a life of IVF Pioneer

The 20th anniversary of clinical IVF was celebrated at Marrakesh in 1998, and Robert Edwards cited Jean Purdy as being one of three original pioneers of IVF. It was an indication that she was already being forgotten 13 years after her premature death from malignant melanoma that he felt it necessary to endorse her place in history to an audience of specialists. Almost 20 more years on, she is so much less visible, and neither Bob nor Patrick Steptoe are around to remind us.?

Jean played a pivotal role in launching effective fertility care worldwide through overcoming years of controversy. The reason she never sought the spotlight was not so much that she lacked the qualifications or charisma of her two male colleagues, but that she enjoyed caring for embryos in the background while Patrick and Bob went into public view. Despite his best efforts, Bob had trouble getting her name incorporated onto a plaque commemorating their joint achievements (Johnson & Elder, 2015). She would never have objected to the push-back and complained that honour was denied had she known about it, since, to her, the work itself was a sufficient recognition. However, Jean Purdy's story has been hidden.?

Jean (Jeannie to her friends) was born in Cambridge in 1945 to George and Gladys Purdy, two years after her brother. While he was a technician in the University Chemistry Department, his wife was a homemaker and mother who, although it wasn't a prosperous or auspicious start in life, enjoyed a happy and loving family life. Between 1956 and 1963, she was a popular and conscientious student at Cambridgeshire High School for Girls, where she was a prefect, joined sports teams, and played violin in the orchestra (Figure 1). Jean's teacher wrote in her final report: 'Jean's lovely personality and knack for getting along with other people make her better suited to her choice of career (nursing).' They were more prescient than they knew.?

She was trained as a nurse at Addenbrooke's Hospital in Cambridge and then worked in Southampton at the Chest Hospital, but was homesick and transferred to the Papworth Hospital in her county, which pioneered open-heart surgery and heart transplants (from 1979). Robert Edwards was looking for a research assistant to replace one who was leaving the Physiological Laboratory in Cambridge in 1968, so she applied for the position. Although she had some experience as a laboratory technician, she was only 23 years old.?

At first, neither Bob nor Sue realized that their move would make a lasting impact on their lives.?

Patrick had recently introduced laparoscopy to Britain and Bob began working with him to treat patients without subjecting them to major surgery in order to recover follicular oocytes. The goal was to bypass occluded Fallopian tubes so that patients could conceive with their own gametes using IVF, a technique that had only worked in rabbits and rodents thus far. They would be led and other thought-provoking scholars who would follow, to explore ever more powerful technologies, since only by risking too far can the limits of human potential be discovered (Eliot, 1931). When human embryology was first developed, the challenges were immense: how to obtain ripened oocytes using keyhole surgery, establish culture conditions for monospermic fertilization and embryonic cleavage, distinguish healthy from abnormal embryos, and replace embryos in the uterus.?

The IVF laboratory manager was hired to be a go-between for the pair of strong male personalities, but she quickly earned such respect from her boss that she became indispensable to them. Between Cambridge and Patrick's practice in Oldham, Lancashire, their tiny team was separated by nearly 200 miles of high-ways that were then mostly non-motorway standard. Louise Brown wouldn't have been born before 10 years of striving and more than 100 trips to the north country. When Bob's duties kept him in Cambridge for undergraduate teaching and mentoring junior researchers, Jean managed the laboratory on her own for up to a week at a time.?

Purdy and Edwards visited Steptoe's Oldham base, where Steptoe conducted a decade-long clinical trial (1968-1978) that led to the success of IVF. In this phase of research, Purdy wrote a lot of notes in his notebooks.

Additionally, Purdy visited Harbor General Hospital in California in 1969 to study the composition of follicular fluid with Guy Abraham. In order to succeed with IVF, more research is needed in the area of follicular fluid. Purdy sent detailed letters to Edwards during her California research trip, which are included in the archive. They depict Purdy's role in the development of the science behind IVF, which is apparent from the length of the letters full of results from experimentation.

The first embryologist was Jean Purdy, who was a laboratory technician, nurse. Since then, she has coauthored numerous books and articles with Edwards. Purdy had contributed equally to the birth of Louise Brown and the founding of IVF centers in Kershaw's Hospital, Oldham, and Bourn Hall (preface to "Implantation of Human Embryos: Proceedings of the Second Bourn Hall Meeting", 1985).

Even during those days, Dr. Kershaw's Cottage Hospital (now a hospice) had primitive laboratory facilities, but their vision and determination made up for the lack of funds (Steptoe, 2015).?

A windowless box-room measuring 8 m2 barely accommodated two workers. On the table were a weighing scale and a large vessel of double-distilled water, shelves for storing dry chemicals, and a pH meter and osmometer for testing culture media.?

Almost everything was taken up by a laminar flow hood, including a Wild binocular microscope. In those days, gassed incubators were unavailable, so Jean cultured cells in a bell "vacuum desiccator (Right Image) " jar filled with 5% CO2 in air inside a standard 37 C incubator. The inventory cost less than ￡10,000 in total.?

Until 1974, only Bob and Jean worked in the laboratory, except for Joe Schulman, who visited from America on a clinical science fellowship. It was a great rarity in his profession to understand the immense potential of IVF.?

The role of Jean became clearer after Johnson and Elder (2015) analyzed all 21 Oldham laboratory notebooks. Among her responsibilities were managing laboratory supplies, creating culture media, monitoring gametes and embryos, and recording data. She benefited from her nursing qualification in the application of sterile techniques and gained a strong understanding of reproductive anatomy and physiology, but the curriculum hardly included embryology.?

