TRIGGERnometry - The IVF Pioneer Who Says His Own Industry Is Lying - Professor Robert Winston

00:00:00 Well, the fact of the matter is we, as a professional, are not telling the truth.

00:00:05 I'm very disappointed.

00:00:07 We all agreed that a lot of people needed this and we were not going to charge private money.

00:00:11 Unfortunately, it became massive industry.

00:00:14 The truth is that a vast amount of in vitro fertilization is unnecessary.

00:00:18 It fails, but then a few months later, somebody gets pregnant spontaneously.

00:00:23 After six attempts at in vitro fertilization,

00:00:26 only 34% of patients have a baby after six attempts now that's never said anywhere how

00:00:32 long do you think it's going to be Robert before you know people walk into a clinic and they're

00:00:37 given the menu and say look we can dial this up this particular gene up you can dial this gene

00:00:43 down and even just go well you know what we've got two girls we'd really like a boy I want a son

00:00:49 that's already happening we're not saying it's happening but I'm sure it is happening

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00:01:12 that's shop.triggerpod.co.uk and become part of the show professor robert winston what a pleasure

00:01:21 is for us to have you on the show. Thank you so much for being here. Thank you for having me.

00:01:25 Oh, it's great to have you. Lots to talk about. We really want to talk about science and medicine

00:01:30 and particularly in the area of fertility and maybe a little bit more. But before we get into

00:01:35 that, can you tell, because I think it's important for people to understand your expertise, a little

00:01:40 bit about your medical career. You're a pioneer of several things as part of IVF. Can you tell

00:01:46 us a little bit about your experience and your life in medicine and particularly in this area?

00:01:51 I mean, going into medicine was a complete mistake. I didn't expect to do that. I mean,

00:01:56 I was, I mean, I had a bad time at school and I think it's partly because my father died when I

00:02:01 was eight and I missed that male figure in a very male society, which I was in, because I was in

00:02:09 one of these elite schools. And my mother had no money because she was supporting three children

00:02:19 and I was the oldest. And I got a scholarship, which was very helpful. But I always had this

00:02:27 odd feeling that I was going to die at the age of 42 because that's what my father did. And

00:02:32 And therefore, you know, why bother to try?

00:02:35 And I wasn't academically inadequate, but I stopped scoring during my time at school.

00:02:44 So by the time I'm in GCSEs or the equivalent, the O-levels are all right, but I don't want

00:02:48 to bore you with all this stuff.

00:02:49 But when it came to A-level, I really performed very badly in the mock A-levels, and my school

00:02:54 said, well, he's never going to university, and just sort of pretty well wrote me off,

00:02:58 actually, which was quite common in those sorts of schools.

00:03:01 I left school actually with quite good A-levels, because I suddenly realized I had to work,

00:03:08 but with no clear idea what I wanted to do. I had a place at Cambridge,

00:03:12 but I wasn't sure that I wanted to do natural sciences. I thought, actually,

00:03:17 medicine's so glamorous. They're interesting people. It was nothing to do with what you'd

00:03:25 now ask a medical student. And I think it's very important that we understand that it's really

00:03:31 useful for young people not to know where they're going, not to be too concerned about the usual

00:03:39 channels to get into a particular place, and to remember that if you're sensible, you're going to

00:03:44 change direction again and again anyway. And I think I've done that a bit. And so, I mean,

00:03:49 during school and then later on, because I wasn't doing my academic work very well, I got really

00:03:53 involved with theatre, and I decided I really wanted to do theatre. In fact, at university,

00:03:58 I produced plays and ended up doing a play of the Old Professor, which did incredibly well commercially.

00:04:03 And I then came to my senses and realized, actually, I should be doing something which

00:04:08 is what I've been trained to do. So I went in to do clinical medicine, but that was unsatisfactory,

00:04:14 because it wasn't really a challenge in the way that I wanted. It was the intellectual side,

00:04:19 which turned out to be really interesting.

00:04:22 I wasn't a great scientist, of course not,

00:04:26 but it was just the way of thinking about puzzles, about stuff,

00:04:31 and thinking, well, that really does mean something,

00:04:34 because you could change things.

00:04:36 And so, I was incredibly lucky,

00:04:38 because when I came from Edinburgh,

00:04:40 I couldn't get a job because I'd been a hippie.

00:04:44 And I'd been four years trying to get jobs in medicine

00:04:46 and doing that for a while.

00:04:47 but once I'd been to Edinburgh, nobody would take me an interview. And I wanted to do women's health

00:04:52 because it seemed to me to be an unused area of medicine, which was not then very popular.

00:05:00 And I was, I mean, those interviews were horrible, actually. They were, you know,

00:05:07 I remember one interview in the West End of London from a very famous hospital.

00:05:10 There were 14 people round the table and me. They all had their backs to the light,

00:05:16 so I couldn't really see their faces. They're all in three-piece suits. They were all male,

00:05:19 except three of them were in morning dress because they'd been to their private practice

00:05:23 in Harley Street, which was quite usual to be in morning dress and with a wing collar.

00:05:29 So I knew as I walked into the room, I wasn't going to get this job.

00:05:33 And of course, one walked out backwards and bowed through the door. At least,

00:05:37 I think I tried to bow, but did it very unsuccessfully. I thought, well, you know,

00:05:41 what a waste of time that was. And I was really lucky. I was out of work for a little while. And

00:05:46 then I wrote a letter to somebody who I thought was really eminent, a man called John McClure

00:05:52 Brown. And remarkably, I got a letter by return of post, handwritten, saying, I don't have a job

00:06:00 for you, but if you want to come and chat about a career, do you want to come along seven o'clock

00:06:03 one evening, and he got me onto the idea of doing an academic medical job. And my first

00:06:13 project grant was something I had no qualifications to do that research.

00:06:21 It was in an organization which didn't have any expertise in that particular area.

00:06:26 I had no funding. I had no chance of getting the need. And bizarrely, I got this letter on

00:06:33 my boss got the letter to say that they wanted me to do the project I'd applied for.

00:06:38 And that seemed like a dead end, because it didn't seem to go anywhere. And yet, of course,

00:06:43 in time, that led to about 40 or 50 publications over many years, which led on to all sorts of

00:06:49 areas which were much more relevant. IVF was one of them, actually, but not the key one.

00:06:53 So, you know, I was very lucky. And over time, I was working very much on my own.

00:07:03 But I was very supported in the department by McClure Brown. He was amazing to me,

00:07:08 actually, in many ways. And every time he had a foreign visitor, there were always foreign visitors,

00:07:14 he would invariably say, oh, you don't want to come, you don't want to come sit, watch me operate,

00:07:17 go and see what Winston's doing down in the corridor. He would always do that.

00:07:22 And he really promoted my feeling that maybe I could do something.

00:07:26 Maybe he just didn't like foreigners.

00:07:30 Well, it's fascinating hearing a story,

00:07:32 and you often find people who've gone on to accomplish a lot

00:07:35 actually do it in a very non-linear way, as you say.

00:07:39 For people who, I mean, IVF has become such a big part

00:07:42 of our public discussion now for a lot of reasons.

00:07:45 One of them is people are delaying having children,

00:07:48 and you've had a lot to say about it,

00:07:50 which we'll get into. But for people who are unfamiliar with the whole thing, can you just

00:07:54 explain what IVF is in basic terms for the layman? Yes, IVF stands for in vitro fertilization,

00:08:00 in vitro being in glassware. So what you're doing is fertilizing a human egg outside the body.

00:08:06 And people have been trying to do that since about 1900, really, so about 100 years. And

00:08:13 nobody got it going at all. There were some suggestions that people in the late 30s,

00:08:18 around the time, just before the Second World War, got fertilized eggs. I've seen their photographs,

00:08:24 and I doubt if those eggs really were fertilized. And we tried that eventually. But in the meantime,

00:08:31 at that stage, I was doing reproductive medicine and not really interested in IVF. I thought it

00:08:36 was a dead end. I didn't think it would work. And I went to America, and I was in a university,

00:08:42 which, of course, like all American universities, was absolutely forbidding any kind of work with

00:08:46 human embryos, because that was actually considered disgraceful, and there were religious reasons why

00:08:53 the university said this, and they couldn't get funding at all from Central States. So eventually,

00:08:58 when it became obvious that it might be successful, I met a man called Chang, who was a Chinese

00:09:04 individual who'd been trained. He got his PhD in Cambridge, but then he went to Massachusetts,

00:09:11 And he was a Chinese elderly withered individual who'd been working in the fields in China, 1.00

00:09:19 had escaped that. It was very bright. He was completely unintelligible. You know, 1.00

00:09:24 when he spoke rapidly, you didn't know what he was saying. His lectures were phenomenal.

00:09:29 And this guy was incredible, because he was the first person to do in vitro fertilization

00:09:35 in a mammal. And he did five different mammals. And at the same time, I met Anne McLaren,

00:09:41 who was on the World Society. And I visited her lab and said, look, I'm trying to get human eggs

00:09:48 to fertilize like Chang, but they don't work like his mammals, his other mammals do. And she looked

00:09:54 at me, she said, well, with my mice, she said, she was doing this in mice. She said, with my mice,

00:09:58 I think it's something to do with the sunspots. And I thought, she's not really an astrology

00:10:04 person, is she? What she was saying was, she hadn't got a clue. Anne was an amazing scientist,

00:10:10 and she was very, very supportive of what we were trying to do.

00:10:13 And she visited my lab and she said, what you're doing is great.

00:10:17 And so we were doing this at the same time when Steptoe and Edwards

00:10:21 were doing this up in Alderman, in Cambridge.

00:10:25 And although they got the first, well, they didn't get the first pregnancy.

00:10:27 The first pregnancy was actually in Australia, but it miscarried.

00:10:30 That was a few years earlier.

00:10:32 And then they got Louise Brown, and then we got pregnancies very quickly.

00:10:36 but they were very, very unsuccessful initially, as we all were. And I think I was extremely

00:10:42 lucky because I realized that the key success would be nothing to do with fertilization,

00:10:48 but much more to do with the hormonal control of how the eggs actually developed in the ovary and

00:10:53 when you collected them and so on. And I met an amazing man called Steve Hillier, who was

00:10:59 my sort of age group. And Steve had worked in... I advertised for somebody who was interested in

00:11:05 IVF. He wrote back saying, I don't know anything about IVF, but I do understand hormones. I thought,

00:11:09 that's the sort of rhetoric I want. Steve came in and he'd been developing hormone assays.

00:11:14 And we were doing a lot of interesting chemistry at Hammersmith, where I was working at the time.

