Foreseeing a distressingly dry future as a research chemist, my accidental road to becoming an embryologist started when I accepted the offer of a MSc project at the Postgraduate School of Obstetrics and Gynaecology (O&G) within National Women’s Hospital (NWH), Auckland.

My MSc thesis involved trying to isolate a possible hormone from 5000 chicken brains, which I found far more interesting than the alternative of analysing and synthesising chemicals. The MSc was followed by a PhD in the same department, this time trying to isolate a hormone from bull seminal plasma.  I found the Postgraduate School of O&G at NWH a strange place. It was part of, but physically and functionally isolated from, the rest of the University including the Medical School, and the fiefdom of idiosyncratic Professor (Prof) Denis Bonham (now mainly remembered through the Cartwright Inquiry).  But it had the redeeming presence of a small group of sympathetic students and researchers, and it was the home of Mont Liggins, a medical scientist of towering repute after whom the Liggins Institute is named.  It was through Mont’s contacts that I found a job after my PhD as a research officer in the department of O&G at the Queen Elizabeth Hospital in Adelaide.

The Department in Adelaide had a wonderful mixture of doctors, scientists and technicians, undertaking all sorts of reproductive research in sheep as well as people.  Among other projects, I was put in charge of the Donor Insemination (DI) lab.  DI, then known as AID (Artificial Insemination by Donor) before AIDS forced a rename, was a cutting edge of fertility science in pre-In Vitro Fertilisation (IVF) days.  Its workload was high, with no alternative treatments for male infertility.  IVF was a very new and uncertain technology.  When I arrived in Adelaide in 1981, Louise Brown was only three years old, and Australia was the only other country to have IVF children, with the oldest just turning one. Nevertheless, many O&G departments were considering the exciting promise of IVF, and Adelaide was no exception.  It was in Adelaide that I learnt the ethos and lab techniques of IVF.  

The ethos consisted of absolute dedication and hard work by a small, egalitarian team of a doctor (John Kerin), scientist (Lou Warnes), technician (Regan Jeffery) and nurse (Sue Brown).  Like many early IVF scientists, Lou had a background in animal embryology from an agricultural research institute.  At that time, everything to do with human IVF had to be discovered or invented, how to make culture medium pure enough to sustain human embryos (Lou started with rain water collected from his roof), whether to try to stimulate the ovary with drugs or accept the natural menstrual cycle, how to time egg collection (women collected urine every four hours for testing), what leeway there was in timing egg collection, what sort of catheter to use for embryo transfer (a catheter designed for tomcats with prostate problems did the trick in Adelaide), and so on.  

It was demanding; each piece of glassware used had to be washed in acid, then detergent, and then rinsed in 10 consecutive changes of increasingly pure water; egg collection could occur anytime day or night.  After 50 or so IVF cycles in Adelaide, there had been only two transitory pregnancies, and I remember a departmental meeting called to decide whether to give up on this fickle treatment.  Fortunately, following tweaks and changes, 1982 saw a steady, if modest, number of cycles resulting in ongoing pregnancies.

Meanwhile, in Auckland, Dr Freddie Graham, buoyed by the emergence of successful IVF programmes in Australia, the USA and Europe, wanted to start IVF locally.   Freddie was a senior lecturer in the Postgraduate School of O&G with expertise in tubal microsurgery. It was the dismal surgical outcome for many types of Fallopian tube damage that drove the development of IVF. 

I recall receiving a telephone call in Adelaide from one of my former PhD colleagues in Auckland asking what a human egg looked like. Freddie needed to know.  Mont Liggins came to the rescue by seconding to Freddie a young researcher from California who was undertaking a sabbatical with Mont.  Pam Binkerd had some experience in monkey embryology at the California National Research Centre at Davis.  Freddie and Pam did their first egg collection in July 1983 and soon had ongoing IVF pregnancies.  Pam’s time in NZ was limited, so Freddie had to find a replacement.  I sort of matched the requirements, and so the accident of having had some exposure to an IVF programme, plus knowledge gained from running a DI programme, tipped me into my 40-year-long career. 

What was the IVF programme like when I arrived in April 1984?  It had been created on a shoestring with no funding until the creation of my position as Scientific Officer. Equipment, materials and staff time had been donated, scrounged or diverted.  An old neonatal humidicrib had been turned into a movable micro-lab by cutting holes in the Perspex, adding a microscope paid for with money diverted from a doctor’s surgical microscope, and bolting on a gas cylinder. 

I shared a small laminar flow cabinet to make up culture medium in an aseptic environment, and the embryos sat in test tubes on the middle shelf of a shared incubator, with placental tissue and cells from guinea pig ears on the shelves above and below.  Women dropped off their 24 hour urine samples (divided into four bottles, one for each six hours) at the nurses office on the lower ground floor, egg collections were done by laparoscopy under general anaesthetic (GA) in the hospitals general operating theatres on the ground floor, The humidicrib was normally parked in a research lab on the second floor, alongside the shared incubator, and embryo transfers were done by trundling the humidicrib up the patient lifts to a ward on the 7^th floor.  Much of my time was spent preparing materials -  purifying water from a still which then went into a machine donated by the Auckland Infertility Society (AIS), using the water to make culture medium and to acid wash and then repeatedly rinse glass pipettes and other glassware to make then embryo safe, fire polishing every pipette tip to stop eggs and embryos from sticking, and even resharpening, relining and sterilising recycled egg collection needles.

Things improved and expanded over the next three years.  When Prof Sir Bill Liley (the pioneer of fetal blood transfusions) sadly died, the IVF programme ‘inherited’ his lab and a technician post.  A generous businessman donated a brand-new incubator that he had bought in a government surplus sale, and the AIS raised money for a computer.  Prof Bonham’s private DI programme was transferred to the team, including a liquid nitrogen bank of frozen donor sperm that formerly sat under Prof Bonham’s secretary’s desk that she called the ‘Ark Royal’ (because it was full of seamen). 

We started intrauterine insemination (IUI) of washed husband’s sperm (then called AIH) which I had studied in Adelaide as a lower tech treatment for male and unexplained infertility.  Twenty-four-hour urine collections were replaced by twice daily blood tests.  The hospital agreed to spend $20,000 a year on urinary-derived FSH hormones, which brought stronger and more reliable ovarian stimulation than clomiphene tablets alone, so more couples had more embryos available.  With some people having more than three embryos, we started embryo freezing on a small scale, but the transfer of three embryos at once to boost the chance of a pregnancy remained standard for many years. 

Access to theatre was always a challenge, especially since egg collections could be timed anywhere between 6 am and midnight.  This led the early adoption of ultrasound guided egg collection, which in those days used an ultrasound probe on the belly, with a long thick needle going through the skin, in one side of a full bladder and then out the other side into the ovary.  Ultrasound egg collections freed us from needing to use the operating theatres and general anaesthetics, but it could be painful until ultrasound probes became small enough to use a vaginal route to the ovary.

By 1986 we had a well established and comprehensive ART programme servicing all of NZ but demand far outstripped resources, with the waiting list being equivalent to seven years’ workload.  This led to the start of Fertility Associates as a second and private clinic in 1987, and later IVF clinics in Christchurch and Dunedin by 1990.