‘Boon for the Barren Woman’: John Rock and ‘Conception in a Watch Glass’
In the mid-1930s John Rock was the director of the Fertility and Endocrine Clinic - which he had founded in 1926 as the Sterility Clinic - at the Harvard Medical School-affiliated Free Hospital for Women in Brookline, Massachusetts.5 The IVF study was part of a multifaceted research programme in human fertility which he and his collaborators conducted from the 1930s. Its projects included studies on the timing of ovulation, changes to the endometrium (the lining of the uterus) during the menstrual cycle, the earliest stages of embryo development, and IVF. Together, this work built a foundation on which much of twentieth-century reproductive medicine was to rest.
Rock’s early research included a set of discoveries that enabled physicians to establish (at least after the fact) the presence and timing of ovulation, bedrock knowledge which led to the embryo and IVF research that would occupy him for the next 15 years. He first mentioned the idea of human IVF in an anonymous editorial in 1937, published in The New England Journal of Medicine. ‘The “brave new world” of Aldous Huxley’, he said, ‘may be nearer realization’ as a result of the work of a young Harvard biologist. Gregory Pincus (1903-67) had recently accomplished the birth of a rabbit after fertilizing an ovum ‘in a watch glass’ then implanting the resultant embryo in another rabbit. More practically speaking, Rock concluded, if this technique could be made to work in humans, ‘What a boon for the barren woman with closed tubes!’6
An avid reader of contemporary fiction, Rock was unable to resist an allusion to the acclaimed dystopian novel Brave New World, where, in Aldous Huxley’s futuristic scenario, nearly all humans were fertilized in test tubes and spent their prenatal lives in artificial wombs, fatherless and motherless.7 But Rock would surely have refrained from this offhand remark had he known that the IVF rabbit he invoked was about to wreak havoc on Gregory Pincus’s career. A Collier’s Magazine profile of Pincus’s work by J.D. Ratcliff, entitled ‘No Father to Guide Them’, predicted that the young biologist’s research could lead to a world in which women would no longer have to depend on men in order to bear children. And when that happened, the author suggested, women might not need men for anything else either. Pincus was denied tenure and his future career was placed in doubt.8
In 1938, Rock hired Miriam Menkin (1901-92), who had worked for Pincus before he lost his job. Smart, tenacious, and meticulous, she was perfect for this project and for Rock, who had little patience himself for the tedium of the laboratory. The next step was to recruit volunteers for the project. All in all, nearly 1,000 women agreed to participate.9 Most of them were patients in one of Rock’s clinics, either the Fertility and Endocrine Clinic, which focused on infertility and reproductive disorders, or the ‘Rhythm’ Clinic, where women were taught how to understand their menstrual cycles so that they could avoid having intercourse during their fertile periods (rhythm was the only kind of birth control legal in Massachusetts at the time). A smaller number came from Rock’s private practice. Many of the infertility patients were receiving a diagnostic procedure or a surgical treatment. Other women were undergoing hysterectomy or a range of more minor surgeries for various gynaecological disorders. All of them were having surgery that involved laparotomy, or the opening of the abdomen, which allowed the ovaries to be visualized.10
Journalist Joan Younger, reporting on the study in 1945, noted that when Rock ‘began asking some of the women who came to the hospital if they would co-operate’ in this project, they said yes for various reasons. Some of the infertile women hoped that future generations of women could be spared their suffering. Patients at the rhythm clinic tended to be sympathetic to the infertile women they had met while waiting for their appointments just down the hall. Still others might have agreed just because Rock or one of his staff asked them. ‘Without these women’, Younger wrote, ‘the knowledge that human ova [... ] can be handled outside the body might have been delayed another decade, another generation’.11
After six years of failure, Menkin fertilized her first egg in February 1944. By accident rather than design, she altered several of Rock’s protocols. Worn out from having been kept awake two nights running by her teething baby, Menkin decided to wash the sperm just once instead of three times and to use a more concentrated suspension. Then, without meaning to, she extended the contact time. ‘I was so exhausted’, she later recalled, ‘that I couldn’t get up’, and she soon discovered that she had sat for at least an hour, transfixed. In shock when she realized that the experiment had actually worked, she called everyone in the lab to see the results. They all became so excited over the newly fertilized ovum that an argument ensued about the best way to preserve it. In the heat of the discussion, they forgot to photograph the specimen. When the argument was over, and Menkin went back to the microscope to begin the preservation process, she could not find the egg. She was mortified, but Rock consoled her. After all, he said, now they knew it could be done. Still, Menkin had no idea which of the accidental new factors had made the difference, so she incorporated all three into her next experiments. Within a couple of months she was able to fertilize three ova from two women, and each of them was carefully photographed before being preserved. Now, she and Rock felt confident enough to send a report to Science, which announced the discovery in August 1944.12
