Transcript of IVF Pioneer Robert Winston Interview on TRIGGERnometry 

It was in an organization which didn’t have any expertise in that particular area. I had no funding. I had no chance of getting the need. And bizarrely, I got this letter, or my boss got the letter to say that they wanted me to do the project I’d applied for. And that seemed like a dead end because it didn’t seem to go anywhere. And yet, of course, in time, that led to about 40 or 50 publications over many years, which led onto all sorts of areas which were much more relevant. IVF was one of them actually, but not the key one.

So I was very lucky. And over time I was working very much on my own, but I was very supported in the department by McClure Browne. He was amazing to me actually in many ways. And every time he had a foreign visitor, there were always foreign visitors, he would invariably say, “Oh, you don’t want to come watch me operate. Go and see what Winston’s doing down in the corridor.” He would always do that. And he really promoted my feeling that maybe I could do something.

What IVF Is and How It Began

KONSTANTIN KISIN: (00:07:26 – 00:07:57): Maybe he just didn’t like foreigners. Well, it’s fascinating hearing a story. And you often find people who’ve gone on to accomplish a lot actually do it in a very nonlinear way, as you say. For people who, IVF has become such a big part of our public discussion now for a lot of reasons. One of them is people are delaying having children and you’ve had a lot to say about it, which we’ll get into. For people who are unfamiliar with the whole thing, can you just explain what IVF is in basic terms for the layman? Yes.

ROBERT WINSTON: (00:07:57 – 00:12:26): IVF stands for in vitro fertilization, in vitro being in glassware. So what you’re doing is fertilizing a human egg outside the body. And people have been trying to do that since about 1900, really. So about 100 years and nobody got it going at all. There were some suggestions that people in the late ’30s, around the time just before the Second World War, got fertilized eggs. I’ve seen their photographs. And I doubt if those eggs really were fertilized. And we tried that eventually. But in the meantime, at that stage, I was doing reproductive medicine and not really interested in IVF. I thought it was a dead end. I didn’t think it would work.

And I went to America and I was in a university, which of course, like all American universities, was absolutely forbidding any kind of work with human embryos because that was actually considered disgraceful. There were religious reasons why the university said this, and they couldn’t get funding at all from central states. So eventually, when it became obvious that it might be successful, I met a man called Min Chueh Chang, who was a Chinese individual who’d been trained. He got his PhD in Cambridge, but then he went to Massachusetts, and he was a Chinese elderly withered individual who’d been working in the fields in China, had escaped that. He was very bright. He was completely unintelligible. When he spoke rapidly, you didn’t know what he was saying. His lectures were phenomenal. And this guy was incredible because he was the first person to do in vitro fertilization in a mammal. And he did 5 different mammals.

And at the same time, I met Anne McLaren, who was in the Royal Society. And I visited her lab and said, “Look, I’m trying to get human eggs to fertilize like Chang, but they don’t work like his other animals do.” And she looked at me, she said, “Well, with my mice,” she was doing this in mice, she said, “With my mice, I think it’s something to do with the sunspots.” And I thought, she’s not really an astrology person, is she? But what she was saying was she hadn’t got a clue. Anne was an amazing scientist and she was very, very supportive of what we were trying to do. And she visited my lab and she said, “What you’re doing is great.”

And so we were doing this at the same time when Steptoe and Edwards were doing this up in Oldham and in Cambridge. And although they got the first— well, they didn’t get the first pregnancy. The first pregnancy was actually in Australia, but it miscarried. That was a few years earlier. And then they got Louise Brown, and then we got pregnancies very quickly. But they were very, very unsuccessful initially, as we all were. And I think I was extremely lucky because I realized that the key success would be nothing to do with fertilization, but much more to do with the hormonal control of how the eggs actually developed in the ovary and when you collected them and so on.

And I met an amazing man called Steve Hillier, who was my age group. I advertised for somebody who was interested in IVF. He wrote back saying, “I don’t know anything about IVF, but I do understand hormones.” I thought, that’s the sort of letter I want. Steve came in and he’d been developing hormone assays. And we were doing a lot of interesting chemistry at Hammersmith where I was working at the time. And Steve was really successful and he was very, very important in the regular pregnancies we got with IVF in a way that nobody else was getting anywhere in the world. And so much of the credit should go to him really. He organized the lab. He did everything.

I think I can say this now, probably on a podcast, but early on, we somehow persuaded the Prince of Wales to come and visit the laboratory. And Steve had decided that we should separate the egg laboratory from the sperm laboratory. If you think about it, it was an obvious thing to do. Nobody else was doing that. Nobody did it for a long time. But of course, eggs have to be kept in a sterile environment, free of bacteria. It’s impossible to do that with sperm the way that they’re collected, obviously. And so when the Prince of Wales came in, he was relatively young then, unfortunately a journalist behind him and he said, “What’s this small room?” I said, “Well, this is where we collect the sperm.” He said, “Well, I certainly wouldn’t want to do it here.”