00:11:20 And Steve was really successful. And he was really, I think, very, very important in the

00:11:25 regular pregnancies we got with IVF in a way that nobody else was getting anywhere in the world.

00:11:31 And so much of the credit should go to him, really. He organized the lab. He did everything.

00:11:39 I think I can say this now probably on a podcast, but early on,

00:11:45 we somehow persuaded the Prince of Wales to come and visit the laboratory. And Steve had decided

00:11:52 that we should separate the egg laboratory from the sperm laboratory. If you think about it,

00:11:57 it was an obvious thing to do. Nobody else was doing that, and nobody did it for a long time.

00:12:00 But of course, eggs have to be kept in a sterile environment, free of bacteria.

00:12:05 It's impossible to do that with sperm the way that they're collected, obviously.

00:12:09 And so, when the Prince of Wales came in, he was relatively young then, he came in,

00:12:14 unfortunately a journalist behind him, and he said,

00:12:17 what's this small room? I said, well, so this is where we collect the sperm.

00:12:22 He said, well, I certainly wouldn't want to do it here.

00:12:26 Prince of Wales being the current king, of course.

00:12:28 Of course, yes. And he was absolutely wonderful. I mean, obviously since, and I've seen him pretty

00:12:36 often, but he was really interested in young people. His interest in music was something

00:12:42 which I obviously was in tune with. And actually, he was very helpful in all sorts of ways with some

00:12:50 of the projects we were doing. And it was nice to think that he was preferred to listen to that

00:12:55 stuff when it was considered really outrageous. And it's difficult to believe it's true. You know,

00:13:01 I'd come back from America because it was so, you know, not acceptable there. It wasn't acceptable

00:13:07 in Britain either. And, you know, it was highly controversial. And the first thing I probably had

00:13:11 to do, you know, if you're not a very good scientist, what you do is you try and communicate

00:13:16 it perhaps, you know, because that becomes important. And so I think my real success

00:13:22 was actually getting on the media very often. And at the same time, I was starting to do a bit of

00:13:26 television work. And so I was fortunate, I think, really, in that respect, that the BBC

00:13:34 and many other channels had all sorts of discussion programs. And we had the usual

00:13:39 people thumping the table saying that this is, you know, this is against the idea of life and

00:13:45 protecting lives and so on. So, yeah, I mean, looking back, when the first votes in the House

00:13:53 of Commons and the House of Lords were held, there were two-thirds of majority in both houses,

00:13:58 that this was not something that was acceptable, that it should be banned. And that was in 1984,

00:14:07 that vote. And then it was not until 1989, that's right, and then 1990, when the Act of Parliament

00:14:19 came through, which in fact was finally approving of in vitro fertilization, but it needed to be

00:14:25 regulated. And the nature of the concerns is because you're taking a fertilized egg and some

00:14:30 of them are discarded. And if you believe that life begins at conception, then once an egg is

00:14:36 fertilized. That's a human being. You're dealing with a human being, that's the idea. And the

00:14:40 question, of course, is you're starting, you're creating life. We're not creating life because

00:14:45 the sperm and egg are already alive. And of course, most human embryos don't survive the

00:14:50 first few days in the uterus. Most embryos, in fact, don't implant properly. Those that do,

00:14:57 many miscarry. So, for example, a miscarriage occurs for about 25% of pregnancies. Many people

00:15:03 don't even realize they're pregnant when they actually have that period. It's just a bit delayed

00:15:07 and they don't notice. But in fact, they've lost a pregnancy. So nature herself does not actually

00:15:12 respect the human embryo as being a sacrosanct person. And indeed, my view, and that of Anne

00:15:21 McLaren's view, and I was very much persuaded by her, was that the important thing was that

00:15:26 when can you see life really beginning? And it's actually when you've got consciousness.

00:15:32 So the earliest stage that you can see a brain or anything like a nervous system

00:15:36 is really in about 14 days when the primitive streak up the side of the embryo shows the

00:15:42 spinal cord and the beginning of the brain.

00:15:45 And Anne was very influential in making that the 14-day limit.

00:15:50 And actually, that eventually had a lot of effect.

00:15:53 And that was something I very much promoted.

00:15:56 And we were able to demonstrate that was the case.

00:15:59 I think that was important. You know, it went back because a lot of Christians were very adamant

00:16:06 because Christianity is absolutely opposed to this. And I said, well, you know, Thomas Aquinas

00:16:10 talks about Cairo and anima. Anima is the mind and Cairo is the flesh. And he says that the flesh

00:16:18 is there 40 days before it's a human being. And Christians were really upset by my pointing that

00:16:25 out because they didn't really want to know what Thomas Aquinas had said, you know, in the 14th

00:16:30 century or 15th century. And that was a widely held view by many theologians in different

00:16:36 religions, including Jews. I mean, the Jews in the Talmud, which goes much earlier, were saying

00:16:43 that the embryo is mer ba'alma, mer fluid, just water. And therefore, in fact, somebody who

00:16:50 miscarried would not need to grieve for the birth, did not need to have a burial, did not need to

00:16:55 a whole lot of things that we go through, the rites of mourning, which is very interesting.

00:17:01 So this is an ancient idea which it was convenient to forget. I mean, it shouldn't matter. I mean,

00:17:08 I have nothing against religious views, but of course, when you impose your particular version

00:17:13 of the religious view on other people in a democracy, you're running big risks. We're

00:17:18 seeing that now with assisted dying, of course. There are many people who would like to see

00:17:22 see a sister dying to relieve suffering, to make it possible for some people who really have no

00:17:27 chance of surviving more than a few more weeks, to actually at least have a few more weeks in

00:17:32 comfort. But it's been opposed by a group of people in the House of Lords who are adamant

00:17:38 that actually they are right, because in fact, this is what their faith tells them. And I feel

00:17:44 that that's a great disadvantage to science. Science and religion are very similar. We do

00:17:51 religion and we do science because we're uncertain. We're uncertain where we are, how we came here,

00:17:56 where we're going to. Nobody knows what happens after life. That uncertainty is a part of the

00:18:01 basic human need. We have to understand certainty and deal with it. The trouble really is that

00:18:08 certainty is dangerous, and certainty is as dangerous in religion as it is in science.

00:18:14 And Robert, looking at how the industry began, your involvement in it,

00:18:20 Has it surprised you that the way it's gone and how it's become, well, it's become a mainstream industry now?

00:18:26 Yes, I'm very disappointed.

00:18:28 You know, I don't want to sound like a saint because I'm not.

00:18:31 But in my group, I built up a large group of people, you know, who are very clever and very happy to take quite modest incomes, which, of course, academic things are.

00:18:42 And we all agreed that a lot of people needed this and we were not going to charge private money and we didn't.

00:18:46 So any private fees that we got from overseas patients, they were all pooled, and they went

00:18:51 back into a research pod.

00:18:53 And that actually led to an organization called the Genesis Research Fund, which over the

00:18:59 years, with all its appeals, has raised about just over $100 million for research, mostly

00:19:05 at Imperial College.

00:19:06 But of course, we have control over how that money is spent.

00:19:09 And currently, we've got 11 employees on those funds, which go way back.

00:19:16 Unfortunately now, of course, it's become very difficult to persuade young people not

00:19:21 to take a private income.

00:19:22 Understandably, the houses are so expensive, it's very different from how it was in the

00:19:26 80s.

00:19:27 So, you know, we weren't being particularly generous.

00:19:29 It was just, in fact, we benefited from that research, actually, to be fair.

00:19:33 So we weren't disinterested.

00:19:34 And I think that's really important to understand that.

00:19:36 But it did mean we could limit the amount of fees we charged.

00:19:41 We could often give it free.

00:19:42 The health service was very helpful in that respect.

00:19:45 And for a while, that worked very well.

00:19:48 I think, unfortunately, it became massive industry.

00:19:53 It's now $23 billion industry across the world.

00:19:58 And the fees are huge in all countries.

00:20:02 I think very often there's a lot of overcharging,

00:20:04 and there are certain areas where pretty huge pot money is being made, unfortunately.

00:20:10 And in Britain, like everywhere else, it's the same.

00:20:13 You read the news and think you're informed.

00:20:16 You're actually just selectively informed.

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00:20:21 It quietly decides which stories you never even hear about.

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00:22:01 because i suppose one of your criticisms of it is when people are infertile or they they have

00:22:09 issues with their facility that becomes a diagnosis people don't actually want to understand

00:22:15 the reasons or not looking at the reason you're spot on that's exactly the problem and it happened

00:22:20 in a debate in holland recently when one of my colleagues a doctor said that infertility is

00:22:28 is a disease, it's not a symptom, because I just said it was a symptom. Of course,

00:22:36 that statement was completely inadequate from a doctor who's done in vitro fertilization.

00:22:42 So I was horrified to hear that, because of course, actually, you're completely right.

00:22:48 It's something has gone wrong with the system. It's not there. We often don't know what the

00:22:53 reason is. But so often, once you make a diagnosis, you don't need in vitro fertilization.

00:22:58 And the truth is that a vast amount of in vitro fertilization is unnecessary.

00:23:03 It fails.

00:23:04 But then a few months later, somebody gets pregnant spontaneously.

00:23:07 But people get so panicked, they go to a private clinic and they get IVF.

00:23:11 And of course, that's to the disadvantage of the patient and to the NHS, of course.

00:23:16 So the NHS is funding treatments, which really are quite likely to be unsuccessful, but will 0.96

00:23:21 be successful indirectly because they get pregnant anyway.

00:23:26 you know, it sounds obvious, but it's important to understand the effect of infertility on a couple.

00:23:32 It really changes their lives. You know, they feel very guilty, very normally feel quite guilty.

00:23:38 They feel they've damaged themselves. They feel that something happened in the past, maybe a

00:23:41 miscarriage, maybe an abortion they had, whatever it was, some flu infection has affected them.

00:23:49 And they get very concerned that they've done something wrong to themselves.

00:23:53 And the depression and emotional change is massive.

00:23:57 Every menstrual period that follows

00:23:59 becomes a real turmoil for some women.

00:24:02 Not all, but it's very, very common. 0.85

00:24:05 And it ends up, of course,

00:24:06 inevitably with fracture between male and female.

00:24:10 Because although males likely feel also this grief,

00:24:14 they deal with it in different ways.

00:24:15 And so you end up actually not having intercourse.

00:24:20 And so actually, as the statistics show well before IVF, the more you have sex, the more

00:24:27 chance you have of getting pregnant.

00:24:28 And the timing of it is not nearly as important as people believe.

00:24:31 There are many ways of timing ovulation, which are sold over the counter in chemist shots.

00:24:36 Best not to use them.

