The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution (17 page)

Another patient, Mrs. M. B., regularly used contraception. But even so, after eleven years of marriage she had six children (and had suffered one miscarriage) before she turned thirty. She visited Rock after a botched abortion. The first time Rock saw her at the hospital, he refused to approve a hysterectomy, which clearly would have been intended to sterilize her. Instead, he suggested that she get fitted for a diaphragm. When she returned to the hospital yet again after having become pregnant and attempted to perform her own abortion, Rock relented and agreed that a hysterectomy was appropriate.

Meeting these women emboldened Rock. He had long believed that the Church and the state of Massachusetts were wrong for rejecting birth control, but he was gradually becoming radicalized. In 1945, he wrote to one hundred women to ask a series of questions about how their hysterectomies had affected their health and well-being. He wanted to know how the operation affected their marriages and sex lives. About half of the women told Rock their sex lives were no different from before the operations. Five said their sex lives were worse. Eleven (including one woman who had dumped her husband for a new man) said their sex lives were improved. Three women said their husbands had rejected them since the hysterectomies because, as one of them put it, she had lost her “nature.”

Not many doctors had the courage or confidence to ask women about the quality of their sex lives. The more Rock got to know these women, the more interested he became in birth control. In the 1930s and 1940s, most of his work—and the work that interested him most—centered on helping women overcome infertility. At the same time, he was becoming the most famous fertility specialist in the country. The rich, powerful, and famous traveled from across the country to see him, among them Merle Oberon, a native of Bombay who starred in Hollywood features that included
Wuthering Heights
and
The Dark Angel
. At the age of sixteen or seventeen, Merle had been sterilized. Her mother, hoping to protect her beautiful daughter from an early pregnancy, had ordered the procedure without explaining its implications to the young girl. By the time she was in her thirties, Oberon wanted children and asked Rock if it was possible to
reverse the procedure
her mother had forced on her.

In the 1950s, every young adult woman seemed to be having children, or wanting to. Raising children was an act of patriotism in postwar America. It was the key to happiness, the path to fulfillment. Men and women who couldn’t reproduce were pitied. Year after year in the 1950s, the nation became more fertile. In the 1930s, the average American woman had about 2.2 children over the course of her lifetime. By 1957, that number would hit an all-time high of 3.7. Women who weren’t getting in on the baby-making action were considered incomplete and undesirable. Men were shamed for “shooting blanks” and had their masculinity questioned. Since doctors knew little about what caused infertility, women took most of the blame. Usually, physicians pointed to psychological causes, saying the women were suffering stress or else they were subconsciously afraid of having children. In 1951, an article published by a sociologist, gynecologist, and psychologist (all of them men) in the
Journal of the American Medical Association
pronounced that women who lacked the desire for children were so rare “they
may be considered as deviants
.”

Even Dr. Abraham Stone of Planned Parenthood argued that infertile women needed to adjust their attitudes if they wanted to get pregnant: “For conception to take place a woman must be a woman. Not only must she have the physical structure and hormones of a woman, but she must feel she is a woman and accept it. . . . Being a woman means acceptance of her primary role, that of conceiving and bearing a child. Every women has a
basic urge and need
to produce a child.”

Demand for fertility treatments exploded in the 1950s, but doctors offered little help. Beginning around 1950, Rock conducted a series of experiments on women struggling with what he called “unexplained infertility.” He suspected that some of the women were not conceiving because their reproductive systems were not fully developed. When a woman with such a condition did somehow become pregnant, the ensuing pregnancy helped her reproductive system mature. To test his theory, he recruited eighty “
frustrated, but valiantly adventuresome
” women for an experiment in which he would use hormones—progesterone and estrogen—to create “pseudo pregnancies.” He confessed to the women that he had no idea if it would work, but the women trusted him and went along.

Rock’s experiment was based on his understanding of three kinds of hormones:

•
Androgens, the masculine hormones, although they are present in both sexes. The most active androgen is testosterone. These hormones control the development and function of the male genitals. They promote a man’s muscular strength, the growth of his facial hair, and his deep voice. In both men and women the androgens help account for sex drive.