KONSTANTIN KISIN: (00:12:27 – 00:12:28): Prince of Wales being the current king, of course.

ROBERT WINSTON: (00:12:28 – 00:14:25): Of course, yes. And he was absolutely wonderful because obviously since then I’ve seen him pretty often, but he was really interested in young people. His interest in music was something which I obviously was in tune with. And actually he was very helpful in all sorts of ways with some of the projects we were doing. And it was nice to think that he was prepared to listen to that stuff when it was considered really outrageous. And it’s difficult to believe, but it’s true. I’d come back from America because it was not acceptable there. It wasn’t acceptable in Britain either. And it was highly controversial.

And the first thing I probably had to do, if you’re not a very good scientist, what you do is you try and communicate it perhaps, ’cause that becomes important. And so I think my real success was actually getting on the media very often. And at the same time, I was starting to do a bit of television work. And so I was fortunate, I think, in that respect that the BBC and many other channels had all sorts of discussion programs. And we had the usual people thumping the table saying that, “We’re against the idea of life and protecting life,” and so on.

So looking back, when the first votes in the House of Commons and the House of Lords were held, there was a two-thirds majority in both houses that this was not something that was acceptable, that it should be banned. And that was in 1984, that vote. And then it was not until ’89, sorry, ’90, it was ’89, that’s right, and then 1990 when the Act of Parliament came through, which in fact was finally approving of in vitro fertilization, but it needed to be regulated.

Ethics, Religion and the 14-Day Limit

KONSTANTIN KISIN: (00:14:26 – 00:14:37): And the nature of the concerns is because you’re taking a fertilized egg and some of them are discarded. And if you believe that life begins at conception, then once an egg is fertilized, that’s a human being.

ROBERT WINSTON: (00:14:37 – 00:18:13): You’re dealing with a human being, that’s the idea. And the question, of course, is you’re creating life. We’re not creating life ’cause the sperm and the egg are already alive. And of course, most human embryos don’t survive the first few days in the uterus. Most embryos, in fact, don’t implant properly. Those that do, many miscarry. So for example, a miscarriage occurs for about 25% of pregnancies. Many people don’t even realize they’re pregnant when they actually have that period. It’s just a bit delayed and they don’t notice, but in fact, they’ve lost a pregnancy. So nature herself does not actually respect the human embryo as being a sacrosanct person.

And indeed, my view and that of Anne McLaren’s view, and I was very much persuaded by her, was that the important thing was that when can you see life really beginning? And it’s actually when you’ve got consciousness. So the earliest stage that you can see a brain or anything like a nervous system is really at about 14 days when the primitive streak up the side of the embryo shows the spinal cord and the beginning of the brain. And Anne was very influential in making that the 14-day limit. And actually that eventually had a lot of effect. And that was something I very much promoted and we were able to demonstrate that was the case. I think that was important.

It went back because often a lot of Christians were very adamant because Christianity is absolutely opposed to this. And I said, “Well, Thomas Aquinas talks about caro and anima.” Anima is the mind and caro is the flesh. And he says that the flesh is there 40 days before it’s a human being. And Christians were really upset by my pointing that out because they didn’t really want to know what Thomas Aquinas had said. In the 14th century or 15th century, that was a widely held view by many theologians in different religions, including Jews. The Jews in the Talmud, which goes much earlier, were saying that the embryo is mayim b’alma, mere fluid, just water. And therefore, in fact, somebody who miscarried would not need to grieve for the birth, did not need to have a burial, did not need to have a whole lot of things that we go through, the rites of mourning, which is very interesting. So this is an ancient idea, which it was convenient to forget.

It shouldn’t matter. I have nothing against religious views, but of course, when you impose your particular version of the religious view on other people in a democracy, you’re running big risks. We’re seeing that now with assisted dying. Of course, there are many people who would like to see assisted dying to relieve suffering to make it possible for some people who really have no chance of surviving more than a few more weeks to actually at least have a few more weeks in comfort. But it’s been opposed by a group of people in the House of Lords who are adamant that actually they are right because in fact this is what their faith tells them. And I feel that that’s a great disadvantage to science.

Science and religion are very similar. We do religion and we do science because we’re uncertain. We’re uncertain where we are, how we came here, where we’re going to. Nobody knows what happens after life. That uncertainty is a part of the basic human need. We have to understand certainty and deal with it. The trouble really is that certainty is dangerous, and certainty is as dangerous in religion as it is in science.

The Commercialization of IVF

FRANCIS FOSTER: (00:18:15 – 00:18:26): And Robert, looking at how the industry began, your involvement in it, has it surprised you that the way it’s gone and how it’s become— well, it’s become a mainstream industry now?

