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You may recall back in October I warned you about an infantile Netflix film with the oh-so twee title of ‘Joy’, which was all about the two British inventors of IVF, Patrick Steptoe and Robert Edwards.
Fertility treatment, IVF or otherwise, does not lend itself to soppy film stories.
First, the subject is simply too complex and nuanced for such a drama.
More importantly, the subject of fertility treatment is way too full of scandal to be turned into a dewy-eyed film.
It is understandable that people feel sentimental about wanting children and so on. But with every medical procedure, and most especially with fertility treatment, it is vital not to be sentimental.
It is all about asking questions and probing on your own steam, without being led up the garden path by clinicians and mental health counsellors.
Once you delve around under the bonnet of what really goes on in fertility clinics, you will find accusations of sharp practice in many areas.
People often suspect over-charging and while that may be true, the money side of things is small beer next to some of the medical accusations put at the industry by people such as Professor Robert Winston, who was very much in the orbit of the two inventors of IVF.
Robert Winston has never lionised his own work, or that of Patrick Steptoe and Robert Edwards.
Winston’s books, articles and interviews are all about reducing the layers of intervention and thereby reducing the risks.
It is quite clear to any lay reader that Winston views IVF as a high-level, high-cost, high-risk intervention.
To get to the point, we had this ineffable film about Patrick Steptoe and Robert Edwards, which is almost like a marketing for IVF exercise.
And then in the past week we had a story emerge that made for a much more insightful look at the life of Patrick Steptoe.
Here is the soppy, sentimental headline from the Daily Telegraph:
‘The IVF pioneer, the secret sperm donor – and the lives torn apart’
Wouldn’t that have made a much better film than ‘Joy’?
We don’t need infantile films simplifying this hugely complex area of medicine.
We need a trip to Home Truth Corner about how we have all ended up in a world where IVF is commercialised and lower-risk treatments seem to be marginalised.
The Telegraph’s story is quite small in scope.
However, if you read the story carefully, you can see many more interesting issues arising out of it.
This is the story in a nutshell.
Two people, David Gertler and Roz Snyder, think that fertility clinician Patrick Steptoe secretly impregnated their mothers without consent using sperm donated by a senior lab technician.
That is the main story, but, as is so often the case in these newspaper fertility stories, it is the sub-topics that are much more interesting.
The two adults were not conceived by way of IVF. The story does not say how they were conceived. It might be the case that they were conceived by low-cost, low-risk IUI, which stands for intrauterine insemination.
IUI is one sub topic in this story that is really worth exploring for anybody interested in low-cost, low-risk fertility treatment.
And then we get to this sub topic. This part of the story is a cracker: ‘At the time, Steptoe, a consultant gynaecologist at Oldham, was pioneering laparoscopy, a procedure that enabled him “to clear adhesions” in the fallopian tubes to improve the chances of natural conception.’
Ah! That passage is extremely important. The genius of laparoscopy means that the adult receives all the intervention, not the child.
The child is not frozen. The reproductive material is not interfered with at all.
‘This is because NICE has recommended, with dubious wisdom, limited use of the laparoscope because of the cost. Yet this “cost-saving” approach actually results in more patients having unnecessary and expensive IVF treatment.
‘Consequently, surgical treatments for infertility are less frequently done on the NHS, in spite of the excellent success rates that can be achieved.’
You can see quite clearly the argument that Winston makes there.
Good medicine is about reducing layers of intervention. Not increasing them. IVF is supposed to be the last resort. Yet it seems too often to be the first choice.
Why is the NHS railroading women onto high-cost, high-risk IVF when the laparoscope could reduce costs and reduce risks?
Has the medical industrial complex captured every part of the NHS?
This is Professor Robert Winston speaking in a newspaper interview titled ‘Robert Winston: “I do have a very dark side”: “The tubal surgery we were doing [at Hammersmith Hospital] was wonderfully successful – and still is more successful than IVF – but nobody is doing it any more.”
‘Why not? “IVF is very commercial. The people doing it are among the best-paid in medicine: They charge a lot per treatment and it is not in their interest to make it more effective. Having people fail means that they come back again.”
‘Winston was not part of this plot to exploit infertile couples because private practice was frowned on at Hammersmith Hospital where he, and others, focused on research – but surely he should have spoken out?
‘“Two years ago, when I was making A Child Against All Odds, the BBC said it didn’t want me to raise these issues,” he says sheepishly.’
What conclusion do you draw about Big Medicine and Big Media from those remarks?
To return to this couple of adults, David Gertler and Roz Snyder, what is most interesting about their life story is that they were saved all from all the long-term risks associated with IVF and were instead conceived using a much lower long-term risk method.
Wouldn’t that have made a much better Netflix movie?
Wouldn’t the remarks made by Robert Winston above have made for a much better movie?
The world does not need medical movies that cry in their voice of Dr Pangloss: ‘All is for the best in this best of all possible worlds.’ Really Dr IVF Pangloss?
Are you sure there are not questions to be asked?
Just as I have signposted readers to Patrick Steptoe’s use of laparoscopy, which some would argue is much more useful than IVF, I also want to signpost the detail on IUI.
