I own a sterling-silver necklace with a heart-shaped pendant engraved with the number “1.” I wear it only on special occasions or when I speak at fertility conferences. The necklace was a childhood gift from two pioneering fertility doctors, and it’s a reminder that I’m a kind of accidental expert on reproductive technologies — although my birth was anything but an accident. Forty years ago this December 28, I became the first baby born in the U.S. via in vitro fertilization (IVF).
The event, which occurred at a hospital in Norfolk, Virginia, called for a packed-house delivery room, complete with a PBS-documentary film crew. Security guards blocked the doors to any potential intruders. On the street outside, protesters picketed against IVF, which was legal in Virginia but illegal in my parents’ home state of Massachusetts. Near the protesters, TV news crews waited for word on whether I had come out “normal.”
After a successful delivery, my mother and I were declared perfectly healthy. Howard Jones, M.D. — who, with his wife, Georgeanna Jones, M.D., had founded the fertility clinic where I was conceived — told the press, “I think this is a day of hope.”
For my parents, my birth was the fulfillment of a dream. For the United States, it signaled new possibilities for infertile couples — and a radical shift in our understanding of when and how it was possible to become a mother. In a way, IVF helped redefine the careers and family expectations of every woman in the boomer generation and younger, whether or not they ever sought fertility treatments themselves.
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How it began
The first so-called test-tube baby in the world, Louise Brown, was born in 1978 in the U.K., though much of the scientific groundwork for her birth had been laid in the U.S. In 1944 two scientists at the Free Hospital for Women in Brookline, Massachusetts, were the first to successfully fertilize a human egg with sperm “in vitro” — that is, in a glass laboratory dish — but they soon ended their experiments. In 1965, while my future doctors Howard and Georgeanna Jones were practicing at Johns Hopkins University in Baltimore, they mentored a visiting British researcher as he repeated the feat. In 1973 a Columbia University physician took the next logical step: He created and then incubated a couple’s fertilized egg, planning to implant it into the woman’s uterus four days later. If he had succeeded, it would have been the first IVF pregnancy in the world. But when a hospital administrator got wind of the doctor’s project and feared controversy, he destroyed the incubating egg, and the physician resigned under pressure. Research on IVF stalled in the U.S. And that British visitor who’d worked with the Joneses in Baltimore, Robert Edwards, became part of the U.K. team that brought Louise Brown into the world.
The Fertility Timeline
Our understanding of human reproduction is surprisingly recent — and ever expanding
- 1827 - Discovery of the existence of the human female egg
- 1884 - First successful human pregnancy via artificial insemination
- 1934 - Successful in vitro experiments on rabbits
- 1944 - First in vitro fertilization of human eggs
- 1949 - Pope Pius XII denounces fertilization of eggs outside the body.
- 1953 - First live birth via frozen sperm
- 1978 - First IVF baby, Louise Brown, is born in the U.K.
- 1981 - Birth of the writer, the first U.S.-born IVF baby
- 1983 - A child is born via egg donation in Australia.
- 1990 - Screening of an embryo for genetic defects before implantation
- 1992 - Successful use of injection of a sperm directly into an egg
- 2014 - Birth of a baby to a mother with a transplanted uterus
Why did American IVF research fall behind? Public pressure and fear. Some critics questioned the ethics of creating and destroying human embryos. Others worried about the health of any children created by the technique, predicting they could have serious deformities. And some objected on religious grounds, claiming that, in the words of Moral Majority leader Jerry Falwell Sr., researchers were “delving into an area that is far too sacred for human beings to be involved in.” After the failed Columbia University IVF attempt in 1973, the federal government instituted a freeze on funding for IVF research.
But after Brown’s birth in the U.K. demonstrated just how normal a test-tube baby could be, the resistance in the U.S. began to drop away. In 1980 the Joneses, who had reached Johns Hopkins’ mandatory retirement age of 65, opened the country’s first IVF clinic, in Norfolk. As Dr. Howard once told The Washington Post, “We thought it was an alternative to fading away.” Within a year, my mother had become one of their first patients.
My family’s story
My parents, Judith and Roger Carr, both came from close families. Married young, they started trying for a baby as soon as my mom graduated from college with her teaching degree. But Judith, now 68, experienced three ectopic pregnancies — the fertilized eggs grew outside her uterus — leading to miscarriages and damage to her fallopian tubes that left her unable to conceive naturally. My devastated parents first learned about IVF from my mother’s primary care physician. “The doctor said he didn’t understand much about it,” my mother recalls. “Although I had no idea how complex the process would be, Roger and I were willing to explore the possibility.”
