Professor Robert Winston, IVF pioneer, scientist, television presenter, author, peer and politician needs no introduction. His twinkly eyes and bushy moustache are currently starring in ‘Jamie’s Dream school’ where he has caused a stir by getting a bunch of GCSE free kids to explore science by analysing sperm under the microscope.
It’s something he’s done quite a lot of himself. In the 1970’s he says he was “lucky enough to find myself working in an area of medicine where I could make a difference”. And make a difference he did. Though he is now better known as the public face of science, forty years ago he was busy developing groundbreaking tubal microsurgery and sterilization reversal techniques. And by 1980 he had set up the hugely successful IVF service at the Hammersmith Hospital where he pioneered refinements that would vastly improve the technology.
In person, Professor Winston is as amiable as he is on the television. We meet in a smart restaurant but he refuses to talk to me while I am running a tape recorder. As soon as I turn my machine off however, he opens up, and at certain points I fear for the other diners as our conversation runs the full gamut of human sexual behaviour. As a scientist Professor Winston tackles the subject of sex with the same objective curiosity that informs his view of the world, and it is totally and utterly refreshing.
Despite his enormous success, he remains passionate about reproductive medicine and is hugely sympathetic towards women who find themselves dealing with infertility. “The investigation and treatment of infertility is inhibitory and it leads to a terrible loss of self-esteem.” Because IVF is not a single event, but rather a series of hurdles which have to be cleared before a couple can move on to the next, “it is a very exhausting process, and women usually have a greater psychological investment in pregnancy so failure is much more difficult them to deal with.”
Almost inevitably, infertility treatment interferes with sex. “Timing sex around ovulation can make it feel like a chore and having to disclose personal details about your sex life to a third party can be intimidating.” Sperm counts, post-coital testing, drug treatments and hormones all conspire to destroy feelings of intimacy and in some case the IVF process leads to sexual dysfunction such as erectile problems in men and vaginal dryness in women.
The monthly cycle becomes something that a woman begins to dread. “Menstruation is particularly tough. A woman who wants to get pregnant is continually hoping, every month, that this time it will be different, this time it will work. And she is devastated then when she gets her periods. When she eventually seeks medical help, her expectations are cranked up. For two weeks after an embryo transfer she fantasises that she is pregnant. It is all she can think about, and then a fortnight later, she menstruates and it feels like the end of the world.”
One of the most difficult aspects of infertility is the fact that there isn’t always an explanation for it. The HFEA estimates that there is no known cause for 23.9% of infertility but Professor Winston disputes this. “The real number is much smaller than that. There is almost always a reason for infertility and if you are not getting pregnant the most important thing you need to do is get yourself a proper diagnosis.” Most alternative fertility specialists suggest that stress is a big factor in unexplained infertility but Professor Winston does not agree with this either. “That relationship is not proven and there is actually some research which suggests that stress can even boost fertility.”
He does, however, acknowledge that there is a psychological aspect to unexplained infertility and he recounts a tale about a married woman who came to see him with her husband. “Their tests all looked fine and when we were alone I told her that there was nothing wrong with her husband. She told me that she knew that already because she couldn’t get pregnant with her lover either.” Was he surprised? “I was I suppose, but I then tested her lover’s sperm and found it was also normal so I suggested to her that maybe, part of the problem was that she couldn’t make up her mind who she wanted to get pregnant with.” A few months later the woman came back to see him and told him that she had left her husband for her lover and after three-and-a-half weeks she had become pregnant.
He has, of late, been openly critical of the growing commercialisation of the IVF industry. Around 90 per cent of IVF treatment is done privately, and there is a fear that some doctors are putting desperate couples through the emotional and financial expense of IVF when there is little hope of a successful outcome. At present, the chance of conceiving through IVF in the UK is about 20 per cent per cycle with fresh embryos, and about 12 per cent with frozen ones and there is no improvement in a woman’s chances regardless of how many times she tries.
Although clinics are obliged to point out that there is a 76 per cent failure rate with IVF across the board, a study published in The Obstetrician & Gynaecologist journal found that although clear information on success rates is given to couples, the majority believe that they will be “the minority who achieve pregnancy” and when that does not happen, they can end up blaming each other.
