Famous IVF memoir had hidden ghostwriter who spun breakthrough into emotional quest, archives reveal

Previously unseen documents show how a poet performed a major ghostwriting job on the autobiography of the two British pioneers behind the world's first "test-tube baby", so that the book used emotional storytelling to aid public acceptance of a controversial medical technology.

A Matter of Life, co-authored in 1980 by geneticist Robert Edwards - who spent much of his career at Cambridge and went on to win the Nobel Prize - and gynaecologist Patrick Steptoe, tells how their research led to in vitro fertilisation (IVF). The book is the basis for last year's Netflix film Joy.

A study of Dannie Abse's archive in the National Library of Wales by Prof Nick Hopwood from the University of Cambridge reveals how Abse overhauled reams of rough and underwhelming text submitted by the duo to a publisher that had bought the doctors' story of the "baby of the century" in the hope of a quick bestseller.

A renowned poet and autobiographer as well as a full-time physician, Abse transformed the narrative, adding scenes and emotive dialogue with those unable to conceive to highlight the human stakes of IVF and fleshing out the characters of other women such as Edwards's assistant Jean Purdy.

Abse also stretched reality to create the impression that tackling infertility was a careers-long quest for the two men, according to Hopwood's study published in the journal Medical History.

"Abse improved and enriched the story in many ways. Some changes are problematic as history but without his work very few people would have read the book, which might not even have been published," said Hopwood, who is based in Cambridge's Department of History and Philosophy of Scienceand a co-chair of Cambridge Reproduction. "Abse helped them promote IVF at a time when the technique was controversial."

"It's rare to have such rich records of a collaboration on an autobiography and they give extraordinary access to the shaping of a breakthrough story by commercial pressures."

"The process illustrates how, through autobiography, ghostwriters craft what we know about not just politics, sport and the royal family but science and medicine, too"

_{Prof Nick Hopwood}

Records show that the publisher Hutchinson confirmed an advance of £60,000 (equivalent to around £400,000 today) for Edwards and Steptoe just eight days after the birth of the first IVF baby Louise Brown in July 1978, to capitalise on global media coverage. The book was released twenty months later, prior to the main scientific publications.

Today researchers increasingly ask journalists to help them tell their stories. But Harold Harris, a senior editor at Hutchinson, had to work hard to persuade Edwards to let Abse rewrite their lacklustre drafts.

Harris lured the authors by writing that, although they would have to give up a tenth of their royalties, "your actual earnings in cash will be considerably greater with Dannie Abse's assistance than without it". The publisher requested an additional 30,000 words by explaining more and making the style more "relaxed".

While the final book barely mentions Abse (the dedication expresses "gratitude for his invaluable help"), Hopwood's study demonstrates how thoroughly he reshaped the book that remains the main historical source for the science and medicine behind IVF.

As well as adding various literary references, from Aldous Huxley to the Bible, Abse restructured the book, doubling the number of chapters and converting long descriptive passages into vivid scenes with characters and dialogue.

"Medical autobiographies cast heroic doctors in struggles against feared scourges," said Hopwood. "Here the drama, and support for IVF, depended on creating awareness of the distress caused by infertility. After a few failed attempts to come up with a strong opening, Abse tabled this right at the start and set out the quest for a baby as the arc of the book."

Abse retitled the first chapter The Quest and rewrote it completely, as he did most of the rest. He began by having a woman suffering from infertility encounter Steptoe during his student days. This established the distress caused by the condition ("What have I done wrong", she cried, "not to have a family of my own?").

Abse also had her conveniently question Steptoe about blocked Fallopian tubes to allow this form of infertility to be explained.

This deliberate creation of a "quest narrative" can be traced through Abse's archive, says Hopwood, who found repeated embellishments designed to suggest that Edwards had long been dedicated to overcoming infertility, when he had in fact established himself in a line of research more likely to be used for contraception than conception.

For example, Edwards's initial draft declared little interest in science until boredom overtook him during a degree in agriculture. Abse rewrote this so that Edwards became fascinated with reproduction years earlier, as a wartime evacuee on a farm. He had Edwards recall "the natural laboratory behind hedges… and barn doors" where he "watched with wonder the birth of calves, sheep, pigs, foals".

The poet consistently inserted foreshadowings of IVF, from talk of "genetic engineering" on the farm to a riff on the biblical tale of the old-age child of Sarah, Abraham's wife.

He homed in on a mention of friends of Robert Edwards and his wife Ruth Fowler who could not conceive, adding a lyrical description: "[t]he trees bore fruit, the clouds carried rain, and our friends, forever childless, played with our [daughters]", to reinforce the claim that this inspired the scientist to replant embryos in the womb.

Comments on Abse's final draft show clashes with Edwards, including over this segment and those that referenced religion, but the publisher mostly overruled his objections in the margin such as "Not true" or "This isn't me!" After her husband won the Nobel Prize in 2010, Ruth Edwards co-edited a revised edition that finally took the offending passages out.

Abse's rewrite also fleshed out the roles of women, including Fowler and Edwards's assistant Jean Purdy - more to add relatable characters than from any feminist agenda, Hopwood believes.

Purdy, a former nurse, became "one of the cast" through extended descriptions and dialogue. Abse inserted praise for Purdy's determination, loyalty and support for the patients. He added details of her long car rides with Edwards from Cambridge to Oldham, such as stops at a transport café where Bob Dylan played on the jukebox. (Purdy's own corrections replaced "listen" with "be subjected" to, indicating that she was no Dylan fan.)