00:24:38 It's best actually just to enjoy what you're doing in bed or on the hearth rug or maybe

00:24:42 on holiday as often as possible.

00:24:44 because actually that's a good way

00:24:47 of at least making sure

00:24:49 that you are genuinely infertile.

00:24:51 It takes, on average,

00:24:53 the average couple

00:24:54 about four to five and a half months 0.95

00:24:57 to get pregnant. 0.93

00:24:59 Something like that is about,

00:25:00 that's the sort of distance.

00:25:02 You seldom get pregnant immediately,

00:25:03 but some people do.

00:25:05 But it's not really,

00:25:06 you're not really infertile

00:25:07 until you've been trying

00:25:08 if you're a young woman for a year

00:25:09 because that's how the statistics

00:25:12 just work out.

00:25:13 Now, we don't understand that.

00:25:15 But clearly, we can do things to enhance it.

00:25:18 I mean, you know, one of the things, of course, is just to really help people to come to terms

00:25:24 with what they're doing and to recognize their partnership may be more important in all sorts

00:25:27 of ways than they realized. 1.00

00:25:29 And, of course, in vitro fertilization becomes a torture because you end up with women, 0.69

00:25:35 if they can afford it, going for 18 cycles of IVF. 0.84

00:25:39 And they become professional patients.

00:25:41 and they know all about IVF, but they don't understand, actually, why it's not working,

00:25:46 because nobody understands why it's not working. And then, of course, when they go back to be

00:25:50 investigated, we find, for example, in our clinic, they've got a simple thing that's wrong with the

00:25:55 uterus or a simple thing that's wrong with the tubes. And if you correct that, which often is

00:25:59 very minor, minor, inexpensive thing to do, you can get a pregnancy. And that happens again and

00:26:06 again. So a lot of our pregnancies were generated when we were doing a large number of IVF. I don't

00:26:12 do it anymore. But, you know, we're getting patients pregnant with not doing IVF.

00:26:18 Robert, we both have a lot of friends and we know people who are going through this process. And

00:26:24 it's obviously incredibly painful emotionally and the effect that it has on the female body

00:26:29 particularly, let's actually talk about what are the stats? What are the actual likelihood of

00:26:36 becoming pregnant with this technology, freezing eggs and all of this? Because this is really

00:26:43 important so that people actually understand what it is that they're getting into when they begin

00:26:49 this medical intervention. Well, the fact of the matter is we as a profession are not telling the

00:26:53 truth, because we give encouragement to people to think that IVF is the best way forward and

00:27:00 actually is the most successful way of getting pregnant. And the problem, of course, is that

00:27:04 what most people don't recognize is that IVF is a very complex process which takes about a month

00:27:12 really each time you do it. So the first thing that you have to do is you have to ensure that

00:27:17 there's nothing which is preventing somebody getting pregnant, which might just be some

00:27:21 different disease or some other process. So often, you may need to look more carefully

00:27:27 at the general health of that person. Certainly, for example, their weight would be one thing,

00:27:33 really important. Losing weight can make a very big difference. But many clinics don't bother to

00:27:38 let people lose weight or encourage them because actually, why bother? Just get the treatment

00:27:43 because people want to have IVF rather than losing weight. But it's going to be less successful.

00:27:51 The first thing to point out is that the first real stage are the eggs inside the ovary.

00:27:59 Now, one of the problems is that in each menstrual cycle, well, let's go back a bit.

00:28:06 If we take a little child at birth, she probably has a million eggs in her ovaries.

00:28:14 by the time she's 16, having periods and potentially fertile, she'll only have about 300,000 of those 1.00

00:28:22 eggs left. That's what our figures tend to show. And various other research groups have shown the

00:28:27 same thing. So women are losing eggs from the moment they're conceived, actually. Unlike you 1.00

00:28:35 and me, we're making sperm as we sit here. So while a woman during a month will be losing, 0.99

00:28:42 you know, a few hundred eggs, we'll be making millions of sperm. We're different. Actually,

00:28:47 there are fundamental differences between men and women, but we won't go into that because

00:28:51 that's a different something. Oh, we will, but later.

00:28:54 But it's very important to understand that. And so what happens with each menstrual cycle,

00:29:01 the hormone cycle, if it's working properly, will recruit a number of eggs from the ovary to start

00:29:07 maturing. And that maturation is very complex because it requires the right hormones to be

00:29:13 there in the right quantity, and it requires therefore the right genes to be switched on.

00:29:18 There are a number of different genes, a gene which needs the egg to be penetrated,

00:29:22 a gene which requires the first cell division for the first embryo start development. All that sort

00:29:27 of stuff has to happen. So the first thing is you need to have eggs which are ripe. You know,

00:29:33 Actually, a hard, unripe pear tastes bad.

00:29:36 It doesn't taste very good, and it won't really make much of a meal.

00:29:40 You have to have the egg properly matured.

00:29:43 Steve Hillier understood that.

00:29:45 That made a very big difference to our program,

00:29:47 because he got the hormones really as close to nature as he could do.

00:29:52 And we did all sorts of tempering with that over a few years,

00:29:55 which made it more and more successful.

00:29:57 But it still meant that even so, at the end of that time,

00:30:00 when you collect eggs which you think are fertile, at least 50% or 60% of them probably won't

00:30:06 fertilize. Half those eggs won't fertilize, and there may be reasons. First of all, there may be

00:30:12 reasons you didn't realize that the sperm are not working, or there may be other problems,

00:30:16 actually, with the nature of the genetics of the egg, or so on. Once you've got an embryo,

00:30:22 we then put it in a fluid for culture, and it will go into that culture in a black box, literally,

00:30:28 a dark container full of fluid, which is the culture medium in which it grows. And for five

00:30:38 days, it is left in culture and then taken out as an embryo. Now, during that time, many of those

00:30:44 fertilized eggs, because not all are fertilized, don't actually develop. They don't develop new

00:30:49 embryos. There are lots of reasons for that. All sorts of things go wrong with human fertilization.

00:30:53 We don't know whether that's a natural problem

00:30:56 or whether it happens only because of the fluids we're using.

00:31:00 One of the problems is the fluids we use are not properly understood.

00:31:05 We're using commercial media, which seem to work,

00:31:08 but very little research is being done,

00:31:10 even now, on the best methods of trying to improve that culture fluid.

00:31:15 But you think about it, that's the first five days of life,

00:31:19 which is critical to the development of a human being.

00:31:22 when genes are being switched on and being programmed by the environment.

00:31:26 So they're actually responding to the environment.

00:31:30 So that's been one of the research areas that we're working on at the moment.

00:31:33 But you see, then you get to the stage when you've got an embryo, that precious embryo.

00:31:38 And then after, you know, let's say five, six days in that environment,

00:31:44 you're going to put that embryo back into the uterus.

00:31:47 And most of them don't get pregnant.

00:31:48 about 20% of embryo transfers result in a live baby. But that doesn't represent, of course,

00:31:55 the beginning, because you're failing from the very start of the stimulation of the ovary to

00:32:00 get enough eggs. So every stage is important. Now, of course, many clinics will not actually

00:32:07 state their failures at different stages. The government doesn't even keep proper statistics

00:32:11 on that. So we don't really know, even now, how many eggs are actually stimulated from the ovary

00:32:20 in an average clinic. It varies so much. The records are not good, and yet they should be

00:32:25 there because the Human Fertilization Embryability Authority was set up with a statutory obligation

00:32:31 to provide better information to patients. That's one of my biggest grumbles about the

00:32:38 situation at the moment. That needs to change, but it's very difficult to persuade the Department

00:32:42 of Health. They don't really want to get involved with something which isn't supported by politicians

00:32:47 one way or the other. To them, it's not really important. There are more important things because

00:32:51 the health service needs so many other things. But actually, it is really important because it

00:32:56 affects the health service money. It's expensive for patients, and it's deeply distressing to fail

00:33:02 two or three times. For the clinic, if you fail, great, they'll come back again. If you treat them

00:33:07 nicely and kindly, they'll come back. So, you know, actually, that increases the revenue to

00:33:12 the clinic, but it doesn't necessarily improve the chance. We know from very good statistics,

00:33:18 which have been done looking at five different countries, including Britain,

00:33:21 Switzerland, France, Germany, that actually after six attempts at in vitro fertilization,

00:33:28 six attempts, separate attempts using the full cycle, only 34% of patients have a baby after

00:33:34 six attempts. Now, that's never said anywhere. That was published a few years ago, but I doubt

00:33:40 if the figures have changed that much. But it never comes out in the figures.

00:33:43 So you're only looking at about 5% success rate per attempt?

00:33:47 Well, I don't think that's true. I think it's more than that, because I think you can improve

00:33:52 egg quality. And of course, if you treat young patients only, you'll do better. And you can

00:33:57 choose your patients. And of course, many clinics do that. They'll choose the patients they think of.

00:34:01 And if you've been pregnant before, which many people have or have had a miscarriage, that will improve their chance because already they're of proven fertility.

00:34:08 So the success rate is not 20%, but that's what will be advertised, but it will be somewhere.

00:34:15 Who knows exactly what?

00:34:17 And one of the things that, and correct me on this if I'm wrong, I'm just telling you from a kind of layman talking to people perspective.

00:34:24 I think we increasingly, due to various social changes in society, women wanting to pursue careers for longer, all sorts of things.

00:34:33 We're now in a place where, I don't know, big companies routinely offer egg freezing to female employees as a way to manage this situation, let's say.

00:34:42 But with these kind of success rates, are we telling women lies effectively about the fact that this is a way to mitigate the problem?

00:34:51 I think it's a harsh, harsh thing to say. I think, you know, we were working on egg freezing 0.83

00:34:59 in Malabar at Free well before it was being done. And we were looking actually only freezing eggs,

00:35:04 which have been collected, also freezing at ovarian tissue, which we think you could use

00:35:10 perhaps to mature eggs, because you'd have better control. It's questionable that, but, you know,

00:35:15 it's never really been a successful one or the other. If you look at really carefully conducted

00:35:22 figures, what you see, of course, is that freezing brings a huge—it's a massive change to the

00:35:29 embryo. Its change in a fraction of a second is a vast change in temperature. It's called

00:35:36 vitrification. And this process has been shown to disrupt all sorts of functions in the egg.

00:35:44 Also, of course, the antifreeze which is used is not a liquid you drink, for obvious reasons.

00:35:56 In fact, it might be a very good way of getting rather simulating to the brain. I mean, not the

00:36:03 way you bought, you know, it would be sleepy at best. No, I mean seriously, that's a problem.