ROBERT WINSTON: (00:18:26 – 00:20:13): Yes, I’m very disappointed. I don’t want to sound like a saint because I’m not, but in my group, I built up a large group of people who are very clever and very happy to take quite modest incomes, which of course academic things are. And we all agreed that a lot of people needed this and we were not going to charge private money, and we didn’t. So any private fees that we got from overseas patients, they were all pooled and they went back into a research pot. And that actually led to an organization called the Genesis Research Trust, which over the years, with all its appeals, has raised just over £100 million for research, mostly at Imperial College. But of course, we have control over how that money is spent. And currently, we’ve got 11 employees on those funds, which go way back.

Unfortunately now, of course, it’s become very difficult to persuade young people not to take a private income, understandably, because houses are so expensive. It’s very different from how it was in the ’80s. So we weren’t being particularly generous. In fact, we benefited from that research actually, to be fair. So we weren’t disinterested. And I think that’s really important to understand that. But it did mean we could limit the amount of fees we charged. We could often give it free. The health service was very helpful in that respect. And for a while that worked very well. I think unfortunately it became a massive industry. It’s now a $23 billion industry across the world and the fees are huge in all countries. I think very often there’s a lot of overcharging and there are certain areas where huge money is being made. Unfortunately. And in Britain, like everywhere else, it’s the same.

Is Infertility a Disease? The Emotional Toll on Couples

FRANCIS FOSTER: (00:21:55 – 00:22:17): And I suppose one of your criticisms of it is when people are infertile or they have issues with their fertility, that becomes a diagnosis. People don’t actually want to understand the reasons or not looking at the reasons.

ROBERT WINSTON: (00:22:17 – 00:26:16): You’re spot on. That’s exactly the problem. And it happened in a debate in Holland recently when one of my colleagues, a doctor, said that infertility is not a disease. It is a disease. It’s not a symptom, because I just said it was a symptom. Of course, that statement was completely inadequate, and from a doctor who’s done in vitro fertilization. So I was horrified to hear that, because of course actually, you’re completely right. Something has gone wrong with the system. We often don’t know what the reason is, but so often once you make a diagnosis, you don’t need in vitro fertilization. And the truth is that a vast amount of in vitro fertilization is unnecessary. It fails, but then a few months later, somebody gets pregnant spontaneously. But people get so panicked, they go to a private clinic and they get IVF. And of course, that’s to the disadvantage of the patient and to the NHS, of course. So the NHS is funding treatments which really are quite likely to be unsuccessful, but will be successful indirectly because they get pregnant anyway.

Actually, it sounds obvious, but it’s important to understand the effect of infertility on a couple. It really changes their lives. They feel very guilty, normally feel quite guilty. They feel they’ve damaged themselves. They feel that something happened in the past, maybe a miscarriage, maybe an abortion they had, whatever it was, some flu infection has affected them. And they get very concerned that they’ve done something wrong to themselves. And the depression and emotional change is massive. Every menstrual period that follows becomes a real turmoil for some women, not all, but it’s very, very common. And it ends up, of course, inevitably with fracture between male and female. Because although males likely feel also this grief, they deal with it in different ways. And so you end up actually not having intercourse. And so actually, as the statistics show, well before IVF, the more you have sex, the more chance you have of getting pregnant.

And the timing of it is not nearly as important as people believe. There are many ways of timing ovulation which are sold over the counter in chemist shops. Best not to use them. It’s best actually just to enjoy what you’re doing in bed or on the hearthrug or maybe on holiday. As often as possible because actually that’s a good way of at least making sure that you are genuinely infertile. It takes on average, the average couple, about 4 to 5 and a half months to get pregnant, something like that. That’s the sort of distance. You seldom get pregnant immediately, but some people do. But you’re not really infertile until you’ve been trying, if you’re a young woman, for a year. Because that’s how the statistics just work out.

Now, we don’t understand that, but clearly we can do things to enhance it. One of the things of course is just to really help people to come to terms with what they’re doing and to recognize their partnership may be more important in all sorts of ways than they realized. And of course, in vitro fertilization becomes a torture because you end up with women, if they can afford it, going for 18 cycles of IVF. And they become professional patients. And they know all about IVF, but they don’t understand actually why it’s not working because nobody understands why it’s not working. And then of course, when they go back to be investigated, we find, for example, in our clinic, they’ve got a simple thing that’s wrong with the uterus or a simple thing that’s wrong with the tubes. And if you correct that, which is often a very minor, inexpensive thing to do, you can get a pregnancy. And that happens again and again. So a lot of our pregnancies were generated when we were doing large numbers of IVF. I don’t do it anymore, but we’re getting patients pregnant with not doing IVF.

