The Fertility Doctor: John Rock and the Reproductive Revolution

  • Margaret Marsh &
  • Wanda Ronner
The Johns Hopkins University Press, 2008 384 pp., hardcover, $29.95 0801890012 | ISBN: 0-801-89001-2

The Fertility Doctor, a biography of clinician John Rock, provides a compelling history of the medicalization and moralization of women's health in the twentieth century. The main character in this story, John Rock, was born in 1890 near Boston and trained in obstetrics and gynecology at the time steroid and peptide hormones were discovered. He went on to obtain an attending physician position at Harvard's Free Hospital for Women, where he blended primary care with human research. Rock eventually became known as the fertility doctor, and The Fertility Doctor is a remarkable account of the man, his medicine and the times.

The author team of Marsh and Ronner have used wonderful primary data from family attics, libraries, US Food and Drug Administration (FDA) files and archives from the popular press of the day and the newly formed Endocrine Society to tell the story of this man. Rock was born into a lower-middle-class Irish Catholic family and was forced to find his way early in life. His first job was at a Guatemalan banana company where he came under the tutelage of the local doctor. This experience influenced Rock, who then returned to Boston to attend medical school at Harvard. In rapid succession, he trained in surgery, gynecology, urology and obstetrics, delivered many babies in the slums of Boston, opened a sterility clinic and started his own family. His early story is compelling, and, with excellent foreshadowing of the personal and societal earthquakes to come, the authors draw us into his professional and personal success and struggles—and show how each influenced and motivated his decisions and public advocacy later in life.

John Rock made most of his money on obstetrical cases, and he argued vociferously for his emerging specialty. Up until the early twentieth century, births had always occurred in the home, but in the 1920s and 1930s doctors like Rock began the process of building the raison d'etre for specialty care through writings in The New England Journal of Medicine. Infertility care in the 1930s was surgical, but this changed with the discovery and purification of estrogen and progesterone. Naturally, these new hormones needed to be in the hands of the newly minted gynecological investigators!

Given that more reproductive interventions were on the horizon, Rock began asking key questions about fertility and executed a breathtaking series of studies that are famous to this day. Along with collaborator Arthur Hertig, Rock explored when implantation took place and, in so doing, provided women with some control over their fertility. When Rock investigated progestins, he wanted to manipulate the menstrual cycle so married women could more easily avoid pregnancy. And when he started clinical trials of 'the Pill', the goal was to avoid ovulation entirely and thereby have a reliable form of contraception that was controlled by women—an outcome he thought perfectly acceptable to his Catholic faith. In all instances, John Rock asked a clinically relevant question and then investigated those questions in his patient population.

The birth control pill took center stage in the 1940s and 1950s, and the book discusses the irony of a Catholic physician leading the effort to gain FDA approval. Rock initiated the first studies of the Pill for treating 'menstrual disorder', a use that was approved in 1959. Approval for its contraceptive use came in May of 1960. Rock believed that the Pill should be approved by the Vatican as an extension of the rhythm method. Rock was called upon by the press and public to answer questions and defend the Pill, and he was its most ardent and articulate apologist. By the 1970s, 10 million American women (and over two-thirds of Catholic American women) were using the oral birth control pill.

Clinical studies about reproductive age and in pregnant women are still controversial today—a common refrain being the vulnerability of the study subject and the authoritarian power of the clinician. Going back to the primary clinical data, Marsh and Ronner outline the concerns regarding the initial clinical trials of the Pill and dispel myths that existed at the time of its approval, some of which, remarkably, persist to this day. The reader comes away encouraged by the methods and manner of work and proud of the women who participated in the studies.

Rock died in 1984, having ushered in a new era of fertility management options that women could autonomously control. It took 32 years from the time Rock fertilized the first human eggs in vitro to the birth of Louise Brown, the first baby born from in vitro fertilization. Now, millions of babies are born each year from modern assisted reproductive technologies. Likewise, the Pill is in its fifth decade of use and is the most widely prescribed and one of the safest drugs on the planet. Thus, women can now control their fertility and overcome their own or their partner's infertility. This autonomous control of reproduction has not, as some feared, changed the narrative of what it is to be human—it has simply separated sex from reproduction while giving women control over the plot. Indeed, women coming of reproductive age during the twentieth century changed society and were, in turn, changed by medical advances in obstetrics and gynecology. The Fertility Doctor does an excellent job of bringing into full view a key protagonist in this story, John Rock, as well as his contributions to modern reproductive medicine, in a fast-paced narrative that weaves the characters and the times into a captivating story.