•
Estrogens, the feminine hormones, originating mainly in the ovaries. Estrogens promote the development of breasts, the lining of the vagina, and the lining of the womb in preparation for pregnancy.

•
Progestogens, often referred to as the pregnancy hormones—with progesterone being the most influential in the category—because they regulate the condition of the inner lining of the uterus. When an egg is fertilized, progesterone prepares the uterus for implantation and shuts down the ovaries so no more eggs will be ovulated.

In 1952, Pincus and Rock attended the same scientific conference and
chatted between sessions
about their work. When Rock described his work with the pregnant women, Pincus suggested to the doctor that he try progesterone without estrogen.

Rock experimented with different combinations of hormones and different methods of delivery, trying to find the medicine that worked best and caused the fewest side effects. Sometimes, before giving the hormones to his patients, he injected himself to assess how much pain each dose packed and, presumably, to make sure
he wouldn’t drop dead
. But beyond that, he did little in the way of preparation. He did not test the hormones on rats or rabbits. He did not ask his patients to sign consent forms, but he did explain to the women that the medicine they were about to take would not directly help their infertility. The knowledge he would gain from the experiments might someday help a great many women, he explained, but he was
careful not to make promises
. This was how experiments were done at the time, and John Rock’s word was enough for most of his patients. “Like us,” he said, “
they wanted to try it
.”

He started the women on
fifty milligrams of progesterone
and five milligrams of estrogen and escalated gradually to three hundred milligrams of progesterone and thirty milligrams of estrogen. When the first round of treatments ended, no one was dead and no one had become seriously ill. That was good news. Within months, the news got better. Thirteen of the eighty women in Rock’s care became pregnant. Rock told his colleagues about this promising result. “The rebound reaction,” he called it, because the hormone-induced shutdown of the women’s reproductive systems seemed to have given their bodies a lift and helped them become fertile. Soon, his fellow gynecologists were calling it “The Rock Rebound.”

Rock was encouraged, but he wasn’t entirely convinced the rebound was real. The sample size was too small, and the unexplained infertility was still unexplained, making it difficult to draw conclusions about how or even if the hormone treatments worked. The results were good enough, however, to warrant further study.

Only one serious problem had developed over the course of the experiment: The women taking the hormones were often convinced that they were pregnant because the hormones produced many of the same symptoms as pregnancy: the women became nauseated; their breasts grew larger and more tender; and they stopped menstruating. Rock kept fielding phone calls from his excited patients saying that they thought they were finally pregnant. The women were desperate to have children. Most of them had been trying for years. “They were assured
conception could not occur
during the treatment,” Rock said, but that didn’t matter. The women kept calling and he kept telling them, sadly, that it was only the progesterone creating the illusion of pregnancy.

When he learned of Rock’s work, Pincus was pleased but not surprised that the progesterone was having a contraceptive effect. The important thing to Pincus was the plain fact that Rock’s patients were not dying. Here was proof, it seemed to him, that it was safe to give progesterone to women.

Rock told Pincus that while he was encouraged by his work with progesterone, he had one big problem: Patients receiving the hormone believed they were pregnant no matter how much he assured them it was not possible, and they were crushed when the truth finally became clear to them. He wished he could do something to ease their anguish.

Pincus proposed an elegant solution—and one that would have enormous consequences for his own work and for the future of women around the world.

A woman’s menstrual cycle is usually twenty-eight days. Each month, estrogen and then a mixture of estrogen and progesterone flood the uterus, making the lining thicker in case it should receive a fertilized egg. Then, if no fertilized egg is implanted in the lining, hormone levels drop and the lining is washed away in a menstrual bleed. That’s what Rock’s patients were missing—the menstrual bleed that signaled to them that their bodies were functioning as normal and that they were not pregnant.