What Are the Real IVF Success Rates?

FRANCIS FOSTER: (00:26:18 – 00:26:50): Robert, we both have a lot of friends and we know people who are going through this process, and it’s obviously incredibly painful emotionally and the effect that it has on the female body particularly. Let’s actually talk about what are the stats, what are the actual likelihood of becoming pregnant with this technology, freezing eggs and all of this, because this is really important so that people actually understand what it is that they’re getting into when they begin this medical intervention.

ROBERT WINSTON: (00:26:50 – 00:28:25): Well, the fact of the matter is we as a profession are not telling the truth because we give encouragement to people to think that IVF is the best way forward and actually is the most successful way of getting pregnant. And the problem, of course, is that what most people don’t recognize is that IVF is a very complex process which takes about a month really each time you do it. So the first thing that you have to do is you have to ensure that there’s nothing which is preventing somebody getting pregnant, which might just be some different disease or some other process. So often you may need to look more carefully at the general health of that person. Certainly, for example, their weight would be one thing, really important. Losing weight can make a very big difference. But many clinics don’t bother to let people lose weight or encourage them because actually, why bother? Just get them to get the treatment because people want to have IVF rather than losing weight. But it’s going to be less successful.

The first thing to point out is that the first real stage are the eggs inside the ovary. Now, one of the problems is that in each menstrual cycle, well, let’s go back a bit. If we take a little child at birth, she probably has a million eggs in her ovaries. By the time she’s 16, having periods and potentially fertile, she’ll only have about 300,000 of those eggs left. That’s what our figures tend to show.

FRANCIS FOSTER: (00:28:25 – 00:28:25): Wow.

ROBERT WINSTON: (00:28:25 – 00:28:52): And various other research groups have shown the same thing. So women are losing eggs from the moment they’re conceived, actually. Unlike you and me, we’re making sperm as we sit here. So while a woman during a month will be losing a few hundred eggs, we’ll be making millions of sperm. We’re different. Actually, there are fundamental differences between men and women, but we won’t go into that because that’s a different subject.

KONSTANTIN KISIN: (00:28:52 – 00:28:56): Oh, we will, but later. But it’s a very— but it’s a—

ROBERT WINSTON: (00:28:56 – 00:33:43): It’s very important to understand that. And so what happens with each menstrual cycle, the hormone cycle, if it’s working properly, will recruit a number of eggs from the ovary to start maturing. And that maturation is very complex because it requires the right hormones to be there in the right quantity. And it requires therefore the right genes to be switched on. There are a number of different genes, a gene which needs the egg to be penetrated, a gene which requires the first cell division for the first embryo to start development. All that sort of stuff has to happen. So the first thing is you need to have eggs which are ripe. Actually a hard, unripe pear tastes bad. It doesn’t taste very good. And it won’t really make much of a meal. You have to have the egg properly matured. Steve Hillier understood that. That made a very big difference to our program because he got the hormones really as close to nature as he could do. And we did all sorts of tampering with that over a few years, which made it more and more successful. But it still meant that even so, at the end of that time when you collect eggs which you think are fertile, at least 50 or 60% of them probably won’t fertilize. So half those eggs won’t fertilize. And there may be various reasons. First of all, there may be reasons you didn’t realize that the sperm are not working, or there may be other problems actually with the nature of the genetics of the egg or so on.

Once you’ve got an embryo, we then put it in a fluid for culture and it will go into that culture in a black box, literally a dark container full of fluid, which is the culture medium in which it grows. And for 5 days it is left in culture and then taken out as an embryo. Now, during that time, many of those fertilized eggs, because not all are fertilized, don’t actually develop. They don’t develop into embryos. And there are lots of reasons that all sorts of things go wrong with human fertilization. We don’t know whether that’s a natural problem or whether it happens only because of the fluids we’re using. One of the problems is the fluids we use are not properly understood. We’re using commercial media which seem to work, but very little research is being done even now on the best method of trying to improve that culture fluid. But you think about it, that’s the first 5 days of life, which is critical to the development of a human being when genes are being switched on and being programmed by their environment. So they actually are responding to the environment. So that’s been one of the research areas that we’re working on at the moment.

But then you get to the stage when you’ve got an embryo, that precious embryo. And then after, let’s say 5, 6 days in that environment, you’re going to put that embryo back into the uterus. And most of them don’t get pregnant. About 20% of embryo transfers result in a live baby. But that doesn’t represent, of course, the beginning. Because you’re failing from the very start of the stimulation of the ovary to get enough eggs. So every stage is important. Now, of course, many clinics will not actually state their failures at different stages. The government doesn’t even keep proper statistics on that. So we don’t really know even now how many eggs are actually stimulated from the ovary in an average clinic. It varies so much. The records are not good and yet they should be there because the Human Fertilisation and Embryology Authority was set up with a statutory obligation to provide better information to patients. That’s one of my biggest grumbles about the situation at the moment.

