A very fertile mind

Professor Simon Fishel worked with the team that created the first IVF baby in 1978 and with Nobel Prize winner Professor Sir Robert Edwards. His new book offers a glimpse behind the scenes of one of the biggest scientific breakthroughs of the 20th Century, and where we go next…

What was your original inspiration for entering this field?  I often get asked this - my response is that the field did not really exist, it was born out of the work at Bourn Hall. What inspired me to join Bob Edwards at Bourn Hall rather than continue my own research as I had recently completed my PhD and had another research job was the belief that what we could do in the laboratory could not only change people’s lives but create new lives that will become new generations. That we would be working with the miraculous science – as I sought it – that was embryology to help people overcome their infertility.

IVF was seen as such a controversial procedure – in the 40 years since Louise Brown’s birth, how have opinions on IVF changed?  IVF has moved from being considered outrageous, against the work of God and wholly unacceptable by not only lay and religious members of society but also eminent medial and scientific peers, to being accepted as a standard medical procedure by all but a particularly religious group who believe fertility/human conception is in the provenance of the divine. However, IVF still continues to innovate and reach beyond just infertility and whenever there is novelty in the IVF field eyebrows are raised and debate occurs. Even the regulator has modified its views on practice over time, as has all of the successful new procedures been accepted socially.

[caption id="attachment_91792" align="alignleft" width="192"] Breakthrough Babies is published by Practical Inspiration, out now, priced £14.99, available from Amazon. To be in with a chance of winning a copy just send your name, address and organisation to phil.prime@laboratorynews.co.uk by May 31st.[/caption]

How have IVF procedures changed over the years to make use of technical advances?  Major changes in IVF have occurred by the use of refined drugs for controlling and stimulating the production of eggs, and how those eggs are collected. the management of the patient has become more sophisticated on the back of a growing corpus of knowledge. The laboratory work has changed beyond recognition both in terms of the introduction of more sophisticated equipment and its routine practice in general. The introduction of genetics, for assessing chromosomes and single genes, and the use of time-lapse incubators have expanded the use of IVF and improved success rates to double and in some cases triple that achieved in the early - mid 1980's

What is holding back scientific progress in this field? Is it simply a case of ethical considerations?  Both ethical considerations, regulation and law. Even in Europe the regulations or legal environment is hugely variable from one country to another. Also, evidence-based medicine is always the highest standard to attain when delivering treatment options, but acquiring that level of evidence is difficult, and indeed has been almost impossible for reasons of funding, patient recruitment (unwillingness to be in a control arm if they can pay for the actual treatment) and appropriately orchestrated clinical trials. This is, in fact, a huge barrier

Where should we draw the line, in regard to designer babies and gene-edited babies?  Where it is known, or unknown, about safety and health risk to the child. I accept that can never be fully understood until eventually undertaken, but all the research that can possibly be done first must be done. I don't believe technology per se should be described as 'going too far' – this has to be put in context of what the technology is trying to achieve. Consider heart transplants in the middle ages – it would have been believed that the soul of the individual would be transferred! I believe some have that view of DNA today – that it is somehow sacred; not when it causes devastating disease it isn't! If it can be health-giving medicine, and perhaps a cure at the outset of the baby's life by gene-editing, rather than a lifetime of drugs, then that is positive medicine. A final point here too is who should be making such decisions?

Do you think attitudes will change with other forms of scientific manipulation of life, such as CRISPR?   If what I have seen over the past 4 decades, in this context, is any judge, I have no doubt that each subsequent generation, who will have a greater understanding and appreciation of medical science, will adopt new technologies with greater ease. They are likely to be accepting even of witnessing the evolution of the human by the human rather than 'natural process of evolution'.

What potential does IVF treatment have outside of creating life?  Saving life – such as in the cases of 'saviour sibling'; ensuring a child is not born with a devastating disease as a result of a single gene disorder. It can help couples with recurrent miscarriage, couples who have a translocation condition. There is now the option to look at polygenic disease giving risk-ratios for embryos – for example in a group of embryos they can be ordered according to their risk of having Type 1 diabetes, or some cancers, cardiac disease or cognitive dysfunction. It can be said, therefore, that these technologies can be of economic benefit to healthcare systems. IVF can also help preserve fertility, especially important in relation to declining birth rates and in those countries where maternal age is creeping higher and higher at the birth of (or trying for) the first child. Such technology could be important in a social context for countries with severe declining birth rates.

Professor Simon Fishel is founder of the CARE Fertility Group and was part of the original team undertaking IVF