00:36:09 So it's also true that when you freeze a lot of eggs, sometimes the tendency in a clinic is to

00:36:18 stimulate that ovary as much as possible to get as many eggs as possible. But of course, that then

00:36:23 denies the possibility of the proper timed maturation of that egg at the best time when

00:36:29 it's collected. Thereafter, it's going to be frozen. And we know that, of course,

00:36:33 a huge proportion of frozen eggs don't thaw. I have the figures going back from when they

00:36:40 did collect them at the HVA. And I've looked at, literally, data from several hundred thousand

00:36:48 patients. I mean, it's a large number. And we can see that, actually, if you take from the moment

00:36:53 of thawing, using vitrification, which is still the best method, the chances of a single egg

00:36:59 becoming a baby is about 1%, 1.7%. Now, of course, you can produce lots of eggs,

00:37:05 but the trouble is those batches of eggs have to be thawed at the same time. You can't just bring

00:37:12 them because you take a lot. You have to thaw them because you're going to still want to get an

00:37:16 embryo. So the problem is there, which has never been understood. We don't know how many eggs are

00:37:23 being thawed by different clinics. There's no standardization of this. And so I think that's

00:37:28 one of the things we should be recording in the Department of Health, much more carefully, by the

00:37:32 HFEA. And of course, they're not recording many of these statistics, so we don't know how many eggs

00:37:38 that are thawed are being fertilized, how many actually become an embryo, how many of those

00:37:42 embryos are normal, and how many are actually put back into the uterus. All we know is the number of

00:37:47 embryos which are actually transferred to the uterus and produce a pregnancy. With those

00:37:52 statistics, what we can see from, we now have, apart from the publication of the stuff which

00:37:58 I can get through Parliament by a parliamentary question, which I think is probably accurate,

00:38:04 but now, of course, they're not keeping complete figures, so even that is difficult.

00:38:10 There are five or six publications from different countries which show that, at best,

00:38:17 About 4% of eggs, usually less, actually will produce,

00:38:22 after thawing, will produce a pregnancy, a live birth.

00:38:27 The miscarriage rate is still not recorded.

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00:39:04 I didn't mean to put it as strongly as I did perhaps.

00:39:07 I guess what I'm getting at is given everything that you're saying,

00:39:10 I think if you talk to the average person who's not an expert on this,

00:39:14 I mean, like I say, companies offering egg freezing to women to induce them to delay

00:39:20 having children. In the mind of the average person who hasn't looked into this,

00:39:25 if you freeze your eggs now, well, you'll have your babies later. It seems like a linear thing

00:39:30 where you could do it now or you could do it 10 years from now.

00:39:33 It's not quite linear because, of course, the younger you are when you produce eggs,

00:39:38 the more fertile a woman will be, because your fertility is partly related to the quality of the

00:39:45 eggs you're producing and the way they're matured. So a woman of 25 has a much higher success rate 0.68

00:39:52 than IVF. A woman of 30 still has a higher success rate. Once you're over 35, freezing your eggs

00:39:59 is probably not worth doing, as in fact IVF has become as much less likely to be successful. 1.00

00:40:04 But of course, so many women are in fact being encouraged

00:40:07 to start before 35, but a huge number of women,

00:40:11 a big proportion of them, are already too late. 1.00

00:40:14 Now, you can argue that more education should be needed,

00:40:19 but what we need actually are proper statistics

00:40:22 for success of pregnancy at any stage,

00:40:24 and that's not being recorded.

00:40:27 What I'm getting at, Robert, is I think,

00:40:30 based on the things you're saying,

00:40:31 and please do correct me if I'm misunderstanding or misrepresenting, is the reason I use the word

00:40:37 lie is there is this perception in the culture that the success rate, in most people's heads,

00:40:43 this will be how this is, success rate is the same at any point. So you could have your children

00:40:48 at 25, or you could have them at 40, and you just, you know, your freeze eggs at 25, and then 15

00:40:53 years later, boom, you're good. I mean, I had, it was quite a shocking thing to hear, but I had

00:40:57 someone come up to me uh my wife and i were out with our newborn at the time doing something and

00:41:03 someone came up to us we had a nice chat about the baby and then this and then we said to him

00:41:07 well have you got my wife said to them have you got kids uh and the guy because it would it would 0.80

00:41:12 be a guy saying something this dumb he went uh yeah we have two frozen ones in people's minds 0.70

00:41:17 what i'm getting at is they think that a frozen egg is a baby that they just pull out of the drawer 0.98

00:41:24 boom, it's ready to go. And what you're saying is that's not remotely the case.

00:41:28 No, it isn't quite right. And I mean, for example, I do have some statistics which

00:41:33 bear some relationships. I've looked at some statistics which were, which I challenged the

00:41:40 minister in parliament about, of 40,000 eggs that have been thawed for the purposes of in vitro

00:41:49 fertilization, all aged women, I don't know. And there were 604 pregnancies. And some of those,

00:41:57 about 18%, I think, miscarried. So you can begin to see that actually, we're not really telling

00:42:03 the truth. And I think those figures are probably quite accurate. But, you know, who knows? Because 1.00

00:42:10 of course, how things are being developed, how many eggs are being produced, is difficult to 0.99

00:42:15 follow, and we need much clearer evidence before we do want to get women to delay unnecessarily.

00:42:21 It's very difficult because, of course, we're living in a totally different society. 0.98

00:42:26 It's important to understand, of course, we do understand that people want to work. They want

00:42:30 to do things. Women want to use their unique credentials to do different things as late as 1.00

00:42:37 possible. And as, indeed, my own wife did before she died. I mean, she produced three children, 1.00

00:42:43 but she was already in the right stages of, you know, of fertility, but she was relatively lucky.

00:42:50 So, I mean, I think that that is the problem that we, there's the inevitable pressure which 0.78

00:42:57 women impose on themselves, but society doesn't help to actually try to come to do this. But, 1.00

00:43:02 you know, the answer, of course, is quite clear. What we're doing is asking women to pay £5,000 1.00

00:43:09 pounds or more to freeze their eggs, often a lot more. Sometimes some clinics will charge

00:43:14 10,000. It's quite common, and more in America. And of course, nobody is using that money to do

00:43:22 research, which comes back to my original point. We need to be doing far more research. And in

00:43:27 Britain, sadly, the amount of research that's going on generally in the in vitro fertilized

00:43:32 area is not very good. If you look at the number of projects which are being funded by the research

00:43:39 councils by UKRI, for example. Very few research projects are being funded. That's simply not

00:43:48 because, it's because they're not good enough. We've lost the science. We're not doing good

00:43:56 science. We're not producing good projects. We're not thinking about it. Because actually,

00:44:00 when you've got a massive market, if you're a young person, of course you're going to go and

00:44:04 work in a clinic. It would be stupid not to, because you earn immediately five or six times 0.86

00:44:08 what you've done in the public sector. So, I mean, you can't blame people for doing that. 0.94

00:44:16 But it's very difficult to do really useful research in a commercial environment.

00:44:21 You can't easily do statistically and analyzable research comparing one treatment with another

00:44:27 treatment because patients want the best treatment they think, quite rightly. So that becomes a no-no.

00:44:33 and that's a big problem. And so we actually have to understand that we need to look at ways of doing

00:44:39 research more effectively, because there are ways we could do this. But the amount of

00:44:43 experimentation we're doing, for example, on the culture of embryos is negligible. Very few

00:44:49 projects looking at culturing human embryos in Europe at the moment. But that is clearly five

00:44:57 days of critical importance in IVF. And it will be, of course, in egg freezing as well,

00:45:02 because we all have to go through that process.

00:45:04 We want to try and mimic what happens in the uterus,

00:45:08 but the uterus is a black box. 0.75

00:45:10 We've no idea what goes on there.

00:45:12 It's very difficult.

00:45:13 You can't...

00:45:14 The ideal experiment would be 1.00

00:45:16 to persuade a whole lot of women 1.00

00:45:18 to come and have a laparoscopy or an egg collection

00:45:22 just routinely after they've had sex.

00:45:26 That is not going to be something which would be acceptable,

00:45:29 and it's not actually possible for very good reasons ethically.

00:45:34 It would be unethical.

00:45:36 So we can't do the obvious experiment we can do in the rabbit or the rat,

00:45:40 but unfortunately mammals, as in fact Anne McLaren showed,

00:45:44 are totally different from humans because we are unusual.

00:45:47 We menstruate, and that makes a very big difference

00:45:51 to the whole hormonal cycle.

00:45:53 So we're quite different from the animals we can work with,

00:45:56 and we could work with a few monkeys,

00:45:58 but that's going to be increasingly impossible because we feel that humans and monkeys are too

00:46:04 close to each other, you know, for very good reasons. That brain is an advanced brain and

00:46:09 now doing primate research in this sort of field would be unacceptable, quite rightly.

00:46:14 Robert, one of the things that you've spoken about is the epigenetic effects of this technology.

00:46:23 So let's talk about that. Firstly, before we get into it, explain to people

00:46:28 who might not know what epigenetics is,

00:46:30 and then we can talk about the effects.

00:46:32 Yes, epigenetics.

00:46:33 Well, wonderful that you brought that up.

00:46:35 I hadn't thought about talking about that.

00:46:36 But, of course, basically,

00:46:38 we think that genes are genes for things.

00:46:41 You know, you have genes for blue eyes.

00:46:42 You have genes for, let's say, some liver enzyme.

00:46:46 But actually, of course, genes work

00:46:48 depending on the amount of expression,

00:46:50 how they're working.

00:46:51 So, in fact, large amounts of expression

00:46:53 or less expression,

00:46:54 that will change the nature of what the gene is doing

00:46:57 and how that will work.

00:46:59 And also, of course...

00:47:00 Sorry, just to make this understandable 0.99

00:47:02 for stupid people like me, 0.98

00:47:03 when you say expression, what do you mean? 1.00

00:47:05 Just explain that bit a little bit.

00:47:07 So basically, the amount of, let's say,

00:47:11 message the gene is giving to the cells...

00:47:16 So it's not binary, it's...

00:47:17 No, it's not binary.

00:47:18 I see.

00:47:19 So, for example, you can get genes to overexpare

00:47:22 and underexpare.

00:47:23 It's analog.

00:47:24 Yes, and we can do that by changing the chemistry of the gene,

00:47:26 that has happened. So epigenetics is partly how the genes are affected by the environment,

00:47:33 because obviously it's the environment. What we forget, actually, is we've been thinking

00:47:37 for years about, you know, development. Development is either nature or nurture.