That needs to change, but it’s very difficult to persuade the Department of Health. They don’t really want to get involved with something which isn’t supported by politicians one way or the other. To them, it’s not really important. There are more important things because the health service needs so many other things. But actually, it is really important because it affects health service money. It’s expensive for patients and it’s deeply distressing to fail 2 or 3 times. For the clinic, if you fail, great, they’ll come back again. If you treat them nicely and kindly, they’ll come back. So actually that increases the revenue to the clinic, but it doesn’t necessarily improve the chance.

We know from very good statistics which have been done looking at 5 different countries, including Britain, Switzerland, France, Germany, that actually after 6 attempts at in vitro fertilization, 6 separate attempts using the full cycle, only 34% of patients have a baby after 6 attempts. Now that’s never said anywhere. That was published a few years ago, but I doubt if the figures have changed that much. But it never comes out in the figures.

KONSTANTIN KISIN: (00:33:43 – 00:33:46): So you’re only looking at about 5% success rate per attempt.

ROBERT WINSTON: (00:33:47 – 00:33:55): Well, I don’t think that’s true. I think it’s more than that because I think you can improve egg quality. And of course, if you treat young patients only, you’ll do better.

KONSTANTIN KISIN: (00:33:56 – 00:33:56): Yes.

ROBERT WINSTON: (00:33:56 – 00:34:17): And you can choose your patients. And of course, many clinics do that. They’ll choose the patients they think of. 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. So the success rate is not 20%. But that’s what will be advertised, but it will be somewhere, who knows exactly what.

Egg Freezing: Are Women Being Told the Truth?

KONSTANTIN KISIN: (00:34:18 – 00:34:51): And one of the things that, and correct me on this if I’m wrong, I’m just telling you from a layman talking to people perspective. I think we increasingly, due to various social changes in society, women wanting to pursue careers for longer, all sorts of things, we’re now in a place where big companies routinely offer egg freezing to female employees as a way to manage this situation, let’s say. 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?

ROBERT WINSTON: (00:34:51 – 00:38:29): I think it’s a harsh thing to say. We were working on egg freezing in my laboratory well before it was being done. And we were looking actually not only freezing eggs, which have been collected, also freezing ovarian tissue, which we think you could use perhaps to mature eggs because you’d have better control. It’s questionable that, but it’s never really been a successful one way or the other. If you look at really carefully conducted figures, what you see of course is that freezing brings a massive change to the embryo. It’s a change in a fraction of a second, a vast change in temperature. It’s called vitrification. And this process has been shown to disrupt all sorts of functions in the egg. Also, of course, the antifreeze which is used is not a liquid you drink for obvious reasons. In fact, it might be a very good way of getting rather stimulating to the brain. Not in the way you want, be sleepy at best. No, seriously, that’s a problem.

So it’s also true that when you freeze a lot of eggs, sometimes the tendency in a clinic is to stimulate that ovary as much as possible to get as many eggs as possible. But of course, that then denies the possibility of the proper timed maturation of that egg at the best time when it’s collected. Thereafter, it’s going to be frozen. And we know that, of course, a huge proportion of the frozen eggs don’t thaw. I have the figures going back from when they did collect them at the HFEA. And I’ve looked at literally data from several hundred thousand patients. It’s a large number. And we can see that actually, if you take from the moment of thawing using vitrification, which is still the best method, the chances of a single egg becoming a baby is about 1%, 1.7%.

Now, of course, you can produce lots of eggs, but the trouble is those batches of eggs have to be thawed at the same time. You take a lot and you have to thaw them because you want to get an embryo. So the problem is there, which has never been understood, is that we don’t know how many eggs are being thawed by different clinics. There’s no standardization of this. And so I think that’s one of the things we should be recording in the Department of Health much more carefully by the HFEA. And of course, they’re not recording many of these statistics. So we don’t know how many eggs that are thawed are being fertilized, how many actually become an embryo, how many of those embryos are normal, and how many are actually put back into the uterus. All we know is the number of embryos which are actually transferred to the uterus and produce a pregnancy.

With those statistics, what we can see from— we now have, apart from the publication of the stuff which I can get through Parliament by a parliamentary question, which I think is probably accurate, but now of course they’re not keeping complete figures, so even that is difficult. There are 5 or 6 publications from different countries which show that at best about 4% of eggs, usually less, actually will produce— after thawing, will produce a pregnancy, a live birth. The miscarriage rate is still not recorded.

