A Matter of Life (1): The Genesis of Assisted Conception and Blocked Fallopian Tubes

22 Nov 2012

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Blocked Fallopian Tubes

By Olumide Alexandre

This educational series was adopted  from the autobiographical account of the world’s first test-tube baby – a feat that was earlier achieved in 1978 by the  2010 Nobel Laureates’ in Medicine and Physiology for their 34-year long success story that has now brought smiles to over 4million families worldwide.

The Challenge

The life changing question that nurtured a series of inventions and innovations in reproductive medicine was asked during a ward round where one of Mr Gwillim’s medical students at St. George’s Hospital in London would champion the science of Assisted Reproduction Technology. The seed of invention sprouted in the following conversation that ensued with a patient during a ward round:

Mr. Gwillim (Consultant Gynaecologist):

“…but if the egg cannot descend down the Fallopian tubes because these are obstructed in the first place, none of that (process of conception) can happen.”

Patient (with an astonishing look):

“Doctor, can’t the Fallopian tubes which you say are blocked just be by-passed?”

Mr. Gwillim (Consultant Gynaecologist):

“Oh no!”

Patrick Steptoe (Gwillim’s medical student):

“Mr Gwillim looking at the students – for a participatory response; we shook our heads – in consent.”

The Science

Those words were indeed the seeds of a new era in medicine which would later birth the days of Assisted Reproduction Technology. Mr. Gwillim – the then Consultant Gynaecologist at St. George’s Hospital, London had to really be truthful albeit sympathetic with the words: “I’m afraid you will never… Never – be able to conceive a baby!” That verdict of ‘never’ though softly spoken, leaves the woman shaking, empty, her face too naked, and her private grief too unconcealed.

Mr. Gwillim carefully explained to his medical students – one of whom would be the world acclaimed Patrick Steptoe – who together with Dr. Robert Edwards – announced the birth of the world’s first test-tube baby; that “2 out of every hundred female adults have blocked tubes.” Although surgical repair of the occluded fallopian tube might restore fertility, most times scar tissues are formed in the repair – still en-trapping released eggs; and if ever a sperm cell manages to reach the position of the egg, the damaged cilia lining the tubal walls make motility difficult and as such may favour the formation of ectopic pregnancies instead.

The gradual course to conception basically begins with the shedding of the egg from either ovaries - brushed in by cilia-like structures at the end of the fallopian tube and all the way through the smooth musculature where it lays in wait for a single spermatozoon amongst the numerous spermatozoa swimming up from the vaginal course, through the cervical opening, into the uterus and to the fallopian tube where the egg gets fertilized and finally begins its journey to the uterus for implantation and continued healthy growth till parturition.

That is what simply happens in the woman with the healthy or patent fallopian tubes with no distortions or blockage whatsoever. Mr. Gwillim’s patient looked uncomprehendingly at her X-ray films lit on the screen. Her tubes were severely distorted and blocked as a result of some previous infections. However we now know in modern science that infection may not just result from sexually transmitted diseases which may progress to the very damaging Pelvic Inflammatory Disease (PID); it may also arise from:

Abdominal infections from a ruptured appendix, Severe gallbladder disease, Trauma which injured the intestines, or  Inflammatory bowel disease – amongst others.

The mechanism with which the infections progress to cause a blocked fallopian tube is such that it induces the immune system to form scar tissues within or around the pelvis– as a means of fighting off the infection or during the process of healing which may subsequently scar-up distorted affected sites or result in an outright closure of the tubes from its ends.

Mr. Gwillim – the then Consultant Gynaecologist only lived in the science of his time and all his instinct could tell  – deducing from the patient’s history and medical records, was indeed a just fact that left the patient defeated and without hope. She was sentenced to a childless life. How sad!

A Flicker of Hope

Right about the time that same patient had to leave St. George’s Hospital, London without hope, a Harvard scientist, Dr. John Rock, thought he had actually managed to fertilize a human egg in vitro (outside the body – in the petri dish) where he reported that he had seen this fertilized egg divide into three cells. His claims were however pathetically discounted as other scientists criticized that all he saw was an example of parthenogenesis – a bizarre case where the egg had been stimulated to divide without being fertilized by a sperm. Unknown to the critics, Dr. John Rock already came close to solving the challenge, but his enthusiasm was already lost to their pessimism.

However soon enough, that one conquest of “by-passing the blocked fallopian tubes” to fertilize the egg – would be shared by these two Nobel scientists at Oldham in Manchester, United Kingdom. With a team of other eminent scientists and clinicians, they finally helped Lesley Brown achieve pregnancy and the eventual birth of Louise Brown – the world’s first test tube baby, after nine years of childlessness due to blocked fallopian tubes.

Tags: Health, Blocked Fallopian Tubes

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