00:47:48 Actually, of course, nurture is just as important as nature, but we've always been hooked on genes,

00:47:53 nature. Now, of course, there's actually nature, nurture, and development. And the interesting

00:48:00 thing, of course, is development is really important because development is actually a

00:48:03 response, to some extent, to what is happening in your environment. It's highly controversial,

00:48:09 but there's increasing evidence that if you're subjected to all sorts of unfortunate environmental

00:48:16 influences, particularly when you're young, you may have all sorts of things happening later on

00:48:21 in older age. So, for example, without going into great detail, there was one very, very important

00:48:27 study years ago, which nobody believed, including me when I read the paper, as it was nonsense,

00:48:32 where they showed that little boys aged nine, if they were in a good environment in one part of

00:48:37 Sweden, where there was a good harvest in the 19th century, at the beginning of the 19th century,

00:48:42 the end of the 18th century, their male grandchildren were more likely to die young.

00:48:52 Having had a good environment at the age of nine, that made no sense at all,

00:48:56 until you begin to realize that the genes, perhaps, are being programmed to accept what's

00:49:00 going to happen when, in fact, you have a different change in your diet. So, possibly,

00:49:07 the reason why heart disease and hypertension and other diseases were common in that cohort

00:49:13 might be due to changes in the body ability to regulate itself in different environments.

00:49:19 So we are programmed by the environment we're in. We understand that increasingly. That's

00:49:24 epigenetics, if you like. Now, of course, I don't want to push this because there's a lot more work

00:49:29 being done than that. But for example, epigenetics occurs in all sorts of areas, including cancer

00:49:34 biology, we can now modify genes expressed, perhaps, and that may make a difference.

00:49:43 I think the point is this, that we have clear experimental evidence in animals,

00:49:50 rodents, for example, that changes in the environment can make a major difference,

00:49:54 for example, to brain development. For example, one experiment done in 2016 in McGill University

00:50:01 showed that actually if mother rodents didn't lick their offspring, they fed them milk,

00:50:11 but they didn't lick and cuddle them, those mice or rodents were more likely to have different

00:50:18 development, more likely to be unable to get out of a maze successfully, were slightly more likely

00:50:24 to be aggressive. They passed that trait on to the next generation when they in turn are pregnant.

00:50:29 Wow.

00:50:30 That seems to be an epigenetic effect, and we now know that we can see changes in the

00:50:35 gene expression of a particular molecule which affects the oestrogen.

00:50:41 So it's intergenerational, so it's not, you know, you were neglected as a kid, you had

00:50:45 a bad life, you pass it on.

00:50:46 Well, of course, it doesn't help either.

00:50:48 No, no, no, of course.

00:50:49 But actually, of course, it's relevant, of course.

00:50:51 It's really complex, because we should argue, of course, that we should not be so absolutely

00:50:57 intent on Janine's, but much more about what we can do for the environment with our children.

00:51:02 That certainly includes, of course, Sure Start, for example, primary education, because once

00:51:08 primary education is finished, that brain is no longer quite as plastic as it was, for example,

00:51:13 when the child was three or four. So actually, how we start to interest them in doing things,

00:51:19 which would include music or experimenting, but actually teachers in primary schools are not

00:51:25 given the chance to do that. They don't have the background, sometimes, or they don't—generally,

00:51:33 very few are scientifically qualified. They might have an A-level in science, but that gives you

00:51:38 very little experience to do experiments with a child, because, of course, most teachers will

00:51:45 be nervous about doing experiments. It might be dangerous. It might cause an accident. It might

00:51:50 be something which takes up too much time, and it's too costly to do. Much easier to tell

00:51:55 the story didactically. That's a real problem, I think, in our education. And we're increasing

00:52:02 that now, of course, with the new methods of education, where in fact all sorts of practical

00:52:08 work is becoming less important in all fields. Now, it's interesting to see how the government's

00:52:16 relating to apprenticeships at a later stage. But in my view, we should be offering manual

00:52:22 skills of all sorts much early on. There's a lot of experimental evidence in music,

00:52:29 for example, that music actually can, certainly it improves dexterity. Secondly, you can show

00:52:37 that some people who are exposed to music early actually become much more appreciative

00:52:41 of music later on. You can show also that it improves memory. It certainly changes actual

00:52:50 physical views, certain analytical observations. Musicians and scientists actually have quite a

00:52:59 lot of similar. Actually, scientists generally like music, and of course, musicians are often

00:53:04 quite good at science. They're not trained, but if they are, they become very good. In my laboratory,

00:53:11 I had a lot of people in a musical who were some of the best scientists, much better than me,

00:53:15 actually, far better. You know, I was a poor scientist, by comparison with some of the people

00:53:20 who are in the lab. What you do there, of course, when you're the poor scientist, you

00:53:26 want to make sure you recruit the right people, because one of the great advantages

00:53:30 that we all have is collaboration. And collaboration is what actually is really

00:53:34 important. But we don't teach that in school either. And of course, music does teach collaboration.

00:53:42 And so do we know what the long-term effects of this technology are

00:53:47 for the people who are the product of it?

00:53:49 No, I don't think we do.

00:53:51 And of course, I don't want to say IVF is dangerous

00:53:53 because there's no evidence that it is.

00:53:55 But I think, to be fair, as we found with that Swedish experiment,

00:54:01 that wasn't recognised for a very long time.

00:54:03 It was only, in fact, when it was the male grandchildren of a male father.

00:54:09 because then it was a wonderful man called Pembry,

00:54:14 Dr. Pembry, who's in Bristol.

00:54:18 He pointed out to me, he said,

00:54:19 you know, there may be something at ASL.

00:54:20 This is nonsense.

00:54:21 He said, no, no.

00:54:22 Marcus Pembry said to me,

00:54:23 you know, actually, think about it.

00:54:25 That's sex-linked.

00:54:26 That must be genetic.

00:54:30 And he thought about that.

00:54:31 It was very clever.

00:54:32 I don't think anybody realized

00:54:34 when the paper was published

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00:56:06 And Robert, one of the topics that we haven't addressed in this,

00:56:10 and I know you're an expert in female fertility, is male fertility.

00:56:14 Because when we talk about infertility, we automatically think it's the female body,

00:56:19 there's something going wrong there.

00:56:20 All that isn't always the case, and we have a very real issue with male fertility.

00:56:25 So let's talk about it. 0.99

00:56:26 Well, if you look at the statistics, it's probably fair to say that with an infertile couple, 1.00

00:56:30 at least 30% of the time. It's probably both partners. And some of the time, maybe another 1.00

00:56:37 30%, it'll just be the male, and another 30% it'll be the female. Very arbitrary sort of figures.

00:56:43 But, you know, so actually male fertility is very important. We don't look at that nearly enough.

00:56:50 I think there's a lot of quite good expertise in Britain. There's some very good male experts.

00:56:55 Unfortunately, they're not often called in to help with IVF. It's great pity that, in fact,

00:57:00 clinics doing regular in vitro fertilization don't subject themselves more to advice from

00:57:09 male experts, andrologists, who I think should be encouraged to give a much greater

00:57:17 credence to what they do. But we also need to say that we need to do much more research.

00:57:22 It's not just bad genetics because the sperms don't work. There are things that I think should 0.83

00:57:28 be able to be done better to encourage fertilization. We have some mechanical ways of

00:57:33 doing this. We can inject sperm directly into the egg if they don't swim. But that in itself 1.00

00:57:38 may carry risks that we don't know about yet. Although, of course, it's being used so often,

00:57:43 we haven't seen abnormal babies. Nonetheless, it's very questionable whether it really increases

00:57:49 fertility in most couples or not, you know, this injection. We were, again, doing this very early

00:57:56 on. And we tended not to want to use it as a routine treatment ever in our laboratory. And

00:58:03 I think that's still the way how we've left it. There's a narrative in the media that the quality

00:58:08 of sperm is declining. Yes, I know. Is that accurate? Well, you know, it's very difficult

00:58:13 to understand that. You know, there are a lot of very good papers on this now which show that, in

00:58:17 in fact. But the problem, I think, this decline in fertility has, this decline in sperm function

00:58:26 hasn't really equated with loss of childbearing. And I think one of the problems may be

00:58:34 that what I did was to look at the figures at Hammersmith Hospital, because that was one of

00:58:40 the first clinics that collected sperm over 60 years ago. So we have a lot of experience,

00:58:45 And we went through the ways the sperm were collected, and we looked at differences in motility, for example, and structure.

00:58:56 And it wasn't obvious that it was much different over 60 years or so.

00:59:00 Now, that's not a good paper. It's not a good, it was a rule of thumb, rough idea.

00:59:07 Because actually, one thing is, the way we collect sperm now is much more sophisticated.

00:59:12 The way we photograph sperm is much more sophisticated.

00:59:15 So, in fact, we're not able to see much more things.

00:59:18 And now, of course, we do do things like electron microscopy, which, of course, is able to look

00:59:23 at the sperm in very, very high magnification.

00:59:26 But we don't really fully understand all the chemistry in great detail.

00:59:29 So there's more to be done.

00:59:31 And I think it's true to say that that's true of fertilization as well, because it's

00:59:34 different in different species.

00:59:36 And it's very difficult to get eggs to actually fertilize, because obviously people, if they're

00:59:42 going to give eggs, want to actually have a baby, or they want to have their eggs frozen.

00:59:47 So there is a real ethical problem there as well, persuading women to give up some of

00:59:51 their eggs for experiments which are helping to get pregnant.

00:59:54 So a lot of the things we hear in the media, these definitive narratives, is not…

00:59:59 I'm not…

01:00:00 I think the data are fuzzy.

01:00:02 I think it's very, I mean, I'm not entirely persuaded that that is a serious issue.

01:00:08 Fertility is unquestionably declining in the Western world, but there are so many good

01:00:13 reasons for that.

01:00:13 And what are they? 0.84

01:00:15 Oh, well, I think for the women working later in life, clearly, I think people having fewer

01:00:21 children, I think the changes, you know, I think the changes in family finances where

01:00:26 both couples need to get an income to make it justifiable. More and more people having single

01:00:32 children. I mean, I think, and many people perhaps deciding that it's perfectly reasonable to have

01:00:38 children at all. Many people, I think, are starting to feel, do we really want to bring a child up

01:00:43 in this world? I mean, there are all sorts of issues were never thought about in the 40s.

01:00:50 So I think those things are, you know, after the war, there's always a burst of fertility.

01:00:55 there was in the early 40s. Interestingly, after some wars, particularly after the Thirty Years' War,

01:01:03 the Thirty Years' War in 1618, well, that's when it started, finished in 1648. There's some

01:01:11 suggestion that not only did fertility increase in Europe, but more male babies were born. 0.57

01:01:17 Yeah, we heard the same. I was born in the Soviet Union, and I don't know if it's factually correct, 0.99

01:01:23 but the narrative in Russia is there was a huge increase

01:01:28 in male babies being born after World War II. 0.99

01:01:30 Yes, absolutely right.