KONSTANTIN KISIN: (00:38:30 – 00:39:33): I didn’t mean to put it as strongly as I did, perhaps. I guess what I’m getting at is given everything that you’re saying, I think if you talk to the average person who’s not an expert on this, like I say, companies offering egg freezing to women to induce them to delay having children. In the mind of the average person who hasn’t looked into this, if you freeze your eggs now, well, you’ll have your babies later. That it seems like a linear thing where you could do it now or you could do it 10 years from now.

ROBERT WINSTON: (00:39:33 – 00:40:26): It’s not quite linear. Because of course the younger you are when you produce eggs, the more fertile a woman will be. Because your fertility is partly related to the quality of the eggs you’re producing and the way they’re matured. So a woman of 25 has a much higher success rate at IVF. A woman at 30 still has a higher success rate. Once you’re over 35, freezing your eggs is probably not worth doing, as in fact IVF has become much less likely to be successful. But of course, so many women are in fact being encouraged to start before 35, but a huge number of women, the big proportion of them, have already— already too late. Now, you can argue that more education should be needed, but what we need actually are proper statistics for success of pregnancy at any stage, and that’s not being recorded.

KONSTANTIN KISIN: (00:40:27 – 00:41:28): What I’m getting at, Robert, is I think based on the things you’re saying, and please do correct me if I’m misunderstanding or misrepresenting, is the reason I use the word lie is there is this perception in the culture that the success rate, in most people’s heads, this will be how they see it, is success rate’s the same at any point. So you could have your children at 25, or you could have them at 40, and you freeze your eggs at 25, and then 15 years later, boom, you’re good. It was quite a shocking thing to hear, but I had someone come up to me. My wife and I were out with our newborn at the time doing something, and someone came up to us. We had a nice chat about the baby. And then we said to him, my wife said to him, “Have you got kids?” And the guy, because it would be a guy saying something this dumb, he went, “Yeah, we have 2 frozen ones.” In people’s minds, what I’m getting at is they think that a frozen egg is a baby that they just pull out of the drawer, boom, it’s ready to go. And what you’re saying is that’s not remotely the case.

ROBERT WINSTON: (00:41:28 – 00:46:14): No, it isn’t. You’re quite right. And for example, I do have some statistics which bear some relation to this. I’ve looked at some statistics which I challenged the minister in Parliament about, of 40,000 eggs that have been thawed for the purposes of in vitro fertilisation, all-aged women, and there were 604 pregnancies. And some of those, about 18%, I think, miscarried. So you can begin to see that actually we’re not really telling the truth. And I think those figures are probably quite accurate, but who knows? Because of course, how things are being developed, how many eggs are being produced is difficult to follow. And we need much clearer evidence before we get women to delay unnecessarily.

It’s very difficult because of course we’re living in a totally different society. It’s important to understand, of course we do understand that people want to work, they want to do things. Women want to use their unique credentials to do different things and as late as possible. And as indeed my own wife did before she died. She produced 3 children, but she was already in the late stages of fertility, but she was relatively lucky. So I think that is the problem, there’s the inevitable pressure which women impose on themselves, but society doesn’t help. But the answer, of course, is quite clear. What we’re doing is asking women to pay £5,000 or more to freeze their eggs, often a lot more. Sometimes some clinics will charge £10,000. It’s quite common and more in America. And of course, nobody is using that money to do research, which comes back to my original point. We need to be doing far more research.

And in Britain, sadly, the amount of research that’s going on generally in the in vitro fertilized area is not very good. If you look at the number of projects which are being funded by the research councils, by UKRI, for example, very few research projects are being funded. That’s simply not because they’re not good enough. We’ve lost the science. We’re not doing good science. We’re not producing good projects. We’re not thinking about it. Because actually, when you’ve got a massive market, if you’re a young person, of course you’re going to go and work in a clinic. It would be stupid not to because you earn immediately 5 or 6 times what you’d earn in the public sector. So you can’t blame people for doing that, but it’s very difficult to do really useful research in a commercial environment. You can’t easily do statistically analyzable research comparing one treatment with another treatment because patients want the best treatment they think, quite rightly. So that becomes a no-no, and that’s a big problem.

And so we actually have to understand that we need to look at ways of doing research more effectively because there are ways we could do this. But the amount of experimentation we’re doing, for example, on the culture of embryos is negligible. Very few projects looking at culturing human embryos in Europe at the moment. But that is clearly 5 days of critical importance in IVF. And it will be, of course, in egg freezing as well because we all have to go through that process. We want to try and mimic what happens in the uterus, but the uterus is a black box. We’ve no idea what goes on there. It’s very difficult. The ideal experiment would be to persuade a whole lot of women to come and have a laparoscopy or an egg collection just routinely after they’ve had sex. That is not going to be something which would be acceptable, and it’s not actually possible for very good reasons ethically. It would be unethical. So we can’t do the obvious experiment we can do in the rabbit or the rat.