By this time Rock had abandoned his Huxleyan flourishes. ‘Conception in a watch glass’, he now argued, could make it possible for women with blocked or absent fallopian tubes to become pregnant, and indeed tubal disease was responsible for about 20% of the infertility cases encountered in Rock’s practice. Some of his colleagues reported even higher figures. Surgery was generally the treatment of choice, but even the best surgeons reported pregnancy rates of only around 7%. In vitro fertilization, because it bypassed the tubes, had the potential to make pregnancy possible for a significant proportion of these women. Looked at in this light, IVF was simply an unconventional means to a conventional end.13
Most of Rock’s scientific and medical peers, including George Streeter, the most distinguished embryologist of that era, were persuaded that Rock and Menkin had indeed achieved IVF (sceptics emerged later). The press, enthralled, had a field day. It sometimes comes as a surprise to contemporary scholars, many of whom are aware of the bitter controversies over IVF in the 1970s, that the reaction to Rock and Menkin’s announcement was almost universally positive. True, there were a few reporters, unable to forget the plot of Brave New World, who wondered whether Rock’s ultimate goal was for babies to begin their lives in artificial wombs, but Rock quickly disabused them: ‘Test-tube babies, or even test-tube rabbits, probably never will be developed outside the imagination of fiction writers.’14
When Rock used the term ‘test-tube babies’, he was referring to artificial gestation, which is very different from IVF, where the goal is to implant a fertilized egg into a woman’s uterus so that she herself can become pregnant. As science journalist Robert Bird reported, IVF followed by a natural pregnancy ‘was a present objective of science’. This achievement was not, he quoted Rock, ‘beyond the realm of imagination, and it seems to offer about the only hope for women whose tubes have been destroyed’.15 Most journalists got the point. ‘Don’t do any thinking [... ] about growing babies in test tubes’, Joan Younger told readers of Collier’s in 1945. The ‘whole idea is fantastic, and scientists have more to do now than to allow their imaginations to roam at large through freakish fields’. Pregnancy via IVF, however, was a different matter. ‘If the many- celled stage of life can be reached’, she wrote, ‘there may be hope that test-tube fertilization will answer the hopes of many childless couples’.16
Fewer than ten years before, Collier’s had invoked Gregory Pincus and his fatherless rabbits as predictors of a future where children came into the world parentless and men could become obsolete. Now the same magazine presented IVF matter-of-factly as a means to help women with fallopian tube disease to have children. The purpose of IVF, the press seemed to agree, was simply to help to solve the ‘problem’ of childlessness. The dystopian anxieties of the 1930s had lost much of their force as the gloomy economy of the Great Depression gave way to wartime prosperity. As the end of the war seemed ever closer, Americans became more optimistic about the future. Furthermore, this was an era that celebrated new scientific and medical discoveries, and few Americans doubted that technological advances would be used to promote the public good. And finally, the wartime upturn in births was about to be followed by a massive baby boom, with men returning from the war to wives and sweethearts, and couples were ‘in a hurry to begin the families so long delayed’.17 If the hoped-for pregnancy failed to occur as expected, the media reported, medical science would come to the rescue. As a result, IVF was viewed not as a threatening or somehow alien technology but as a possible way to allow women suffering from a common cause of infertility to bear children. IVF pregnancies were not even possible yet, but already the idea was becoming ‘normalized’.
The fact that the first steps toward IVF were credited to a clinician whose looks could have given him the leading role in any Hollywood film about a heroic doctor, and who also had a reputation for uncommon rapport with his patients, might also have played a part in making the prospect of babies conceived in a ‘test tube’ a lot less threatening. Luigi Mastrioanni, a prominent reproductive specialist in the late twentieth century who had been one of Rock’s proteges, remembered his amazement at the bond Rock and his patients forged. ‘The way this man communicated with patients was something I’ll never forget’, he told an interviewer. Rock made the women who participated in his studies feel like valued contributors and not simply research subjects. Younger quoted one of them as saying, ‘Gee, I don’t see how you make me so important [... ]. Sometimes I think it’s almost as good as being a doctor myself.’18
Women from all over the country read accounts of Rock and Menkin’s research in the newspapers and popular magazines. Hundreds of them wrote to Rock directly, asking whether this new discovery could help them become pregnant. The letters began to arrive almost as soon as reports of the Science article appeared in local newspapers across the nation. From a small mining town in Pennsylvania, in August 1944, 23-year-old Mrs C. told Rock about the removal of her fallopian tubes ‘do [sic] to adhesions’ and her distress over the prospect of never becoming a mother. ‘After reading on your work I thought perhaps you would help me’, she wrote, closing with the affecting phrase ‘I remain waiting’. Rock replied promptly. Although he was careful to tell Mrs C. that IVF research was in its early stages and was not yet of ‘any clinical value’, he did not completely discourage her. ‘Fortunately, you are young yet so don’t give up hope.’19 In the initial flush of the successful fertilizations, Rock hoped that clinical application of IVF would be within reach in perhaps a decade or so.
