Development of ‘the pill’ examined

The birth control pill, which revolutionized contraception and sparked a cultural reassessment of the purpose of sex and the sanctity of life, was developed by a Harvard fertility doctor who believed people should have children early in life — and as many as they could afford.

John Rock, a Harvard College and Harvard Medical School (HMS) graduate who spent his career at Harvard Medical School and the Free Hospital for Women — today Brigham and Women’s Hospital — invested as much effort into figuring out how to make infertile women fertile as he did finding out how to use hormones in an oral contraceptive, which became known as the birth control pill.

Rock, who retired in 1955 and died in 1984, worked for years to understand human reproduction. His findings, together with those of colleagues and collaborators, today provide an important foundation for reproductive medicine. His work highlighted the early development of the human embryo and the timing of a woman’s ovulation. He was the first to use hormones to treat infertility, and he conducted experiments in in vitro fertilization that would lay the groundwork for the birth of Louise Brown, the world’s first test-tube baby, in 1978.

Rock’s life and career were the subject of an afternoon symposium March 26 at Harvard Medical School’s Francis A. Countway Library of Medicine. Sponsored by Countway’s Center for the History of Medicine, the event celebrated the opening of Rock’s papers to researchers and academics. The collection includes a wide array of letters, reports, scientific documents, photographs, and even slides from some of his experiments.

The library is also hosting a display of Rock’s papers, which includes a brochure for Enovid, the first oral contraceptive approved by the Food and Drug Administration. Enovid, a combination of norethynodrel and mestranol, was approved for use to treat menstrual disorders in 1957 and then as a contraceptive in 1960.

The symposium featured presentations on Rock’s life and science by Rutgers University Interim Chancellor and Distinguished Professor of History Margaret Marsh and by Wanda Ronner, clinical associate professor of obstetrics and gynecology at the University of Pennsylvania. Together, the two wrote about Rock in their 2008 book, “The Fertility Doctor: John Rock and the Reproductive Revolution.”

Other speakers included Elizabeth Siegel Watkins, professor and director of graduate studies at the University of California at San Francisco’s History of Health Sciences Program, and George Zeidenstein, visiting distinguished fellow at the Center for Population and Development Studies at the Harvard School of Public Health. Watkins spoke about the rise and fall of the contraceptive Norplant, while Zeidenstein spoke about global perspectives on family planning and reproductive health.

Rock’s medical career got its start in an unlikely place: a banana plantation in Guatemala. Rock’s father sent Rock, then a somewhat aimless 19-year-old, south to make some money and gain experience. Though Rock disliked both the work and the tropics, he became friendly with the plantation doctor and began to work with him in the hospital there. Rock was eventually fired from the job, and, though he came home in disgrace, he enrolled at Harvard College and then continued his studies at Harvard Medical School.

Rock did his residency at the Free Hospital for Women beginning in 1920 and continued working there for much of his career.

Marsh said that Rock, a practicing Catholic, was a strong supporter of families. He had several children of his own and numerous grandchildren. He counseled young couples to have as many children as they could afford to support, but also believed that couples should be able to stop having babies when they felt their families were complete. His research into in vitro fertilization was aimed at helping infertile women conceive, even though his later research led to the pill.

“Research on human reproduction cannot be separated neatly into one category of infertility and another of contraception,” Marsh said.

Rock did not consider himself primarily a laboratory-based researcher and said that all his work was motivated by his patients’ needs, noted Marsh. Indeed, he was dependent on key colleagues such as Arthur Hertig, with whom he studied the development of the human ova and the early embryo; Miriam Menkin, with whom he conducted in vitro fertilization experiments; and Gregory Pincus, who had accomplished in vitro fertilization of rabbits in 1934 and with whom Rock developed the pill. As important as Rock’s colleagues were the roughly 1,000 women who agreed to participate in the experiments that made his work possible.

“For him, research was a means to an end, never an end in itself,” Marsh said. “You could say his patients’ needs and longings shaped the problems he addressed — either they were unable to conceive or had more children than they wanted.”