But unfortunately, mammals, as in fact Anne McLaren showed, are totally different from humans because we are unusual. We menstruate, and that makes a very big difference to the whole hormonal cycle. So we’re quite different from the animals we can work with. And we could work with a few monkeys, but that’s going to be increasingly impossible because we feel that humans and monkeys are too close to each other, for very good reasons, that that brain is an advanced brain. And now doing primate research in this sort of field would be unacceptable, quite rightly.

Epigenetics: How the Environment Shapes Our Genes

FRANCIS FOSTER: (00:46:15 – 00:46:32): Robert, one of the things that you’ve spoken about is the epigenetic effects of this technology. So let’s talk about that. Firstly, before we get into it, explain to people who might not know what epigenetics is, and then we can talk about the effects.

ROBERT WINSTON: (00:46:33 – 00:47:00): Yes, epigenetics. Well, wonderful that you brought that up. I hadn’t thought about talking about that. But of course, basically we think that genes are genes for things. You have genes for blue eyes, you have genes for, let’s say, some liver enzyme. But actually, of course, genes work depending on the amount of expression, how they’re working. So in fact, large amounts of expression or less expression, that will change the nature of what the gene is doing and how that will work. And also, of course—

KONSTANTIN KISIN: (00:47:00 – 00:47:06): Sorry, just to make this understandable for stupid people like me, when you say expression, what do you mean? Just explain that bit a little bit.

ROBERT WINSTON: (00:47:06 – 00:47:15): Working. So basically the amount of, let’s say, message the gene is giving to the cells.

KONSTANTIN KISIN: (00:47:16 – 00:47:17): So it’s not binary. It’s—

ROBERT WINSTON: (00:47:17 – 00:47:23): No, it’s not binary. Exactly. So for example, you can get genes to overexpress and underexpress.

KONSTANTIN KISIN: (00:47:23 – 00:47:24): It’s analog.

ROBERT WINSTON: (00:47:24 – 00:50:39): Yes. And we can do that by changing the chemistry of the gene. And that is how that happens. So epigenetics is partly how the genes are affected by the environment, because obviously it’s the environment. What we forget actually is we’ve been thinking for years about development. Development is either nature or nurture. Okay. Actually, of course, nurture is just as important as nature. But we’ve always been hooked on genes, nature. Now, of course, there’s actually nature, nurture, and development. And the interesting thing, of course, is development is really important because development is actually a response to some extent to what is happening in your environment. It’s highly controversial, but there’s increasing evidence that if you’re subjected to all sorts of unfortunate environmental influences particularly when you are young, you may have all sorts of things happening later on in older age.

So for example, without going into great detail, there was one very, very important study years ago, which nobody believed, including me when I read the paper, I thought it was nonsense, where they showed that little boys aged 9, if they were in a good environment in one part of Sweden where there was a good harvest at the end of the 18th century, at the beginning of the 19th century, their male grandchildren were more likely to die young. Having had a good environment at the age of 9, that makes no sense at all until you begin to realize that the genes perhaps are being programmed to accept what’s going to happen when in fact you have a different change in your diet. So possibly the reason why heart disease and hypertension and other diseases were common might be due to changes in the body’s ability to regulate itself in different environments. So we are programmed by the environment we’re in. We understand that increasingly. That’s epigenetics, if you like.

Now, of course, I don’t want to push this because there’s a lot more work being done than that. But for example, epigenetics occurs in all sorts of areas, including cancer biology. We can now modify our genes, express perhaps, and that may make a difference. I think the point is this, that we have clear experimental evidence in animals, rodents for example, that changes in the environment can make a major difference, for example, to brain development. So for example, one experiment done in 2016 in McGill University showed that actually if mother rodents didn’t lick their offspring, they fed them milk, but they didn’t lick and cuddle them, those mice or rodents were more likely to have different development, more likely to be unable to get out of a maze successfully, were slightly more likely to be aggressive. They passed that trait onto the next generation when they in turn are pregnant. Wow, that seems to be an epigenetic effect. And we now know that we can see changes in the gene expression of a particular molecule which affects estrogen.

KONSTANTIN KISIN: (00:50:40 – 00:50:46): So it’s intergenerational. So it’s not, you were neglected as a kid, you had a bad life, you pass it on.

ROBERT WINSTON: (00:50:47 – 00:50:48): Well, of course it doesn’t help either.

KONSTANTIN KISIN: (00:50:48 – 00:50:49): No, no, no, of course.

