The wheels of the selection process for the Nobel Prizes can turn in inscrutable ways. This was evident yet again when this year's prize for Physiology or Medicine was awarded to the British biologist Robert G. Edwards for his pioneering role in the development of human in vitro fertilisation (IVF) therapy. He had teamed up with gynaecologist Patrick Steptoe to work out techniques to safely extract eggs from women, fertilise them externally, and implant the tiny embryos back into the womb. As the result of their efforts, the world's first test-tube baby, Louise Brown, was born in July 1978. Some four million more babies have since followed her into this world (thanks to the use of similar methods), giving immense joy to countless infertile couples across the globe. The technique has long since proved its worth. In 2001, Dr. Edwards was given the Lasker Award, which often presages a Nobel Prize. However, according to Christer Höög, a member of the Nobel selection committee, recent follow-up studies that showed that IVF children are as healthy as the normally conceived ones were “a contributing factor” in this year's award. Dr. Edwards, now 85 and in poor health, and Dr. Steptoe, who died in 1988, had to cope with technical hurdles, lack of official support, and much flak in order to achieve their goal. After the U.K. Medical Research Council refused to back their effort in 1971, the duo relied on a private donation to continue. Even after Louise Brown's birth, no governmental support was forthcoming.
But Drs. Edwards and Steptoe were more fortunate than an Indian team led by Dr. Subhas Mukherjee, who developed markedly different IVF techniques. The world's second and India's first test-tube baby was born in Kolkata just 67 days after Louise Brown. But Dr. Mukherjee was prevented from continuing these efforts and could not even publish all the details of his work; he finally committed suicide. As IVF techniques have gained acceptance, much of the scientific controversy that surrounded the early work in this field has subsided. But the widespread use of such methods has created new ethical issues. For example, ‘rent-a-womb tourism' has become a thriving business in India, with wealthy couples from abroad paying poor women large sums of money to carry IVF embryos to full term. Consequently, in a report submitted to the central government in August 2009, the Law Commission of India came out in favour of legislative intervention to legalise altruistic surrogacy arrangements and prohibit commercial ones. As always, government and society must find ways to get the best out of a technology while being vigilant to limit its misuse.