The question then was how to keep the women from ovulating while permitting monthly menstruation. The simplest solution was to have the women stop taking progesterone pills for five days each month. Their hormone levels would return to normal and they would bleed. It made sense to both men because it seemed so natural. Pincus, however, may have had another motive.

One of the companies supplying hormones for his progesterone experiments was G. D. Searle. Though the drug maker had been losing patience with Pincus a year earlier, company officials had never entirely given up on the brilliant but unpredictable scientist. Searle officials continued to believe Pincus might come up with something useful, and it was a lot less expensive for the drug company to write grants for the Worcester Foundation than it would have been to hire its own researchers. For those reasons, despite Pincus’s failures, Searle agreed to pay the Foundation $62,400 for a twelve-month period beginning in June 1953. In addition, Pincus would receive shares of Searle stock, starting with
nineteen shares valued at $921.50
.

Pincus was more than a lab ace for hire. He frequently wrote to officials at Searle with ideas for new products, as he did when he heard about scientists experimenting with a liquid that was injected under the skin
where it would solidify into a pellet
. The pellet would then release hormones over a period of three to five weeks. The scientists in question were developing this liquid pellet to neuter chickens, which made them fatter and more tender. Pincus wondered if there might be human applications worthy of consideration and study. He also approached Searle about funding a cure for hair loss in men, a project he referred to as “Operation Baldness.” Pincus understood that testosterone triggered hair loss in men, and he thought that injecting men with sex hormones to counter the effects of testosterone might prevent or perhaps even reverse hair loss. Searle officials expressed “grave doubts,” but ultimately they
gave him a green light
.

In some of his letters to Searle, Pincus didn’t mention progesterone or birth control. He had a business and lab to run and other ideas to pursue. But he also knew that helping men to regrow hair, while potentially enriching, was not going to earn him the respect he felt he deserved in the scientific community. Birth control offered the best chance for that.

Officials at Searle had not committed to a new contraceptive, and they asked Pincus
not to publicize their involvement
in his project. They also told Pincus that they would not have anything to do with a birth-control pill that interfered with the menstrual cycle. To change a woman’s cycle, one Searle official said, perhaps sensitive to the concerns of the company’s Catholic customers, would be “
going against Nature
.”

It was a peculiar place to draw a line in the sand. Menstruation, which can be debilitating for some women, is only necessary when women are interested in getting pregnant. Wouldn’t reversing baldness also go against nature? Doesn’t penicillin go against nature by fighting infection? Even more to the point, doesn’t progesterone go against nature by shutting down ovulation?

It didn’t matter. If Rock’s patients wanted to have their periods and Searle wanted women to have them, too, Pincus would see what he could do.

ELEVEN

What Makes a Rooster Crow?

T
HE HISTORY OF
endocrinology might be said to have begun on February 8, 1849, at a meeting of the Royal Scientific Society in Göttingen, Germany. It was there that the scientist Arnold Berthold told his assembled colleagues about an unusual experiment in which he had castrated six young roosters. Without their testes, Berthold found, the roosters quit crowing. They also gave up trying to mate with females and stopped fighting with males. They seemed to lose the very essence of what made them roosters.

After observing these changes, Berthold replanted the testes in some of the birds. Suddenly, their combs and wattles grew back. They started crowing, fighting, and trying to mate. The results suggested to Berthold that within the testes of the rooster there must be some substance being released into the blood that affected behavior and body functions.

Forty years later, in 1889, an eccentric seventy-two-year-old French scientist named Charles-Édouard Brown-Séquard had much the same notion. But Brown-Séquard went about exploring it differently. He extracted fluid from the testicles of freshly killed dogs and guinea pigs and injected it into his own body. Almost instantly, he reported, he felt like a new man. The scientist reported that the injections invigorated him, sharpened his intellect, relieved his constipation, and even increased the strength of his urine flow. Scientists today believe Brown-Séquard was the beneficiary of a placebo effect, but his experiment nevertheless gained wide attention and inspired other researchers to explore the secretions of internal organs.