Assisted reproductive technologies (ART) have advanced exponentially since 25 July 1978, which witnessed the birth of Louise Brown, the world's first test tube baby.

Since then, cloned sheep, octuplets, surrogacy battles, selective reduction, frozen embryos, gender selection, three-parent babies and all manner of life-and-death drama accompanying assisted reproduction have graced the media headlines, putting themselves up for debate on the rights and wrongs of each high and low.

But how did it all begin?

Controversial surgeon challenges theory that infertility is a "female problem"

Once upon a time, infertility was what society and medical experts deemed as a female problem. Especially when religion heavily influenced science, hysteria, a twisted womb, an evil spell and God's wrath were all cited in medical texts as reasons for a woman's inability to conceive. In the minds of our ancestors, it could not be a male issue as the woman was carrying the child.

Fortunately, the first physician to challenge that ideology was controversial 19th-century surgeon J. Marion Sims who used a systematic approach to human artificial insemination.

A nurse examines a baby at the New York Nursery and Child's Hospital in 1910. Photo credit: Internet Archive Book Images / Wikimedia
A nurse examines a baby at the New York Nursery and Child's Hospital in 1910. Photo credit: Internet Archive Book Images / Wikimedia

He has been reluctantly known as the father of modern surgical gynaecology as many of his notable medical contributions were the result of research he conducted on slaves without their consent - brutal surgeries to repair vesico-vaginal fistulae, without anaesthesia and minimal recovery time, with some patients subjected to as many as 30 operations.

But Sims was the first to devise and use the first vaginal speculum in his 55 artificial-insemination procedures in six different women at the Women's Hospital, which he founded. The procedures only resulted in one pregnancy and ended in a miscarriage. Sims' techniques would have been effective if the women's ovulation cycles were taken into account.

First artificial insemination to result in a live birth

Thus, the first artificial insemination to result in a live birth was performed by Philadelphia physician William Pancoast, which happened only decades after Sims' attempts. In 1884, a 31-year-old woman and her 41-year-old husband sought his medical advice at Sansom Street Hospital about her inability to conceive.

Like many others before him, Pancoast naturally assumed that the problem was with the woman's fertility. However, after many examinations, he decided that the fault might be in the husband's spermatic fluid.

Collecting a sample of the man's sperm, Pancoast conducted a microscopic examination which indicated that this "spermatic fluid" was "absolutely void of spermatozoons", likely due to a gonorrhoea infection a few years ago.

Initially, Pancoast told the man that the problem could be easily fixed with a course of treatment, but after two months of no progress, it was determined that his seminal ducts were permanently obstructed and he would not be able impregnate his wife.

Dr William Pancoast. Photo credit: Edited Appletons Encyclopedia, 2001 Virtualology TM
Dr William Pancoast. Photo credit: Edited Appletons Encyclopedia, 2001 Virtualology TM

But instead of informing the couple, Pancoast scheduled another "examination" for his patients. This was to test out his theory that the wife could be impregnated with the sperm of another man, proving that infertility can also be man's problem.

With a rubber syringe, gauze and chloroform, Pancoast set to work in front of his six medical students. He knocked the woman out with chloroform, packed her cervix with gauze and inseminated her with a rubber syringe. The source of the semen was from one of the six students who was unequivocally determined as the most attractive out of all of them.

The question of ethics in fertility tests

Nine months later, the woman delivered a healthy baby boy. However Pancoast still did not reveal the circumstances of the conception until after birth. Out of guilt, he eventually told her husband, who also decided that she would be better off not knowing the facts of her final "examination" or the biological father of her child.

And so, Pancoast's experiment remained a secret success for 25 years, until 1909, when Addison Davis Hard, one of the six medical students present on the day of the insemination, published a letter in Medical World describing the case.

Prior to the submission of the letter, Hard contacted the resulting child, who was at that time a 25-year-old businessman in New York and informed him of the details of his conception.

"At that time, the procedure was so novel, so peculiar in its human ethics, that the six young men of the senior class who witnest [sic] the operation were pledged to absolute secrecy," Hard wrote.

The identities of the sperm donor, the couple and their child are still unknown. However, Dr Pancoast's name lives on as a renegade physician who pioneered the practice of sperm donation and artificial insemination, and as a case study in unethical practices in medicine. MIMS

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