Stacey Gregg's blog posts
Dispatches Part 2
July 21, 2016
Stacey Gregg, UK based writer for B!RTH meets Professor Daniel Brison, Honorary Professor of Clinical Embryology and Stem Cell Biology at The University of Manchester; Scientific Director of the Department of Reproductive Medicine; and Co-Director NW Embryonic Stem Cell Centre (NWESCC).
I screwed up location and am waiting on Dr Daniel Brison at the Old Building St Mary’s Hospital in Manchester. A rangy, dark haired man strides past, then doubles back and asks am I Stacey, in a soft, North American accent. We opt for cafe Nero, where he knows the staff and is acknowledged warmly two or three times throughout our conversation. He’s an enthusiastic speaker, leaping straight into inequalities in provision, keen to share.
“You’re pretty clued up for a playwright.”
He sits back five minutes in: “huh.” What? I ask. “You’re pretty clued up for a playwright.” He seems surprised. I shrug it off. I like research. Hey, I did A-level Biology! Later a friend will suggest this was patronising, but I can’t lie, I think it was genuine, and I bloody took it.
He’s talking about the postcode lottery. How all women should be provided three rounds of IVF, but most aren’t. Private work counts for 75% of treatment, usually because NHS waiting lists are so long. He says the cut-off age of 42 is only justified by a lower success rate, which is not a good enough reason. It’s not for us to decide who is too old to have children.
“the oldest child of IVF is only 38”
Brison’s main contention is how little we know about the impact of IVF on the children born by it: the oldest child of IVF is only 38. Epigenetics (the study of cellular variations that result from external or environmental factors that switch genes on and off and affect how cells express genes) suggests there is much about the earliest days of an embryo’s development we don’t know, particularly the effect of freezing and thawing. Brison suggests the safest thing to do is put the embryo straight back in as early as Day 1 rather than waiting 5 days as is common.
There is a trend toward “social egg-freezing.” Originally introduced for cancer patients who would otherwise lose their eggs, it is now becoming a lifestyle choice offered by employers. This is in stark contrast to more cautious approaches in Italy and Germany for example, where they are only allowed to fertilise three eggs at a time, and if they all survive they must all be put back in the patient rather than freezing. This is rooted in religious concerns. At the opposite end of the spectrum again, “Octomom” in California, the likes of which informed the current “one at a time” campaign.
As regards to success rates, Brison speculates it is less that IVF has improved than that freezing has, allowing women’s bodies to recover from the stim drugs and thus improve success rates. Before egg freezing, clinics made a great profit starting from scratch after each unsuccessful transfer.
“Currently, a less well-off couple might donate young eggs in order to afford treatment.”
Another issue is egg sharing. Currently, a less well-off couple might donate young eggs in order to afford treatment. These young eggs may be bought by an older, richer couple. Brison speculates an asymmetry in this arrangement where the buyer likely has more success than the seller. This brings us to those who believes we ought to tell all donors where their eggs are going as in the near future anonymity will be meaningless, and donors will learn anyway. Who can account for the mental and emotional stress this will likely incur?
We discuss cross-border reproduction care, or “fertility holidays/ tourism.” UK clinicians unofficially refer women abroad and it is impossible for the HFEA to regulate this.
““They’ll get there” says Brison, “turning off” genes that could lead to Alzheimers for example.”
Finally, we get on to the more sci-fi end of treatment such as pre-implantation genetic diagnosis.
“They’ll get there” says Brison, “turning off” genes that could lead to Alzheimers for example. Sequencing an embryo, seeing cases of genetic discrimination that likes of which has already popped up in the US. I find out later that its British scientists who have been pushing ahead with human genetic testing on human embryos.
For now though, we finish on a current scandal still washing through the HFEA. The HFEA were left to regulate parental consents regarding eggs and embryos, but have been remiss, and now there are clients wondering where their frozen embryos are. Were they allowed to perish? Were they donated to science, or sold? The maze of unknowns bely the smooth simplicity presented by clinics and advertising. Indeed dig a little deeper and the wave of indefinites and grey areas could really raise the stress levels which, of course, is not good for business.
Dispatches
July 15, 2016
UK based B!RTH writer Stacey Gregg recounts a meeting with Gail, a midwife working in Manchester with twenty years’ experience.
I meet Gail in Manchester in a cafe. She’s worked in UK midwifery for twenty years. We thought it’d be a good idea for me to talk to someone on the front line.
It takes a while to warm up. It strikes me that though Gail is warm and responsive, she seems a little guarded. I wonder what’s made her feel this way.
“The demographic of new mothers has changed.”
We jump right in, talking about the increasing challenges faced by maternity units. The demographic of new mothers has changed. Gail tells me they’re seeing increased rates of diabetes and obesity. Also, more women with medical problems who are receiving better care now, and thus able to have children where once they may not. Mothers with cystic fibrosis for example. Gail says the quality of care can vary a lot depending where you live. Many units face a shortage of midwives, and struggle to recruit. Maybe because of my accent, Gail mentions that Irish midwives often plug that gap, happy to travel from Ireland, or from Scotland, commuting for work.
“They can be quite glamorous now! Not just your Pam Ferris types!”
We talk about the increasing age of first time mothers. How age can bring fertility problems, a more complicated labour, the need for more surveillance which in turn means greater expense to maternity units. The same is true of IVF mothers. Any IVF pregnancy is considered higher risk, so you’ll need an obstretrician on standby. Premature birth is common. Gail has seen big changes in midwives, between the older generation and the new. “They can be quite glamorous now! Not just your Pam Ferris types!” Now its more academic, she says. More stressful. Maybe they have higher expectations, she suggests. I ask why that is: is it that anxiety levels seem generally higher these days? Gail thinks we protect young people too much, from “everyone’s a winner” culture on sports days, to accepting that bullying is horrible but it does happen. She worries this makes young adults less resilient.
This theme returns throughout our conversation. Gail knows things have changed, generally for the better, but its refreshing to hear someone voice doubt. I realise how rarely I hear these kind of doubts without them being couched in party political point scoring. Gail doesn’t feel there are enough midwives, She tells me there will be a crisis soon. Everyone’s expecting it. There will be a big gap as older midwives retire, and her already dedicated staff will be put under more pressure. I learn that Gail deals with complaints, which explains, I think, the wariness of her tone. She tells me that while some midwives are rushed off their feet and not as attentive as some mothers want, it is also the case that complainants are often less angry than scared. Once the baby is born the team are simply more needed elsewhere, so aftercare can feel thin.
“Midwives are a very, very strong group of women.”
Gail talks about her profession with real passion. When she talks about things being tough, she says she prays. At first I think this is a figure of speech, but it becomes clear that Gail’s faith is very much part of her ethos. She tells me that midwifery is the first profession recorded in the Bible, they were the women who saved Moses. That midwives are a very, very strong group of women. That she cries sometimes when she sees fully grown men cry. But she also thinks we are “100% spoiled.” That we’ve reached a time when women think they should be able to “choose C-sections” which is major surgery. Her faith drives her. She’s worked in Africa and would like to return there.
It feels like Gail is judicious about her language because she is very good at her job. But under the PR is someone who wonders if all changes are good changes. Ireland is where we were twenty years ago, she suggests. And that’s not always a bad thing.