Professor Winston believes that “too little research is being done to improve IVF techniques,” but that won’t change while people are prepared to pay anything for a “disappointingly low” chance of conception. He says, “IVF makes an awful lot of money for an awful lot of people and failure rates mean couples come back. Often less effective treatments are used, so that the patients will return and pay for repeat treatments when it fails.” For example, the work he did to “unblock fallopian tubes at The Hammersmith hospital was, and still is, more successful than IVF, but nobody wants to do it anymore because they can’t make any money out of it.”
He is also very dismissive about alternative treatments. “There is a lot of stuff out there on the market that is absolutely crap. Acupuncture, aromatherapy, vitamin supplements, Chinese herbs, none of it is evidence based and none of it has ever been held up to public scrutiny. You ask these people why they don’t do controlled trials and they say that they can’t get the funding, but that is highly suspect. If there was any evidence that it worked it would be funded.”
In the UK, The National Institute for Clinical Excellence (NICE) guidelines suggest that couples should be offered up to three cycles of IVF on the NHS if the woman is aged 23-39 years and there is an identifiable cause for their infertility, or they have not conceived after 3 years. However local health authorities can apply their own criteria to this and with NHS funding cuts looming, IVF is likely to continue as a largely private endeavour.
The basic cost of a cycle of IVF treatment alone is approximately £5000 though this figure varies, depending on the consultations, drugs and tests that may be required for treatment. Procedures such as embryo freezing may also be charged separately. Amazingly, four out of five couples have to stump up this cash out of savings or additional borrowing and on average, a woman will undergo three rounds of IVF before she either gets pregnant, or gives up, so you need to multiply everything by three to understand the true the financial burden borne by those who have no other way of conceiving a child.
Professor Winston believes that “IVF could be provided much more cheaply by hospitals. No one has ever really costed the provision of treatment properly and hospitals simply charge what they think the market will bear. When I was at the Hammersmith, the powers- that-be did an audit of our department because they were convinced we were losing money. When they found that we were actually making money, even though the prices then were very low, they realised that IVF could be a revenue source and they started imposing charges on our department.”
The pain of infertility, coupled with burgeoning costs, intimidating tests and invasive treatment invariably undermine many relationships, yet there is surprisingly little information on the number of relationships that buckle under the strain of IVF. When Professor Winston began working in this area there was a fifty percent chance that a couple would split up during the IVF process. Today, there is greater recognition of the pressure that it puts on relationships and as a result, there is more support available, however the demands of such an invasive procedure still take their toll.
Often it is the woman who is most vocal about her desire to become a mother and this can create conflict if her partner will not agree to, or feels they cannot afford to go down the IVF route. And if a couple spend their life savings and fail to have a child, the consequences can be devastating. In 2000, a study carried out at the Royal Maternity Hospital in Belfast questioned 76 women who had undergone failed IVF and found that five years after their unsuccessful treatment they suffered “significant psychological dysfunction”, particularly stress and depression. Even more depressing is the recent revelation that in the UK an average of 80 abortions are carried out each year after IVF treatment because the relationship has broken down and the woman can not face going through pregnancy alone.
Though it is an area that remains largely unexplored, Professor Winston believes that a good relationship is crucial if a couple intends to embark on IVF. He also believes that there is a significant relationship between sexual satisfaction and fertility. “Twenty years ago we carried out a study which examined the relationship between sexual satisfaction and female orgasm. The study was never published because the female doctor who was instrumental in coordinating it left the hospital, but we found a clear correlation between women who could not have an orgasm and unexplained, as opposed to clinical infertility. These women were medically entirely normal and our tests failed to find an explanation for their childlessness, but the one unifying factor was the fact that they could not have an orgasm. Linking fertility and sexual enjoyment is controversial scientifically, not least because many women seldom have an orgasm and many who have never had one often get pregnant without difficulty, but it is an area that I feel merits further exploration.”
In contrast, Professor Winston has also found evidence of “increased tubal damage in women who do experience orgasm during sex.” One explanation for this he suggests is that “the muscles of the vagina and the womb contract, quite vigorously, during orgasm and it is possible that the suction effect of orgasm may not just gather sperm into the uterus, but also bacteria which can linger in the tubes and cause infection.”
As he says this I catch sight of a woman at the next table blushing and choking on her bread roll. I can only laugh. At seventy-one, Professor Robert Winston is a National treasure… with a twist.