01:01:31 I think that that is, but it's not been,

01:01:34 it's very difficult to do that retrospectively

01:01:37 because unless you're following up couples

01:01:39 all the way through in their behaviour.

01:01:42 But yes, I think it's so, you know, it's an interesting question,

01:01:45 but certainly it's not just the First and Second World War.

01:01:48 It goes right back to the 17th century

01:01:50 and the statistics aren't entirely, you know,

01:01:53 Perhaps nature needed more males at that stage because, of course, males were depleted in society.

01:02:00 Can that be true? Can there be something influencing whether you have more male-bearing

01:02:06 sperm than female sperm? It must be on the male side. So it's an interesting question. I don't 0.90

01:02:11 think the woman has any influence, as far as we know, on which sperm actually chooses the egg.

01:02:19 But maybe we don't know.

01:02:21 So to tie a bow on the whole fertility conversation,

01:02:24 because I want to move on to a different issue,

01:02:26 if you were to just give a sort of public information announcement

01:02:31 about fertility, I mean, one of the things we talked about

01:02:34 is how it changes over time.

01:02:36 For men and women, what does it look like in your late teens

01:02:41 to 20s to 30s to 40s?

01:02:43 How does it look? 0.79

01:02:44 Well, first of all, most couples will get pregnant without any treatment. And although 0.85

01:02:53 a lot of my colleagues talk about infertility effects, one in five couples, one in six couples,

01:03:01 I don't think there's a flaw. I think there's a flaw because they're based on a study which

01:03:05 was done in Bristol University many years ago by a colleague of mine who I greatly admired and

01:03:09 tested. But actually, he was not looking at the underlying causes of the infertility.

01:03:16 And I think that actually, it's probably much closer to about one in 10. So it's not quite as

01:03:22 common as we would boast. So you're looking perhaps at really one in 20 people, or, you know,

01:03:28 because most of them will be from one or the other person. But I think I would say that it's now

01:03:35 undesirable, unfortunately, because it's so expensive to investigate the causes of the

01:03:40 fertility. But I think that we need to be doing that more often. I think unless we're making a

01:03:45 diagnosis, we shouldn't be doing IVF so readily, because so often, if we do a diagnosis, we find

01:03:51 there are other things we can fiddle with which are much cheaper and more successful. For example,

01:03:56 if you have, let's say, an abnormal uterus, which is congenitally abnormal, a very simple procedure

01:04:02 can often correct that without IVF. Same applies to a polyp inside the uterus. The same applies

01:04:07 to many hormonal conditions which are associated with infertility, changes of sugar metabolism,

01:04:13 for example, changes in your hormone output. So we're not doing enough of that, really,

01:04:18 in a sophisticated way. We're doing routine spot tests, which is not proper diagnosis.

01:04:24 Now, of course, the problem is it's expensive. In the short term, it's expensive. In the long term,

01:04:29 it's probably cheaper. Because IVF is so expensive. Yeah, I see what you're saying. I had a guy come

01:04:35 around to my house to do some work and I got chatting to him. He was telling me they had 12

01:04:40 miscarriages in 11 years. And then they went to see somebody and went, oh, you know, you're

01:04:44 basically her fallopian tubes are tangled. We need to sort that out. We sorted it out and instantly

01:04:49 had a child. So continuing to do IVF on someone like that, I mean, it's crazy, right? Well, it is.

01:04:55 I mean, in fact, of course, tubal function has been one of my big areas of research.

01:05:02 And I think we don't understand tubal function at all.

01:05:05 It's another black box where the embryo is fertilized.

01:05:08 That fertilization doesn't occur in the ovary, doesn't occur in the uterus.

01:05:12 It occurs in the fallopian tube.

01:05:14 And it's not just a pipe.

01:05:15 We spend, all of us, if we didn't have IVF to produce this, spend about 48 hours in the

01:05:21 fallopian tube at the beginning before we go into the uterus.

01:05:25 is even more darker. And that jury is something we completely ignore. So yes, I think that's true.

01:05:31 And certainly, I think one of the reasons why we were a bit more successful than IVF early on

01:05:37 was because we were looking at the fluids inside the fallopian tube. I was doing that with Henry

01:05:41 Lees, who was working in the north of England, in York. And certainly, we looked at actually

01:05:47 some things which might affect fertilization and development, which possibly were helpful.

01:05:54 So I think that we don't do that research enough.

01:05:57 It's not easy to do, but it's certainly possible.

01:06:01 Yeah.

01:06:03 Where do your questions start?

01:06:05 Well, my question started actually is I was hoping you would give

01:06:08 a kind of consumer retail version of what the average person's fertility,

01:06:14 the average woman's fertility, and the average male's fertility

01:06:17 looks like over time in terms of the decades in your life.

01:06:21 All right, well, I would say the average couple will have a one in four chance per month for

01:06:26 the first four or five months. Then it gets reduced if they, because they obviously may

01:06:31 have something more likely to be wrong. So certainly for the first five months,

01:06:35 it would be wrong to do investigations unless you've had something clearly identifiable.

01:06:40 For example, an operation which had infection, an appendix might be an appendix removed,

01:06:46 you know, in somebody who's of childbearing age, might cause adhesions, that sort of thing.

01:06:51 So that might be some reason.

01:06:52 And then in that case,

01:06:53 division of those adhesions

01:06:54 might be more successful than IVF,

01:06:56 but it's not being done enough.

01:06:59 And of course, the surgery to repair tubes

01:07:01 is not done nearly enough

01:07:02 because it's more complicated,

01:07:03 but actually in the long run, it is cheaper.

01:07:06 So on the male side,

01:07:08 I think we should be doing much more about male health.

01:07:10 And I think also there's still more need

01:07:13 to look at female fertility 1.00

01:07:15 from the point of view of looking at the hormones.

01:07:19 And what about lifestyle?

01:07:20 what are things that people do and don't do that can improve? 0.67

01:07:24 They don't have sex enough.

01:07:26 All right. 0.92

01:07:27 I'm going home armed with that information tonight.

01:07:29 I don't think changing lifestyle changes things much at all.

01:07:33 Really?

01:07:33 I think sex on the hearthrug is a really good way of doing it. 0.97

01:07:37 And, you know, because I'm not speaking from experience, 0.97

01:07:40 I don't understand.

01:07:42 You're speaking as a scientist, which is even more important.

01:07:45 Yes, actually.

01:07:46 Yes, of course.

01:07:48 Pleasure is important. 0.84

01:07:49 we don't even know what effect human orgasm has, female orgasm, but it certainly seems to produce

01:07:57 more sperm in the fallopian tube, but we can't easily do those experiments.

01:08:00 Yes, I imagine there's quite a challenge, yeah.

01:08:02 But you know, actually, there's a lot of reason to suppose that that can help. But of course,

01:08:08 that requires perhaps a different approach to one's lovemaking. And, you know, I did start to do

01:08:15 years ago, when IVF was in its very infancy, I'm sorry, that's a pun, but you know what I mean.

01:08:22 I had a wonderful young woman who was medically qualified, who wanted to look at this. And so

01:08:29 we set up an experiment where we asked patients where they had unexplained infertility,

01:08:35 what their background was with sex. And of course, if she as a woman was able to

01:08:42 really go through their sexual experience. And she thought that what she saw was that women who 0.93

01:08:51 were having orgasm during it, of course, certainly were slightly more likely to have infection in

01:08:56 their fallopian tubes sometimes. It's interesting. But also, overall, were more likely to get

01:09:04 pregnant with unexplained infertility. So that is something which we've never published,

01:09:12 and it would be dangerous to publish it with the data I've got, because actually we should

01:09:16 have done much more study. But it's a complex thing to do. You need a large cohort of women,

01:09:23 and you need some very sensitive people to go through those things. And you still don't know

01:09:27 whether people are going to tell you the truth. And of course, when I said lifestyle, I meant

01:09:32 lots of different things, because I know anecdotally things like acupuncture sometimes

01:09:37 will help people get pregnant, or talking therapies can help people address emotional

01:09:43 blocks and whatever. And so stress levels and all sorts of other things just anecdotally seem to

01:09:50 It's a very interesting question, because I used to think stress was important. And then I went to

01:09:55 a lecture in San Diego by a very, very famous endocrinologist who was then in his late eighties,

01:10:03 he's now dead, he's no longer, but he was doing work on stress. And he said,

01:10:09 one of the most important things to help ovulations is stress. He said exactly the reverse. He said,

01:10:14 people who are stressed actually are more likely to get pregnant. And he said,

01:10:18 it depends on the kind of stress. And we don't really understand that. And I think actually,

01:10:23 on the other hand, I've seen so many women who, when they're no longer stressed, have

01:10:29 gotten pregnant, and you do wonder about that. One story, it's a long story, but I'll try

01:10:35 and keep it as truncated as possible. Years ago, when we were not very good at identifying

01:10:40 the cause of infertility, I had a woman who came to see me, who'd been trying for a pregnancy

01:10:46 very conscientiously for about four years, and she'd not got pregnant, and I was sure

01:10:51 there was nothing wrong with her. We looked at her husband, there was nothing wrong with him.

01:10:56 And she said to me, you know, it can't be my husband, it's got to be me. Because, in fact,

01:11:05 my husband was responsible for a pregnancy, which he never told me about at all recently.

01:11:10 And I said, well, that doesn't necessarily mean a job of what we'd expect. He would be fertile.

01:11:15 It means that actually, you know, there's something else going on that we don't understand.

01:11:18 You know, she continued to see me, and she never got pregnant. Then finally,

01:11:23 one day she came into my clinic. She said, you know, I've got a boyfriend. Our marriage is

01:11:28 breaking up. And we're quite serious. And, you know, I wonder whether that will make a difference

01:11:34 to my fertility. And I said, well, I don't know. And she was having regular sex with this man for

01:11:41 two years. And she came back and she said, I've had two years of regular sex with my boyfriend, 0.98

01:11:46 and he's been pregnant. He's had his wife pregnant as well.

01:11:49 Are you telling me it's not my fault? I said, I really don't know. 0.99

01:11:54 She rang me from an airport. I'm off to Australia. We've decided to go to Australia.

01:12:01 She was pregnant three weeks later with that man. 0.93

01:12:06 So it was the country, it was England.

01:12:07 Yeah, it was England. 0.95

01:12:08 England was ruining her fertility. 0.99

01:12:10 But you know, she had decided to change her life. 0.96

01:12:13 Yes, I was kidding. Of course.

