“I became aware that there was a big need, that there was a major academic value in doing research in the area. I was very much concerned about the distress, particularly among women and couples, who were trying to have a pregnancy. And I think also, it’s a very underrated field because essentially, for most of us, the most important single thing we do is to actually bring up children,” Prof Robert Winston replies when I ask what ultimately drove his interest and involvement in the area of human reproduction and infertility over a long and prolific career.
“I was very, very concerned about the huge private practice in IVF, and felt strongly that it should be a right for everybody to have that access if possible.
"The publicity around IVF is very misleading," he says. "The impression is that it's a really successful treatment, but actually the European global figures, if you take the whole of Europe including Britain, you can see that after six cycles of IVF treatment, only 44 per cent of patients have had a live baby. That is not the impression that is given to the public."
Healthcare is so expensive
The failure to recognise infertility as the significant healthcare issue that it is, is something Prof Winston feels very strongly about. “It seems to me that what is not accepted by health officials, given that healthcare is so expensive, is that the pain of repeated miscarriage, or the pain of years of infertility, trying all sorts of treatments, is just as bad as the pain of osteoarthritis or any other thing which would be treated under healthcare.
“Anybody who has not managed to get pregnant after a year of reasonably regular intercourse is regarded as infertile,” Prof Winston explains. “If you’re over 30-35 then there may be more urgency, because fertility definitely tails off as you get older.
“Homespun remedies, like changing your diet,” are not solutions to infertility, he says. “Infertility is a symptom of an underlying condition,” adding that many commercial items sold, which suggest they will help a person to become pregnant, won’t “really make a significant difference and very few of them have been tested scientifically”.
Prof Winston believes too many people are going into IVF in what is seen as “an easy way of getting pregnant”.
“Actually it’s far from easy,” he says, “and it doesn’t deal with the underlying diagnosis either. It’s really important to make a diagnosis, understand why people are being infertile because there are at least 100 different medical conditions which will not be obvious, which don’t cause serious ill health, but have a very big impact on whether or not one is likely to get pregnant easily.
“Most of those are ignored and, in most cases, no diagnosis is made and so the patient goes to an IVF clinic and gets this treatment which circumvents the underlying problem, gets them pregnant sometimes, but doesn’t really sort out why they’re not getting pregnant.”
Whereas, if the underlying issue was treated, Prof Winston explains, “you could have a natural fertile life”.
The idea that infertility may be on the increase is not one to which Prof Winston necessarily subscribes. “There’s a huge amount of suggestion that male infertility is much more common now than it was. I’m not entirely convinced of that. We’re much more ready to complain about it now. It’s not such a secret. Ten, 15, 20, 30 years ago men would keep very, very private the fact that they might be having a problem with their sperm count or some difficulty with having sex or whatever it might be. This was seen as an attack on virility.”
Through his work, Prof Winston has seen first-hand the huge distress and mental anguish infertility can cause. “People, after a few months, say they have a great deal of anxiety. They think they’re letting their partner down or themselves down, or they’ve done something themselves which has made them infertile. This is followed with a kind of loss of self-respect. A feeling of guilt is very, very common among infertile people, which is quite unreasonable, but it’s there. It’s one of the reasons why they keep quiet about it.
“And then of course you have this corrosive effect on the relationship between the couple. It’s very frequent for men to become impotent and for women to lose orgasm and for women to feel not a proper woman. Women have told me how they felt like an empty vessel during intercourse. All sorts of comments like that are really, really common.
One of the problems with miscarriage is that it's not taken very seriously
“And that leads to profound pain. Every menstrual period becomes a nightmare. Every little thing you do, you feel that you’re somehow contributing which is one of the reasons why of course this is a particularly good market for the homespun home remedies. People are eager to try anything to break the cycle and, of course, sometimes they’ll get pregnant anyway and they’ll think this new remedy is what they’ve just taken, but of course they actually would have got pregnant had they just being trying properly.
“A lot of relationships break up. Some, of course, become closer, but most don’t.”
Both partners, Prof Winston explains, can experience a “sense of failure, a sense of depression, often quite extreme... I think it’s not to be underrated, it’s a serious problem. It does affect one’s mental health as well as one’s physical wellbeing.”
Preventable baby loss
Prof Winston is chairman of the Genesis Research Trust, which funds research to progress the understanding of miscarriage, stillbirth, preterm birth, and reproductive cancers, in order to reduce preventable baby loss. He says it has made “huge advances” in the area of miscarriage. “One of the problems with miscarriage is that it’s not taken very seriously – ‘well, you can always try again’ is what you’re told. Or you have a quick scrape and leave hospital, but to the woman that’s a profound injury.”
Current research being undertaken by Genesis may lead to a situation where some miscarriages can be prevented in future pregnancies, Prof Winston says. “That will be the hope, that people become less prone to getting recurrent miscarriage.”
When it comes to the pain and tragedy of stillbirth, he says “the biggest single issue... is that at least 50 per cent of stillbirths are preventable. That’s the awful fact, either there’s been inadequate obstetric care or the patients have not attended the antenatal visits, or there’s been some mistake during labour.
“People don’t say this enough, a lot of stillbirths are actually preventable. Our profession needs to be much more aware, that we need to be doing much more to try to really implement better antenatal care. There are a number of stillbirths which are completely unexplained, and that is an area of research that we’re [Genesis Research Trust] involved in.”
I don't think there's any evidence at all that vaccination actually destroys your fertility or <br/> changes your fertility
As the Covid pandemic rages and the vaccination rollout continues, a deluge of misinformation and unfounded theories have taken hold, including theories around fertility and vaccinations.
“I don’t think there’s any evidence at all that it actually destroys your fertility or changes your fertility,” Prof Winston says. “There’s no reason why it should. The vaccinations shouldn’t affect that aspect of the immune system at all. And people are getting pregnant, having been vaccinated and what would be much worse would be to run a pregnancy while you’re about to get Covid. That’s more serious. At the moment, the evidence we’ve got would suggest this is one of these mythological things.
“A lot of friends or relatives of friends have rung me up and say ‘Do you think I should actually get the vaccination or should my daughter get vaccinated?’ And my answer is ‘Yes, because it’s much more dangerous to get the virus and then find yourself pregnant than anything else.’
"Viral infections certainly damage pregnancies, that we do know. The German measles is one example. But there are many other viruses which actually can affect the pregnancy adversely and kill the baby or make it abnormal. So there seems, at the moment, every reason you would want to protect yourself against viral infections if you could do and clearly vaccination is one such [way]."
The Genesis Research Trust is hosting its first Begin before Birth online public conference on Tuesday, June 15th. The conference will explore emotional wellbeing during pregnancy and beyond, and will benefit new and expectant parents and practising professionals. Tickets are available at symposia.org.uk