This is from a Daily Mail article titled: ‘The cut-price fertility boost that childless couples are not told about: IUI versus IVF “comes down to profit margins”, say doctors’:
‘IUI involves inserting a sperm sample that has been washed in a super-charged transport solution to promote sperm swimming speed directly into the womb. This is done on the precise day of the month that an egg has been released.
‘Women are generally also given a low-dose egg-stimulation drug to ensure the one egg naturally produced in every monthly cycle is in perfect condition. It costs £600 to £700 per attempt, compared with £6,000 to £7,000 for IVF.
‘Not only is the treatment cheaper than IVF, but the drug regimen is much lighter.’
I don’t want to spend too much time on the money angle. That’s too obvious. But I do want to flag up that last sentence.
Note the drug regimen being much lighter. It is the long-term risks associated with fertility drugs and the doses they are used in that readers might want to follow up. The money is almost beside the point when you are trying to consider long-term medical risks to the woman and the child.
It is the time bomb nature of medical risks that many people are unaware of.
The same article goes on: ‘Yet IUI is not being promoted to women – some doctors believe this is because the more expensive IVF is more profitable for clinics.’
In the same article we hear from NHS consultant Dr Gulam Bahadur: ‘“The only people benefiting from these NICE guidelines recommending only IVF are people offering privately funded IVF.
‘He adds: “The NICE guidance against offering IUI is based on one study from 2008, which suggested it has a success rate of only 6 per cent. That is not true. NICE is only receiving advice from people who do IVF and I don’t think it is handling conflicts of interest very well.”’
Woah! Let’s pause again. There is a lot of information being condensed into these very short paragraphs. The words I want to draw your attention to, though, are: ‘One study.’
One study? Are you kidding? That was quick.
How convenient that just one study can alter the NICE guidance against offering IUI.
Fancy that!
The article goes on, Dr Gulam Bahadur’s ‘comments have been endorsed by Roy Homburg, professor of reproductive medicine at Queen Mary Medical School in London, who told an international meeting of infertility experts in New York in March that for the one-third of patients with unexplained infertility – those without a diagnosable mechanical problem in either partner – IUI was just as good as IVF.
‘“I completely agree with the suggestions that IVF may be inappropriate and is exploitative of many patients,’ Professor Homburg said.
‘“There is no evidence whatsoever for the NICE recommendation.”
‘IUI versus IVF comes down to profit margins, says Dr Gedis Grudzinskas, a former emeritus professor of obstetrics and gynaecology at St Bartholomew’s & The Royal London Hospitals.
‘“The clinics can make more on IVF, so that is what they do, but also patients often think they are more likely to get instant results with IVF because mostly the sperm is injected straight into the egg, so that is what they ask for.’
This seems to be a controversial topic in the West. Is it also something else that is out of control in the surrogacy factories of Ukraine?
Here is a headline:
‘IVF treatment used by 23,000 women in turmoil as shock report reveals that birth abnormalities have doubled’
And this is what the article says: ‘ICSI – intracytoplasmic sperm injection – effectively creates children from single sperm that Nature might have weeded out as unsuitable.
‘Infertility consultant Gedis Grudzinskas said: “The use of ICSI has increased in the UK over recent years and in some centres it is used universally. That’s irresponsible and this study should cause those centres to rethink their policy.
‘“Some of these ICSI decisions could be commercially driven.”
‘Dr Alastair Sutcliffe, an expert on the effects of IVF in children, added: “I am against the widespread increasing unrestricted use of ICSI because it is hardly a Darwinian way of reproducing.”
‘Professor Michael Davies from the University of Adelaide said it was unclear whether the increased birth defects following ICSI were down to a problem inherent in the technique, or because of the quality of sperm used, which could carry damaged DNA.
‘He said: “There are some seriously defective sperm that can be selected and there are many occasions when that sperm could never naturally fertilise an egg.
“This is a technology that is operating at the absolutely limits of available knowledge, which does open up a debate about how fast should some of these things be implemented.”
As you can see from above, the ICSI technique is for male infertility, but its use seems to extend well into cases where male infertility is not an issue.
Let’s go to another headline: ‘IVF clinics are “embezzling” £42 million a year from couples who are desperate for children by charging for a needless add-on treatment, fertility expert warns’
Professor Chris Barratt, of Dundee University, told the Progress Educational Trust’s annual conference in London: ‘“The question is why do you have a large number of people having ICSI who don’t have male-factor infertility?
‘“Why is that happening? The only conclusion logically you can come to is that it is financially driven. That might not be true. But it is the only logical conclusion.”’
If you want a more detailed account of the advent of IVF and the risks associated with such treatment, do check out the book A Child Against All Odds by Robert Winston.
The book’s sub-title is particularly instructive:
‘How far should we go in the struggle for life?’
If you read that book, you might come to the conclusion that perhaps Patrick Steptoe’s finest hour was his use of the laparoscopy and his artificial insemination clinic.
The Telegraph article notes that in 2010, Robert Edwards won the Nobel Prize for but that Patrick Steptoe had by then died. The prize cannot be awarded posthumously.
Do you remember Alfred Nobel and what his most famous invention was?
It was something that he thought might help humanity. It was soon commandeered off him and instead of being used in an ethical way, it was used in all the worst possible ways imaginable.
Do you think there is a lesson there in the way IVF has gone from last resort medical treatment to commercial behemoth?
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