where Graham adopted a sexual view on sterility, Walker proposed a purely medical one, stating that the infertility of women came from various medical conditions, including blocked fallopian tubes, and not from lack of achieving orgasm.⁴

In the 1850s and 60s, there arose a new name in medical treatments: J. Marion Sims. He began as a surgeon in Alabama who actively avoided obstetrics until he was called upon to operate upon a number of slave women who had all undergone difficult births and as a result suffered from vesicovaginal fistula. Though it took him years, Sims did solve the problem of operating on and healing the fistula. As a result of this success, he persuaded various well-connected female philanthropists to support him in a venture to create a women’s hospital, a venture in which he was successful; from his work, Sims would be named in history as the Father of Gynecology.⁵ The arrival of this new field in medicine meant new treatments could be devised to aid the infertile. Sims was also the first to experiment with artificial insemination, using a syringe with a long, dull, and bent at the end needle.

From the time of Sims in the mid-19^th century, we now jump to the 20^th. Beginning in 1895, and continuing for more than a decade, American surgeon Robert Tuttle Morris practiced ovarian transplantation, a process in which he implanted sectioned parts of ovaries from fertile women into women who were either infertile or had lost their ovaries in surgery, thirty years before the discovery of estrogen or the coining of the term ‘hormone’.⁶ During this time period, a test was also devised to test if the fallopian tubes were blocked or not, where previously surgery was the only option. From the 20^th century came the two largest infertility treatments which still exist today: artificial insemination and the process of in vitro fertilization and embryo transfer.