As one of the first 50 couples admitted to the Joneses’ new clinic at the Eastern Virginia Medical School, my parents commuted via airplane for hormone treatments, the harvesting and fertilization of the egg that would become me, and prenatal checkups. The fee at the time, not covered by insurance, was not insignificant for a young couple: up to $4,850 in lab fees and doctor fees for each attempt. But at ages 28 (Mom) and 30 (Dad), my parents made history as the parents of the first IVF baby born in the U.S.
I realized at a very young age that my birth was momentous. I was the only kid in my class who’d been on the cover of Life magazine and the subject of a Nova documentary. The Joneses helped me memorize a two-sentence explainer of my origins for anyone who asked: “The sperm and the egg were combined and fertilized in a petri dish. Once the egg was fertilized, it was put back in the womb, and nine months later, I was born, just like every other baby.” I remember Dr. Georgeanna once telling me, “Your parents wanted you so very much. They just needed a little help from science.”
A changing society
Since my birth, IVF has become one of the most widely known and broadly accepted types of assisted reproductive technology. Approximately 2 percent of babies born in the U.S. are the product of IVF or a related therapy, according to the Centers for Disease Control and Prevention. Although still expensive, at $12,000 to $17,000 per attempt, IVF is now covered by at least some health insurers, including those that operate in the 19 states with fertility-insurance laws in place.
Originally seen as an option for only young heterosexual couples, IVF now offers biological parenthood to same-sex couples, single women with fertility issues and older women whose fertility has declined. The breakthrough technology has also led to other treatments — such as the use of donor eggs, embryo and egg freezing, and surrogacy — for people who are hoping to bring a child into the world.
But the most widespread impact of IVF may have been felt by Americans who have never used it. Although the technology hasn’t turned off a woman’s biological clock, its existence has quieted the ticking, especially for women in their 20s and 30s who want to pursue an education and develop their careers before starting a family. The birth control pill, approved by the Food and Drug Administration in 1960, made it practical for a woman to delay childbearing; IVF made it possible for her to hope to start a biological family in her 40s or sometimes even in her 50s, when the odds of natural conception decline. In the past 50 years in the U.S., the average age of first-time mothers has risen from 22 to 28, and women have become eight times more likely to delay having their first child until age 35.
As a result, “stereotypes about women and age are being dismantled,” wrote the authors of a 2008 University of California, San Francisco, study on this rise in older motherhood. Even if relatively few women become mothers through IVF and related technologies, the authors predicted, the availability of these technologies “will likely affect women’s roles in later life, extending the period of midlife and deferring what people think of as old age into the 80s and beyond.”
This is not to say that IVF is foolproof. In my sideline as a speaker at fertility conferences around the globe, I hear heartbreaking stories from women who have struggled to conceive. And one story in particular comes to mind: a woman in her 50s who got pregnant after spending $30,000 on fertility treatments. “My body is tired,” she told me. “And my checkbook is, too.” There are many others for whom no fertility treatments will work or for whom the treatments are too costly to try. According to one 2012 study, the rate of involuntary childlessness had doubled since the 1970s in several Western countries; the authors blamed this on the trend toward delayed childbearing combined with a lack of access to IVF and other fertility treatments.
In Israel, where IVF is provided for free as part of the national health care system, Wharton School professor Corinne Low has been able to study the technology’s impact on women’s family lives and careers. Women have faced two conflicting pressures as IVF and other fertility treatments have made it possible to delay motherhood. On the one hand, the promise of IVF has encouraged some to put off childbearing while pursuing educational or career goals. On the other hand, when these women finally do have children — whether naturally or through expensive fertility treatments — the data shows they’re spending a tremendous amount of time raising and investing in those children. “It becomes like a trap,” Low explains. The more education and career success a woman has, the more she stands to lose financially by taking time off work. But at the same time, “the more valuable and the more irreplaceable her time at home is. I think for things to really change, we have to recognize the economic value of the creation of the next generation.”
Where we go from here
Fertility technologies continue to develop. Some of the latest include ovary and uterus transplants, screening for inherited diseases before implantation, and the injection of a sperm directly into an egg if the man’s sperm isn’t able to penetrate an egg naturally. The version of IVF that brought me into the world seems primitive by today’s standards.
But what I have learned over the years of speaking with those going through fertility treatments is that people’s hopes and dreams — for their own education and careers, as well as for their family’s — are resilient and inspiring.
While my silver “1” necklace has a personal meaning to me and my parents, it has also become a reminder to me of all the people I’ve met because of my unique birth, including those struggling to create a family and those who have succeeded — whether the old-fashioned way, through fertility treatments or through adoption.
As a mother myself, I know that no matter how much our society or our technology changes, some things about becoming a parent will always remain the same. “When we finally had you, we had such a feeling of relief that the process was over,” my mother told me recently. “And joy. So much joy.”
Elizabeth J. Carr is a patient advocate in Swanzey, New Hampshire, and a frequent speaker at infertility conferences worldwide.