Good Quality. Ayo Wahlberg

with the Chinese Obstetrics and Gynecology forum:

      My expertise was in reproductive endocrinology. When I treated patients with period issues in the 1980s, I found that many of them not only wanted to cure their period problems, but also mainly wanted to get pregnant. A lot of them had been married for over two years but still couldn’t get pregnant. Therefore I began to look into what was causing their infertility. After research and analysis I found out it was due to blocked fallopian tubes. In most cases this was the major problem. Blocked fallopian tubes were mainly an issue in China, which was completely different from other counties. In China 31.3 percent of female infertility was caused by tuberculosis. We proved that they had tuberculosis through research and biopsy. So this cause was not necessarily the same as in other counties. The main clinical manifestation was pelvic adhesions, and the surface of the ovary couldn’t even be seen. (Zhang, Interview 1)

      Lu, on the other hand, was introduced to the field of ART by her father Lu Huilin, one of the founders of medical genetics in China. Lu Huilin had traveled to the United States in 1924 to further his education at Columbia University, studying under Thomas Hunt Morgan and Edmund Beecher Wilson for a master’s degree in genetics. Armed with a number of Morgan’s works, such as Human Inheritance (1924) and Evolution and Genetics (1925), Lu returned to China in 1929. Disrupted by illness and the Japan-China war (1937–1945), Lu eventually set about translating Morgan’s texts in the late 1940s with a view to spreading his theories to a Chinese audience. In 1950, he published a book on the theory of the gene and Mendelian inheritance and began teaching this theory at the medical college in Changsha. He was widely criticized in a newly communist China, which officially favored the now discredited ideas of Russian scientist Trofim Lysenko on the heritability of acquired characteristics (see Lamoreaux, 2016). Lu’s studies and teaching were interrupted as the Cultural Revolution took hold in the 1960s. As a result, he shifted his attention to medical genetics in the 1970s, forming a research group in Changsha that would develop prenatal diagnosis and genetic counseling techniques. It was this group that would be formally institutionalized in 1980 as the Human Reproductive Engineering Research Department of the Xiangya Medical College. And thus Lu Huilin’s interest in reproductive technologies began to take shape. His initial excitement upon hearing news of Louise Brown some months after her birth in 1979 was sparked by the possibilities of utilizing IVF not so much to overcome infertility as to avoid transmission of genetic diseases.⁵ It was at this time, in the late 1970s, that Lu Huilin’s daughter, Lu Guangxiu, would unknowingly be enlisted in China’s efforts to develop reproductive technologies. As she explained in an interview in her office surrounded by a forest of indoor plants one late afternoon in May 2011:

Figure 3. Lu Guangxiu and her father, medical geneticist Professor Lu Huilin. (Photo courtesy of Lu Guangxiu.)

      I was a surgeon in Guangdong in 1979, and at that time, because my father’s health was not very good, I came back to Changsha to take care of him. During that time, he posed a question to me, asking: “Do you know how we can get an oocyte?” I was astonished to get this question! Because I had never observed any oocytes during ultrasound and the technical equipment was also very poor at that time. So, as a surgeon, I answered, “Maybe you have to open the abdomen to get this oocyte.” I also wondered why he would ask this question. When I came back to Changsha, I had become a teacher of anatomy. In those days, I could teach for half of the year and have my own time for the other half of the year. Being a surgeon was hectic every day, so I was used to the old busy days. I felt I had too much free time in Changsha and I hadn’t many things to do. So I asked my father why he asked this question and he said that he would like to try for an IVF baby. I then said, “Why don’t you let me have a try?” But my father said that I am a surgeon and so I lack basic knowledge of this research and he would think about it. After several days, he gave me some examples of what preparations I would make if I was going to be engaged in this research, such as the equipment, technology, and knowledge; so all these things, I had to begin from scratch. “You will encounter many difficulties and you have to overcome them,” he told me. I thought about it and accepted it and began the research.

