Lord Winston (Lab)

My Lords, I would like to come down to earth a little bit. First of all, I suggest that infertility is not a disease; it is actually a symptom of something wrong, and that is the basic problem here. What we are doing here with in vitro fertilisation is using a medical treatment for a symptom without actually making a diagnosis. That is almost universal; it is not only in this country but in every other country. In my view, that is something that neither the Human Fertilisation and Embryology Authority nor NICE have done. In fact, they have made it very difficult to investigate patients to find out what is wrong. There are at least 100 causes of infertility, some of which are extremely serious and end up with people being childless. They could be treated far more cheaply in all sorts of ways but are not, because in vitro fertilisation is seen, as we have just heard, as the gold standard. Believe me, it is not the gold standard. Indeed, it is not well regulated, for reasons I will explain, and cannot be in this situation. One issues we have to think about is whether we should really be doing some kind of special regulation for one small treatment in the whole medical spectrum. In my sense, that no longer works. The HFEA was an important body in its time, when there was public unrest about the human embryo and it was very clear that in vitro fertilisation was going to be a new treatment. It is now absolutely essential that IVF is normalised. That will be very complicated, but it is something that this Government could do; they could regulate it far more effectively with the vast things at their arm. In vitro fertilisation is of course increasingly expensive, as the noble Baroness, Lady Deech, pointed out, because it is largely in private practice. It is in the National Health Service a bit, but the National Health Service is making a profit out of in vitro fertilisation. One president of the College of Obstetricians and Gynaecologists said to me, “Don’t say too much about NHS IVF: we need it because it is currently, together with abortion, paying for maternal care”. That was what he said privately as a president of the college. How we fund the health service is a real issue to think about. At the moment, private clinics are making vast sums of money. Clinics are being sold for several hundred million pounds at a time; the equipment in them is probably worth about £15 million at best. There is very little understanding and regulation of that, nor is the inspections situation sufficient. In my own laboratory, I remember one year we had a fantastic review saying it was the best lab they had ever visited. We were not then treating patients; we were simply doing research, with some patients being involved in that research. The following year, having changed nothing that was praised, we got a terrible review—for no reason other than the fact there was a different set of examiners, some of whom were in private practice and were jealous of what we were doing. That is a real issue. That resulted in my closest colleague, Kate Hardy, who was one of the best embryologists in Europe, finally saying she did not want to do embryo research any more—she was in tears—and she never did. She was actually so depressed by that review that she gave up and ended up doing other work on the ovary, which did not involve in vitro fertilisation. We lost one of the best scientists we could have had in that field. She had papers in Nature and many other journals. We had worked together, for example, as the first people to do pre-implantation diagnosis, to look at genes in the embryo, and she was one of the four authors of that paper. She gave it up because of what the HFEA had done to her mentally. She really suffered. I want to make it clear that we need to do something much more serious about this. As much as I respect the noble Baroness, Lady Deech, we cannot say that it is the envy of the world: it is not. As a so-called expert in in vitro fertilisation—whatever that means—I have visited virtually every civilised country where in vitro fertilisation is done. They laugh at the idea of the HFEA. It does not matter where you are: they do not think that our regulations are fit for purpose. One of the issues is the way we understand the results of in vitro fertilisation. I mentioned this in the King’s Speech debate the other day, when I pointed out that one area of in vitro fertilisation that is hopelessly accounted for is egg freezing. I showed the data: there are something like a quarter of a million eggs recorded as available which have been frozen. So far, some 34,000 of those have been unfrozen in the past year for the purposes of treatment. Of that number, 2,000 embryos were produced, and only 900 pregnancies were produced. We do not even know the number of live births. People do not want to have an embryo transfer; they want to have a baby. That is why they come. The problem is that, right from the beginning, we ignore the fact that the treatment is a long process. It starts with an assessment of what is wrong, which should mean a diagnosis, wherever possible. Secondly, we have to look at the hormonal control of ovulation. Particularly, we have to understand that the eggs must be matured properly before they can be treated with sperm, otherwise you do not get normal embryos. When that is done, we have the problem, in some cases, of finally getting embryos. But before we do that, we have to understand male infertility, which is very poorly served and really not dealt with at all by the HFEA, even though it is an integral part of infertility. We need to have far more expertise in dealing with male fertility. We have just ignored it completely, quite unnecessarily. All sorts of research could be employed—but we do need more research. Once we have an egg that seems to be fertilised, we culture it. It spends up to five days in a dark medium, the constituents of which we do not know, because the constituents of the media that are available commercially are secret. We have been doing extensive work on this to find out what the ingredients are. One of my colleagues, Sheba Jarvis, has looked with spectroscopy and we found 302 different proteins which we did not know were in one particular medium. That is really quite serious, because some of these proteins may be bioactive and could have an effect on the outcome of the culture. After that black box is opened and the embryo is taken out, if it has produced an embryo—which it does in some cases—we hopefully end up with an implantation. All those stages carry a failure rate, which is not recorded properly in the statistics. In fact, when I recently asked the HFEA to write to the Minister, I was told that we do not know how many eggs are being frozen, how many end up fertilised, how many become embryos or what happens to those embryos—we only know the number of embryos transferred to uteruses and the number of pregnancies. We do not even really know the number of miscarriages, which seems to be at about 15%. That is not satisfactory. In conclusion, I would argue that the HFEA was a great organisation to start with, but it is now no longer fit for purpose. We need to bring it back in to make in vitro fertilisation a proper treatment that is recognised, so that it ceases to be something that is managed by private practitioners at huge advantage to their pockets. That should not be allowed to happen.