Patrick's operating room was next to the laboratory, and Jean didn't participate directly in most of the laparoscopic oocyte retrievals thanks to the territorial nature of resident surgical staff. Her sole responsibility was to convey fluids to Bob, who was responsible for searching for cumulus oocyte complexes and clutching embryos. Her work led to the development of vacuum aspirators, records of embryo development, and chromosome counts in fixed specimens. She had to wake up every few hours in the night to rouse patients to provide urine samples for the measurements of LH surges when the programme switched to single oocytes in natural cycles.?

In the period between 1970 and 1985, Bob made her a coauthor on 26 academic publications, including three in Nature/Lancet. According to her obituary (The Times, March 19, 1985), she was the first person in the world to detect and describe the formation of the early human blastocyst. This led later to the development of embryo stem cell lines and restored hope for regenerative medicine.?

He mentioned her role in his autobiography: ‘It was no longer just Patrick and me. We had become a three- some ... (she was) the patient, indomitable helper without whom none of our work would have been pos- sible ...’ (Edwards, 1989). Schulman (2010) remembered how she was ‘tremendously devoted to Bob and the IVF project’.

Bob provided the inspiration, Patrick provided the application, and Jean provided the dedication in this triangular collaboration. When she could not travel due to her mother's final illness, it was clear that she was an integral part of the programme. Around that time, Bob was depressed by the toll of unsuccessful embryo replace- ment cycles and considered abandoning IVF research for a career in politics. A rumour at the time suggested it was Jean who persuaded him to keep going.?

People described her as quiet, unassuming, self- effacing, all of which were true, but anyone who called her mouse-like never knew how she could roar at social injustices or become defensive when the IVF team was attacked by establishment figures. It was an ugly time because they were accused of breaking moral boundaries by experimenting with embryos, and discounting the risks of creating unhealthy children.?

But despite the reproaches she did not feel any conflict with her Christian faith, regarding IVF as a calling to help couples have the children that nature denied. If she ever harboured dreams of marrying and building her own family, there was never time to fulfil them, but instead she gave all to an endeavour that looked bleak until their breakthrough in 1978 when the first IVF baby was delivered.?

The National Health Service refused to support a publicly funded service during that triumphal time when Patrick was forced to retire from his practice in Oldham due to age. The team made urgent efforts to secure funding for a private clinic near Cambridge where they could collaborate. During this time, Bob was busy writing a monumental textbook of over 1000 pages (Edwards, 1980) to which Jean contributed a great deal by scouring journals for data, but he released her to scout for new premises. Eventually, she found a Jacobean manor house for sale, and this became the renowned Bourn Hall Clinic.?

During this time, Bob was busy writing a monumental textbook of over 1000 pages (Edwards, 1980) to which Jean contributed a great deal by scouring journals for data, but he released her to scout for new premises.?Eventually, she found a Jacobean manor house for sale, and this became the renowned Bourn Hall Clinic. (Left Image)

The clinic hosted scientific workshops for specialists to share experience from around the world. I remember the time in November 1984 when Jean drove us about ten miles from the University Arms Hotel to the Hall.?

Only an unnatural pallor betrayed a dire diagnosis behind her welcoming smile and jokes. When her con- dition deteriorated, Bob arranged a bed for her in the Hall’s attic where she could still be a part of the team and receive visitors. Tim Appleton, a Cambridge physiologist who had taken holy orders and became the first fertility counsellor, spent a lot of time with her. He recalled her saying she was luckier than other people because she knew how long she had left. It was the same fortitude displayed at work that carried her through illness until she passed away at age 39 in 1985.?

Jean was buried beside her mother and grandmother in Grantchester churchyard, a beauty spot outside Cambridge that is forever associated with the First World War poet Rupert Brooke.?

While Jean's life might seem tragic, it is surely enviable because she poured all of her energy into an enterprise that gave it meaning, something few people manage to do, and changed lives for the better.?

If you are searching for Jean Purdy's legacy, do not look for it in published papers or laboratory practices, but in the 370 children she conceived in Oldham and at Bourn Hall Clinic during her tenure and the joy they and others have inspired.?

As a final word, thousands of special organizations and events are held for IVF treatments around the world. In fact, we can put these pioneers in IVF in the rooms where presentations are made in the congress halls in order to keep the pioneer names such as Jean Marian Purdy alive. For example; This Section is at Jean Marrian Purdy.

"At least we can see their names outside of the tombstones."

REFERENCES?

EDWARDS, R.G. (1980). CONCEPTION IN THE HUMAN FEMALE. LONDON: ACADEMIC PRESS. EDWARDS, R.G. (1989). LIFE BEFORE BIRTH: REFLECTIONS ON THE EMBRYO DEBATE. LONDON: HUTCHINSON. ELIOT, T.S. (1931). PREFACE TO TRANSIT TO VENUS (POEMS BY HARRY CROSBY). NEW YORK: BLACK SUN PRESS. JOHNSON, M.H., & ELDER, K. (2015). THE OLDHAM NOTEBOOKS: AN ANALYSIS OF THE DEVELOPMENT OF IVF 1969–1978. V. THE ROLE OF JEAN PURDY REASSESSED.REPRODUCTIVE BIOMEDICINE AND SOCIETY ONLINE, 1, 46–57. DOI: 10.1016/J.RBMS.2015.04.005. SCHULMAN, J.D. (2010). ROBERT G. EDWARDS. A PERSONAL VIEW- POINT. SELF-PUBLISHED. STEPTOE, A. (2015). BIOLOGY: CHANGING THE WORLD-A TRIBUTE TO PATRICK STEPTOE, ROBERT EDWARDS AND JEAN PURDY. HUMAN HUMAN FERTILITY (CAMBRIDGE, ENGLAND), 18, 232–233. DOI: 10.3109/14647273.2015.1077657.?

THE TIMES. (1985). MISS JEAN PURDY. THE TIMES, TUESDAY MARCH 19TH ISSUE 62090; P. 16.?