      Lu Huilin sent his daughter to Beijing on a three-month study trip in 1980 to learn how to fertilize eggs and culture embryos from cows, rats, and mice. Lu Guangxiu’s sister was studying at Beijing University at the time and had many friends and classmates working at the Chinese Academy of Sciences in the field of genetics. So, whereas Zhang Lizhu’s attention had been drawn to infertility by the patients she encountered as a clinical gynecologist, Lu Guangxiu was introduced to reproductive science by her medical geneticist father whose initial interests focused on the use of reproductive technologies to engineer and improve the strength of China’s population. This intersection of clinical infertility and medical genetics, as we will see, turned out to be propitious for the development of ART in China. As they set out to develop reproductive technologies in the early 1980s, one of the first hurdles faced by Zhang and Lu (much like all other early reproductive science pioneers) was how to get a hold of human gametes.

      GETTING GAMETES

      While artificial insemination (AI) using donor sperm has a long history, it was not until the first techniques for viable cryopreservation of sperm were developed in the 1950s that sperm banks —repositories of frozen sperm samples—became feasible (see Swanson, 2012). Working with animal sperm in 1949, a group of British researchers led by Chris Polge “made the discovery that glycerol had the remarkable property of protecting living cells from damage during freezing and thawing” (Polge, 2007, p. 513). A few years later, Polge and his team had engineered the birth of Frosty, the first calf born from frozen sperm with “millions more to follow . . . [as] the technique spread rapidly round the world until nearly all the cows bred by AI were with frozen semen” (ibid., p. 514). Encouraged by Polge’s work, Jerome Sherman and Raymond Bunge from the University of Iowa in America were the first to apply these findings to human sperm in the early 1950s (see Swanson, 2012). By 1953, they reported that “clinical application of practical storage banks for human spermatozoa in infertility problems is now in progress” (Sherman & Bunge, 1953, p. 688) and (following three successful pregnancies using frozen sperm) that “the ability of glycerol-treated, frozen, and thawed human spermatozoon to fertilize and actuate the human ovum has been observed” (ibid., p. 768).

      Notwithstanding this early work on the use of cryopreserved human sperm for insemination in the 1950s, historian Kara Swanson has shown that doctors in America continued to prefer using fresh semen for insemination in the ensuing decades and as a result “frozen sperm would not become a significant part of reproductive medicine until the 1980s” (2012, p. 272). This was also the case in China. As we saw in the introduction, by 1980 Chinese breeders had established a sperm bank for bulls in Beijing, which Lu Guangxiu had visited during her three-month study trip to learn how to freeze sperm with liquid nitrogen. It was on the basis of this visit that she would establish China’s first human sperm bank upon her return to Changsha toward the end of that year, ensuring a significant place for sperm banking in Chinese reproductive medicine during the 1980s, as we will see.

      If the main challenge for Sherman and Bunge and for Lu was to transfer techniques for storing bovine sperm to storing human sperm, scientists working with human oocytes in the same period had to tackle the problem of how to retrieve oocytes in a medically and ethically responsible manner. In a 1968 letter to the editor in The Lancet, Patrick Steptoe had reported that “all aspects of the ovaries . . . can be inspected in minute detail through the modern laparoscope” (Steptoe, 1968, p. 913). This microscopic technique, which allowed surgeons to see inside the abdomen through a small incision using a viewing instrument attached to a tube, had initially been developed in France for purposes of sterilization, but upon reading Steptoe’s letter, Robert Edwards saw its potential as a technique for obtaining oocytes, prompting him to initiate what would become a famous collaboration with Steptoe. It was through the retooling of laparoscopic techniques for purposes of egg retrieval that Edwards and Steptoe would go on to develop IVF in the United Kingdom during the 1970s.

      Not only did the carrying out of early research on fertilization and embryo development require gametes, it also required having access to them in highly coordinated and controlled ways.