01:12:15 So she was changing, you know, who she slept with regularly.

01:12:20 There was no guilt, I suppose.

01:12:21 And, you know, there was a new period and she got pregnant quickly.

01:12:25 I don't know whether she got pregnant a second time because I lost contact with her.

01:12:29 But those stories are not uncommon and they're interesting.

01:12:33 It's fascinating how little we know about it.

01:12:35 Yes, it is.

01:12:36 I quite agree.

01:12:37 It's why the research is so important because at the moment it's all anecdotal.

01:12:40 So much of this stuff is left to, you know, sort of anecdotes.

01:12:45 But actually, there should be much more identification of where we do have things

01:12:49 to test and the things we can investigate better.

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01:13:43 Robert, there's something that I really wanted to talk to you about,

01:13:46 and it's this term, again, it's a media term,

01:13:48 which is designer babies.

01:13:51 Is this something that is widely discussed

01:13:54 as in it's going to be the future of...

01:13:57 Well, don't forget we were responsible for that

01:13:58 because, of course, we were the first team

01:14:02 to identify genetic defects in a couple

01:14:05 that might cause a hereditary problem

01:14:07 which would cause an abnormal baby,

01:14:09 which would be likely to die of that defect.

01:14:12 And with Alan Handyside, I mean, the two of us spent, and Kate, I should say also,

01:14:18 Kate Hardy, we spent five years trying to work out how to do the chemical tests on the genetics,

01:14:24 and also how we could work out whether or not taking a cell from the embryo to make a diagnosis

01:14:30 of the genetics was a safe thing to do, and then transferring an embryo which would be free of

01:14:36 that particular defect in that family and putting it back. And the first babies were born, oh, 1980,

01:14:47 yeah, in 1989, I think, 1980. That's right. They must be over 40 years old because they've had

01:14:56 children. So that's now used worldwide. And it's still limited because, at the moment,

01:15:03 you're looking at defects which are causing death in the baby, and that's allowable by law. However,

01:15:10 there's no question that increasingly a lot of clinics are looking at what's happening in America,

01:15:15 and some are looking in England, looking at genes which might affect hereditary and whether you

01:15:21 could test that in the embryo. It's sort of intelligence, for example, what might cause

01:15:27 particularly good health or desirable characteristics. Will that happen? Yes,

01:15:32 I think it will happen. I think it's inevitable it's going to happen, because I think we are

01:15:36 getting to the stage when we will be able to analyze a complex number of tech teams. And with

01:15:43 big data, we'll be able to actually identify characteristics which we think are associated

01:15:49 with that sort of individual. Is that wise? No, it's not wise. It's really dangerous because,

01:15:54 of course, we might well make people much more intelligent, possible, who get born slightly

01:16:00 more intelligent because, actually, intelligence is not nearly as important as genetics as the

01:16:04 environment in which you're brought up in. But actually, nonetheless, it is important because,

01:16:10 of course, eventually somebody will make a mistake or find a baby that is more intelligent,

01:16:14 but also highly aggressive or autistic or something else. So, you know, I think this

01:16:20 is tampering in a way that's really not wise, but I think it's very difficult to control

01:16:26 because there's massive money involved in this.

01:16:29 And certainly in the States,

01:16:30 this, I think, will be the first place for it to happen.

01:16:33 And it's also not particularly great as well

01:16:35 because if you think about a lot of the people

01:16:37 who actually push humanity forward

01:16:39 or in a scientific sense or great artists,

01:16:42 these are people who invariably are quite flawed psychologically

01:16:46 or they're highly autistic.

01:16:49 If we eliminate those traits,

01:16:51 we're also going to eliminate the outliers

01:16:53 who actually provide us with wonderful technology, art, etc.

01:16:59 Well, look at Beethoven.

01:17:01 You know, perhaps the man who more than anybody else

01:17:03 has changed Western music.

01:17:06 You know, this is a man who's completely antisocial,

01:17:09 who sits on his own with a broken piano,

01:17:12 is going badly deaf,

01:17:14 and actually going deaf from quite an early age.

01:17:17 And he becomes, as he feels, a failure.

01:17:19 At one stage in his later life, he's hardly producing anything.

01:17:24 And now he's on the alcohol, he's got liver damage,

01:17:28 and he's wheeled into the police station in Vienna in a wheelbarrow,

01:17:31 because they found him in the wood, and they wonder who he is.

01:17:34 And the policeman says, oh, that's Beethoven.

01:17:39 He was known. He had form.

01:17:42 And you think, you know, those sorts of things occur in art hugely.

01:17:47 and you look at Picasso, and you think, those images. I was recently looking at the Picasso

01:17:54 Museum in Lucerne, and it's amazing to look at those images. They're so improbable. Are

01:18:01 they human? And yet, when you look at them for long enough, you start to see what he

01:18:05 sort of seems to be thinking. It's an amazing experience to say how little we understand

01:18:12 about our nature, about our whole way our brain works. You know, we don't know how the

01:18:19 brain works. We tamper at it with great risk, I think. And certainly, you mentioned, particularly,

01:18:25 for example, people who are different, classically autism, the number of autistic people

01:18:30 who have been rejected in the past. But now, I'm glad to say, for example, at Imperial College,

01:18:36 for example, we're suddenly taking people like that really seriously as good candidates for

01:18:39 doing science. You know, it's very different. That's changing very much. I think we could

01:18:45 do much more by being less attitudinous about what we see and recognising that people have

01:18:51 all sorts of abilities that we need to nurture. And nurture, again, comes back again, again

01:18:57 and again. But nurture, obviously, is going to be better when you're young. It's much

01:19:02 more difficult later on. But unfortunately, if you're autistic, in a young class where

01:19:06 teachers are under pressure. It's very difficult to give that child the kind of environment that

01:19:11 it really needs, he or she needs, because of course, you know, they're disrupting the class

01:19:16 and they're disrupting what is needed by the curriculum. How long do you think it's going to

01:19:20 be, Robert, before, you know, people walk into a clinic and they're given the menu and say,

01:19:27 look, we can dial this up, this particular gene up, you can dial this gene down, and even just go,

01:19:32 well, you know what, we've got two girls who would really like a boy. I want a son.

01:19:36 Well, I think that's already happening. We're not saying it's happening, but I'm sure it is

01:19:40 happening. I don't think it's openly happening in this country because the HFEA would not give

01:19:46 approval or a license. But I don't believe that it's not happening even in this country. It's

01:19:52 certainly we're sending patients to other countries, Spain particularly, Cyprus particularly,

01:19:57 where they can get sex selection.

01:19:59 If you're a billionaire in America, you're picking...

01:20:02 Of course. And, you know, I have to say, when we...

01:20:04 Because, of course, we were the first people to choose the sex of a baby

01:20:06 because we were interested in sex-linked disorders.

01:20:09 So we were worried about a particular muscular dystrophy

01:20:11 where babies die, males die.

01:20:14 And so we realised this was illegitimate.

01:20:16 And we decided, you know, and we persuaded parliamentarians

01:20:19 that this was a good thing to do, and they agreed.

01:20:21 And we did. So that would be the first sex election. 0.95

01:20:24 That was the first in the world.

01:20:25 and yeah um i had so many offers of massive sums of money from certain countries and you can guess

01:20:34 which countries they were for well you know i need a sum i mean that was really quite it was

01:20:43 and i you know it was obviously we're not going to do that because once you start doing that you

01:20:48 bring the whole technology into disrepute and yourself eventually but there are a lot of people

01:20:54 who would just say, you know, who are very good at what they do,

01:20:57 they're very, in one word, reputable, who think to themselves,

01:21:00 well, I can earn a fantastic amount of money doing this.

01:21:03 I'm not doing anything wrong in inverted commas.

01:21:05 Yeah, I'm providing a service people want.

01:21:06 Yeah, exactly.

01:21:07 Well, you know, don't forget, of course,

01:21:09 that the first manipulation of a human egg

01:21:12 was done in China several years ago.

01:21:15 And, of course, the guy was pilloried, Dr. Hay.

01:21:20 He ended up, of course, in prison.

01:21:22 So it was possible for him to learn the techniques

01:21:25 that we were doing in labs in America and here.

01:21:29 And, you know, he copied them in China,

01:21:31 but of course he used them purely

01:21:33 because he wanted to be famous.

01:21:35 I don't think he wanted money.

01:21:36 I think he wanted to be famous. 0.97

01:21:38 You know, we have this ridiculous society 0.91

01:21:39 that we think being famous is really important. 0.97

01:21:43 It's terrible, actually.

01:21:45 Being famous is not important, actually.

01:21:47 It's something which we should understand

01:21:49 that it's not what we should be teaching people.

01:21:51 Be useful. Yes. Be learning. Yes. Be famous. Because eventually you'll not be famous.

01:21:59 Every person who goes into Parliament at the moment thinks they're going to be more than they are.

01:22:04 You know, we have a new Prime Minister. Like every other Prime Minister, he's going to end

01:22:09 feeling he could have done something totally different. Actually, you know, I feel very sorry

01:22:16 for Keir Starmer, actually,

01:22:18 who I think was treated abominably

01:22:19 by his own party.

01:22:21 But, you know, he would have awfully

01:22:23 gone to that stage in that job

01:22:25 thinking, finally, I can do something for society.

01:22:28 But it's that famous greasy poll

01:22:30 which has been described again and again

01:22:31 by every politician that gets into the cabinet

01:22:34 pretty well.

01:22:36 You know, fame

01:22:37 is meaningless.

01:22:40 Doing something which actually might help other people.

01:22:42 And what we're not doing

01:22:43 and it's really important is to teach

01:22:45 our children to be kind, to be able to listen, not to argue without actually listening to the

01:22:51 argument. And we don't do that well. I don't do that well enough either. You know, we need to do

01:22:56 it much more. But actually, ending up with emotional intelligence is going to be as important

01:23:03 as being famous. It's actually going to be as important as being successful at science or

01:23:07 successful at the art. Emotional intelligence is the key to improving society. And kindness is one

01:23:15 example which we don't talk about very much but i feel when i talk to graduate students phd students

01:23:21 bear in mind you're in your lab just find a lab that's kind you know because actually that

01:23:25 environment will be helpful to you robert there's one other area we wanted to discuss before we

01:23:31 we wrap up which is something you've commented on frequently i remember famously a conversation you

01:23:36 had on question time with fiona bruce who i like and i think actually is uh generally pretty

01:23:41 balance in my experience having done question time a few times but uh you were trying to explain

01:23:47 the science of sex and what makes someone male and what makes someone female uh you did it and

01:23:52 she concluded by saying i think something like some people may disagree with this i mean this

01:23:57 you've mentioned kathleen stock and and that's a trans uh issue but obviously academic freedom has

01:24:03 has been talked about in a number of areas i was i was rather hoping that you'd be interested in

01:24:08 my opinion as a biologist which seems rather more important because I'm just saying only because

01:24:12 the issue of academic freedom isn't solely I'm about to say something which will mean that you'll

01:24:17 probably want to edit the program when I finish but basically right okay we're all braced for it 0.98

01:24:22 I will say this categorically that you cannot change your sex your sex actually is there in

01:24:30 every single cell in the body you have a chromosomal sex you have genetic sex you have

01:24:34 hormonal sex, you have all sorts of different kinds of sex,

01:24:37 psychological, brain sex, they're all different.

