The Modern Laboratory · Room 1 of 8

Room 1

The egg is collected

How a hormone gathered from urine, a husband and wife in Virginia, and a needle guided by sound brought the egg gently into the laboratory.

Every embryo in this wing begins as an egg, waiting in a tiny pocket of fluid in the ovary called a follicle. Left to herself, a woman usually ripens one egg a month. The first step of IVF is to help several eggs grow at once, and then to collect them safely, quickly and with as little discomfort as possible. In the earliest days, eggs were collected by laparoscopy, an operation under general anaesthetic that Patrick Steptoe had mastered. What happens today in a quiet room, in a few minutes, was built by the people in this room.

Bruno Lunenfeld found hope in an unlikely place. Born in Vienna in 1927 and trained in medicine in Geneva, Bruno Lunenfeld worked from 1957 at the Weizmann Institute in Israel. After the menopause, a woman's body makes large amounts of the hormones that tell the ovary to grow follicles, and some of it passes into her urine. Working with Piero Donini, a researcher in the pharmaceutical industry in Italy, Lunenfeld helped turn these hormones, purified from the urine of women past the menopause, into a medicine, human menopausal gonadotrophin, or hMG. In 1962 his team reported the first pregnancy in a woman whose own body could not make these hormones, after hMG had grown her follicles and a second hormone, hCG, had brought the egg to ripeness. He later led the Institute of Endocrinology at the Sheba Medical Center until 1992. The same pairing of hormones would soon change IVF.

Then came the Joneses. Howard W. Jones Jr and Georgeanna Seegar Jones had spent their working lives at Johns Hopkins in Baltimore. In 1938, early in her career, Georgeanna had helped show that the pregnancy hormone hCG is made by the placenta. In 1978, after retiring from Johns Hopkins, they moved to Eastern Virginia Medical School in Norfolk, Virginia, and began an IVF programme in 1980. That first year they tried to collect the single egg of a natural cycle 41 times, and no pregnancy followed.

Georgeanna changed the plan. A specialist in the hormones of reproduction, she reasoned that if hMG could grow several follicles, there would be several eggs, and several chances. From January 1981 the Norfolk team stimulated the ovaries with hMG and then hCG, watching each woman's response closely with blood tests and ultrasound. It worked. Their careful, gentle stimulation became the pattern for IVF around the world. Georgeanna died in 2005; Howard lived to the age of 104.

Then the egg collection itself became gentler. In Copenhagen, Suzan Lenz and her colleagues in Jens Bang's ultrasound unit described in 1981 how a needle, guided by an ultrasound picture, could reach the follicles through the abdomen and the bladder, under local anaesthetic, without an operation. In Strasbourg, Pierre Dellenbach and his team reported in 1984 a shorter route: through the wall of the vagina, with the ultrasound picture still taken from the abdomen. By 1985 they had used it for more than a hundred women, under local anaesthetic, and five healthy children conceived this way had been born. In Vienna, Wilfried Feichtinger and Peter Kemeter then placed the ultrasound probe itself inside the vagina, with a guide for the needle attached, so that the picture and the needle shared one path. Described in 1986, their approach is the basis of egg collection as it is done today.

So when an embryologist today receives a tube of warm follicular fluid and finds the egg inside it, she is holding the gift of a hormone chemist, a husband and wife who would not give up, and a handful of doctors who learned to see with sound.