It didn’t take too long, however, for his responses to become more tempered. When a few months later Mrs M. wrote about her two ectopic pregnancies that required the removal of both of her fallopian tubes, he told her: ‘Fertilization outside the human body, I am sorry to say, has not arrived at any stage in which it can offer any clinical help yet. That it will have sometime, is my ardent hope, in the interests of people just like you, but there is still a tremendous amount of work to be done’.20 As he began to consider the multiple scientific and technical obstacles that remained to be overcome in order to produce an IVF pregnancy, he found the prospects sobering. After all, Gregory Pincus did not have to worry about the health or life of the rabbit into whom he implanted another rabbit’s fertilized egg. Nor did he concern himself about the condition of her potential offspring, although the ‘normal, healthy bunnies’ she produced were surely gratifying.21 But if IVF were to be used in humans, the health of both mother and baby would have to be of primary importance.
Rock’s answers to the many women who wrote to him over the next five or six years reflected both his hopes for IVF’s clinical development and his acknowledgment of the problems that remained unresolved. To Mrs W., who lived in Florida, he wrote, ‘Don’t get discouraged if you are a “very young woman”. Science moves on and the time may easily come, and perhaps sooner than you expect, when something can be done for you’.22 To another woman in her early 20s, he wrote in 1948: ‘At age twenty-four, there is no need to accept absolute defeat [... ] but at the same time, you want to be very practical’. While IVF might become a reality during her reproductive lifetime, ‘there is not sufficient certainty’. He could make no promises and urged her to consider adoption.23
As the years wore on, Rock continued to attempt, without much success, to dampen down the media’s exaggerated predictions. To a writer for Look Magazine he explained in 1950, ‘We don’t know the requirements made by the fertilized egg of its environment, and there are a great many more things we do not know’. Pressed, however, he conceded that ‘theoretically, at least - there are no insoluble problems’. Emboldened by that last sentence, the author - the same writer who had produced the article on Gregory Pincus’s ‘fatherless rabbits’ - proceeded to detail how IVF might allow for ‘an egg taken from a woman’s ovary [... ] [to] be fertilized and incubated outside the body, then implanted in the same woman’s womb’. And for those women without a uterus, ‘motherhood would still be possible with egg-transfer breeding’. After all, women sell their milk, why not their uteruses? ‘Tomorrow, they may offer their bodies as incubators for the babies of women who are denied motherhood. ’24
This article brought Rock a new round of letters from women hoping that IVF could help them, which only made Rock more exasperated by these misleading articles that were giving rise to false hopes. Knowing by now how difficult the path to clinical IVF was likely to be, he tried even harder to explain to the women who wrote to him that IVF was unlikely to be available soon enough to help them. ‘I regret very much’, he wrote to Mrs E.M., ‘that work with human eggs has not progressed anywhere near the stage to which [... ] it would be of any help to you. It is not too difficult to fertilize the eggs, but [... ] to keep them in normal condition until the womb is ready to take them is a major problem on which we must work long and hard.’25 To another enquiring woman, he explained in 1951 ‘that the matter about which you write is still in the very theoretical stage and has nowhere near approached practicality, nor will it within, I believe, many years’.26
By this time he was no longer actively involved in IVF research. It had become obvious to him that it would likely take decades rather than years before this technique could be used to achieve a pregnancy. Rock, fundamentally a clinician whose main goal was to help his patients, soon turned his attention to what he considered more immediately promising surgical therapies for damaged fallopian tubes as well as to hormonal therapies for ovulatory disorders (in an interesting twist of fate, the latter led to his collaboration with Pincus on the oral contraceptive). In spite of the fact that he abandoned IVF for what he considered sensible reasons, questions later arose about whether he had been pressured to do so, either by Harvard or the Catholic Church. Nearly three decades later, Menkin told journalist Loretta McLaughlin that Rock, a prominent Catholic, had certainly been pressured by the Church and perhaps, more subtly, by Harvard Medical School. She believed it was such pressure that caused him to give up the pursuit of IVF.27 However, the record shows that Rock told others that he had discussed the IVF research with a Catholic theologian before he began and had no qualms about proceeding, and his surviving papers give no indication that he felt constrained either by the Church or by Harvard. It is possible that Menkin’s own later recollections had been coloured by the more adverse climate of opinion about IVF in the 1970s.
Menkin herself, however, during the time she spent away from the Free Hospital in the late 1940s, did face difficulties in continuing IVF research. When she and her husband moved to North Carolina soon after the first IVF reports were published, she hoped to continue this work at Duke. However, she found little support there. One doctor was actually hostile, referring to IVF as ‘rape in vitro' Later, when she and her family moved to Philadelphia, she
tried again; there, she faced not hostility but indifference. Moreover, Menkin, who had come back to work for Rock in the 1950s and 1960s when he was helping to develop and then rally support for the oral contraceptive, was there to see Rock roundly criticized by some in the Catholic hierarchy for his work on the Pill. She would not have forgotten that controversy and she may have conflated the two in her mind.
After Rock stopped conducting research on IVF, media interest seems to have waned. Landrum Shettles, then a little-known doctor in New York, published several accounts of fertilization in medical journals during the 1950s. His work, however, received little public attention.29 There was a brief media flurry in 1961 when Italian researcher Daniele Petrucci announced that he had succeeded in culturing an embryo for 29 days. Although he defended his work as ethical when criticism from the Vatican greeted the announcement, he may indeed have been silenced by it.30