01:24:40 And we are very confused about this, unfortunately,

01:24:42 and regrettably it's got into this argument

01:24:46 that people will now accuse me of being transphobic. 0.56

01:24:50 Well, look, there are trans people who say you absolutely can do that.

01:24:53 Well, unfortunately, you can't say this publicly. 0.99

01:24:55 This is one of the big problems.

01:24:56 Even saying this on this programme undoubtedly will result

01:24:59 in my getting a huge amount of hate mail.

01:25:01 It always does.

01:25:02 But I do think it's a big issue about the attitudes.

01:25:07 There are, of course, issues which are important about young people

01:25:11 who are confused about their sex, but we won't go down that route here.

01:25:15 But it does affect a whole lot of issues in schools and elsewhere in our society.

01:25:20 Of course we should accept people as they are.

01:25:23 Overall, I think it's a very sad thing that we can't discuss biological science

01:25:27 without actually getting completely caught up emotionally

01:25:30 with something which is really completely wrong.

01:25:33 Well, as I say, there are people who would vehemently disagree with you,

01:25:36 so I'm just going to make that clear.

01:25:39 It seems to me that we've lived through this strange period

01:25:42 where in the area of the trans debate,

01:25:46 science has just gone completely by the wayside

01:25:50 and people's feelings have come to the fore.

01:25:53 Is that a fair assessment?

01:25:54 Yes, I quite agree with that.

01:25:56 I mean, I think Fiona did an injustice to the argument,

01:25:59 actually on that occasion. She didn't listen to what really I'm saying. I'm not in any way

01:26:05 prejudiced against people who are transgender. It's not the issue at all. The fact of the matter

01:26:10 is that there's a difference between gender and sex. Sex cannot be changed because it is inherent.

01:26:16 All your genes will carry the Y chromosome. All your cells, every cell in your body,

01:26:22 the trillions of them will have the Y chromosome. Mine too. And that actually fundamentally

01:26:27 changes our development. The same for women who have two X chromosomes. And we should celebrate 1.00

01:26:33 that. Now, of course, there may be some people who feel uncomfortable with their sex and they

01:26:37 want to change it, but they're changing their gender. They're not changing their sex. They're

01:26:42 changing what's kind of acceptable by a manipulation. And that is a big problem.

01:26:48 Sometimes, in fact, I found in my clinic so many women who came in infertile who were desperate

01:26:54 because they changed their sex and now felt they made a big mistake, were deeply depressed.

01:26:59 And that was with men as well. And we forget that because, of course, we're doing this sort of thing

01:27:04 because we don't understand this. And so I think remarks like that were deeply unhelpful,

01:27:11 actually. I think Fiona Bruce didn't help the conversation.

01:27:15 No, I don't think she did, but I understand why she did it. This is my point, which is people are

01:27:20 so sensitive about the subject, no one cares about what the truth is anymore. It's about,

01:27:24 let's just make sure we don't offend anyone. It's interesting, though, that, you know,

01:27:27 I used to come on Question Time pretty regularly. I've never been asked on since that time.

01:27:31 Really? Yeah. You know, do I care? No, of course I don't, because actually, I don't think if a

01:27:37 programme can't listen to a sensible argument, which I think it was a reasonably sensible argument.

01:27:42 It was. It was a very brief statement. Yes. And you're a fairly eminent scientist,

01:27:46 So your contribution to this debate should be indexed quite highly, in my view.

01:27:51 Well, fairly nominal, you know, as, you know, I'm a scientist.

01:27:55 No, sorry, sorry, sorry, hold on a second.

01:27:57 Sir Lord Professor Robert Winston, it's not relevant.

01:28:02 I might not, no, it's a serious point.

01:28:04 This is a serious point.

01:28:06 When we're having a public debate about something that involves scientific facts,

01:28:11 the contributions of people who are scientists matter more than the contributions of media

01:28:15 personalities and politicians and other people who don't understand any of this and what i'm

01:28:20 getting at is i think without personal animosity towards fiona in that situation directly i'm just

01:28:25 talking about the broader issue and the debate and the way it's being had is we are prioritizing

01:28:30 people's sentiments over fact well that's of course it's as popular where it's it's it's the

01:28:37 current current trend well i would say once i would say one thing though in in in her defense

01:28:43 or indeed in anybody's defense, you know, scientific facts are only relevant at the time

01:28:48 when they are there, you know, with the things, when I look back at the papers I published,

01:28:54 within four years, they're out of date, because actually we realized what I was thinking was

01:28:57 factual, is different. And so often I got it wrong. And I think we have to be much more aware

01:29:04 of that. However, I do think it's difficult to define sex in the way that's being defined,

01:29:09 Because I think it's very clear there.

01:29:12 So whether it's a scientific fact or not, we have to understand that facts are not the

01:29:18 only way that you make legislation, of course, and that's something that we have to consider

01:29:23 because it's also what is supported by a democratic society, which is, let's say, ethical, and

01:29:32 so on, a whole range of things.

01:29:33 But in particular, of course, I've no doubt that Theodore was considering some people

01:29:38 who are desperately worried about their sexuality, who are, and who are actually going through

01:29:44 a tough time with their parents, and of course, maybe at school and all sorts of, with their

01:29:49 friends. 0.99

01:29:51 As we found, for example, with homosexuality. 0.97

01:29:56 You look at that wonderful program recently with Ian McCullen discussing his homosexuality, 0.98

01:30:01 You think, what an amazing man, but have to go through that, you know, not be able to tell his

01:30:06 parents that actually he was gay. It was a great thing, the way he presented, and he's done that

01:30:15 for a long time, of course, but it was wonderful to see that on the BBC. But I think that's very,

01:30:21 very different to this issue. Yes, it is. It's very different. It is, but we muddle up those

01:30:26 issues. Yes. And sometimes it's probable, according to psychiatrists who one respects,

01:30:33 who've got a good background, who feel that actually some of the people who are requesting

01:30:37 sex change actually, of course, are probably really homosexual in the background. I don't

01:30:43 know whether it's true or not. But, you know, it's a different issue. Could be a different issue.

01:30:49 So can you explain what sex is and what gender is in a simple way?

01:30:53 Yeah. I mean, your gender is really basically, if you like, your visual phenotype, how you look,

01:31:02 how you are. How you present.

01:31:03 How you present, yes. And your sex is actually something which is inherent in every cell in

01:31:10 your body and may cause differences which are very wide. So some people, for example,

01:31:18 many of them will be extremely feminine in the way they talk. Others will be very masculine.

01:31:23 I went to the Orosia yesterday, and there's Agamemnon, who's a giant man, you know.

01:31:31 I think it's important that, you know, we don't think about nuance enough.

01:31:39 Yes.

01:31:39 And that's probably why I was mistaken on question time.

01:31:43 But, you know, to some extent, you know, you want to give a fair point.

01:31:48 The number of emails I had after that statement was phenomenal.

01:31:52 The number of women who wrote to me saying, thank you so much for sticking up for women.

01:31:57 We really, it was literally hundreds of emails, which I've not had for anything else I've done

01:32:02 on the media. And I've done a lot of media work. So, you know, it was interesting.

01:32:06 Oh, yeah. Well, the trans issue is something we've discussed a lot on the show. And the reason

01:32:11 I think it's such a hot button issue is that many women feel that the particular privileges 0.97

01:32:17 and protections that they've been afforded for very understandable

01:32:21 and rational reasons, you know, and they four had to fight for for a long time,

01:32:26 are at risk when people who present as female, or as women rather,

01:32:32 but are actually male, you know, go into certain spaces,

01:32:35 which are women-only spaces and so on.

01:32:37 And a lot of women feel very concerned about that issue. 0.93

01:32:39 It's very difficult, too, because it's very difficult to legislate effectively for that. 0.98

01:32:43 And, of course, that's one of the things that courts have had a problem

01:32:45 because, of course, unfortunately, no matter how good a lawyer you are,

01:32:49 you can't define sex as you can as a scientist.

01:32:52 It's different.

01:32:52 Yes.

01:32:53 And that's not the fault of the lawyers.

01:32:55 It's because, actually, both are important systems of how we make judgments.

01:33:00 Professor, Lord, Sir Robert Winston, thank you so much for coming on.

01:33:04 Our final question, as you know, is always the same,

01:33:06 which is what's the one thing we're not talking about that we really should be?

01:33:12 Wow.

01:33:12 Now, I think maybe political correctness maybe is something we could be looking at.

01:33:22 You know, we are a society now, increasingly, where we're making statements which are politically

01:33:27 correct.

01:33:28 Government does that all the time.

01:33:29 The new prime minister is doing that all the time.

01:33:32 I hope he doesn't make a mistake in that respect, but some of the things that are being said

01:33:37 at the moment may seem helpful to society, but they may not be. And I think we have to recognize

01:33:45 that when we legislate, we legislate for many people who are not necessarily in the same party.

01:33:51 And actually, within a party, there will be people with widely different values.

01:33:56 We've become quite tribal in our politics. And I see Parliament more tribal now than at any time

01:34:04 in the past that I've been there, what, 32 years? Too long, probably, of course. But nonetheless,

01:34:10 I think that tribal effect of thinking is not always helpful. Of course, there are great

01:34:17 differences between Tories and Labour Party and Social Democrats, but they all have useful values

01:34:26 to remember. But often, we actually ignore that completely in the arguments we're putting forward.

01:34:32 Thank you so much for coming on.

01:34:33 Head on over to triggerpod.co.uk

01:34:36 where we continue the conversation with your questions.

01:34:40 Housing before AI helps with embryo selection

01:34:43 or even editing to optimize human ability,

01:34:46 health and longevity.

01:35:01 You

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TRIGGERnometry - September 26, 2026

The IVF Pioneer Who Says His Own Industry Is Lying - Professor Robert Winston

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