Early Childhood, Education and Nurture

ROBERT WINSTON: (00:50:49 – 00:53:41): But actually, of course, that’s relevant. Of course it’s really complex because we should argue, of course, that we should not be so absolutely intent on genes, but much more about what we can do for the environment of our children. That certainly includes, of course, Sure Start, for example, primary education, because once primary education’s finished, that brain is no longer quite as plastic as it was, for example, when the child was 3 or 4. So actually how we start to interest them in doing things, which would include music, or experimenting. But actually teachers in primary schools are not given the chance to do that. They don’t have the background sometimes, or generally, very few are scientifically qualified. They might have an A-level in science, but that gives you very little experience to do experiments with a child. Because of course most teachers will be nervous about doing experiments that might be dangerous. It might cause an accident. It might be something which takes up too much time and it’s too costly to do. Much easier to tell the story didactically. That’s a real problem, I think, in our education. And we’re increasing that now, of course, with the new methods of education where in fact all sorts of practical work is becoming less important in all fields.

Now, it’s interesting to see how governments relating to apprenticeships at a later stage. But in my view, we should be offering manual skills of all sorts much earlier on. There’s a lot of experimental evidence in music, for example, that music certainly improves dexterity. Secondly, you can show that some people who are exposed to music early actually become much more appreciative of music later on. You can show also that it improves memory. Musicians and scientists actually have quite a lot in common, scientists generally like music. And of course, musicians are often quite good at science. They’re not trained, but if they are, they become very good. In my laboratory, I had a lot of people who are musical. Who are some of the best scientists, much better than me actually, far better. I was a poor scientist by comparison with some of the people who are in the lab. What you do there, of course, when you’re the poor scientist, you want to make sure you recruit the right people because one of the great advantages that we’ll have is collaboration. And collaboration is what actually is really important. But we don’t teach that in school either. And of course, music does teach collaboration.

Long-Term Effects of IVF and the Swedish Study

FRANCIS FOSTER: (00:53:42 – 00:53:48): And so do we know what the long-term effects of this technology are for the people who are the product of it?

ROBERT WINSTON: (00:53:49 – 00:54:43): No, I don’t think we do. And of course, I don’t want to say IVF is dangerous because there’s no evidence that it is. But I think, to be fair, as we found with that Swedish experiment, that wasn’t recognized for a very long time. It was only, in fact, when it was the male grandchildren of a male father. Because then it was a wonderful man called Dr. Marcus Pembrey, who’s in Bristol. He pointed out to me, he said, “There may be something.” I thought, this is nonsense. He said, “No, no. Actually, think about it. That’s sex-linked. That must be genetic.” And he thought about that. It was very clever. I don’t think anybody realized when the paper was published why that was important. Now it’s different because we’ve got much more evidence that genes are being changed by the environment.

Male Fertility

FRANCIS FOSTER: (00:54:43 – 00:56:26): And Robert, one of the topics that we haven’t addressed in this, and I know you’re an expert in female fertility, is male fertility. Because when we talk about infertility, we automatically think it’s the female body, there’s something going wrong there. Well, that isn’t always the case, and we have a very real issue with male fertility. So let’s talk about it.

ROBERT WINSTON: (00:56:26 – 00:58:06): Well, if you look at the statistics, it’s probably fair to say that with an infertile couple, at least 30% of the time it’s probably both partners. And some of the time, maybe another 30%, it’ll just be the male, and another 30% will be the female. Very arbitrary sort of figures, but actually male fertility is very important. We don’t look at that nearly enough. There’s a lot of quite good expertise in Britain. There’s some very good male experts. Unfortunately, they’re not often called in to help with IVF. It’s a great pity that in fact clinics doing regular in vitro fertilization don’t subject themselves more to advice from male experts, andrologists, who I think should be encouraged to give much greater credence to what they do.

But we also need to say that we need to do much more research. It’s not just bad genetics because the sperms don’t work. There are things that I think should be able to be done better to encourage fertilization. We have some mechanical ways of doing this. We can inject sperm directly into the egg if they don’t swim, but that in itself may carry risks that we don’t know about yet. Although of course it’s being used so often, we haven’t seen abnormal babies. Nonetheless, it’s very questionable whether it really increases fertility in most couples or not. This injection, we were again doing this very early on and we tended not to want to use it as a routine treatment ever in our laboratory. And I think that’s still the way we left it.

KONSTANTIN KISIN: (00:58:06 – 00:58:10): There’s a narrative in the media that the quality of sperm is declining.

ROBERT WINSTON: (00:58:10 – 00:58:11): Yes, I know.

KONSTANTIN KISIN: (00:58:11 – 00:58:11): Is that accurate?

ROBERT WINSTON: (00:58:12 – 00:59:54): Well, it’s very difficult to understand that. There are a lot of very good papers on this now which show that in fact— but the problem, I think, this decline in sperm function hasn’t really equated with loss of childbearing. And I think one of the problems may be that what I did was to look at the figures at Hammersmith Hospital because that was one of the first clinics that collected sperm over 60 years ago. So we have a lot of experience and we went through the ways the sperm were collected and we looked at differences in motility, for example, and structure. And it wasn’t obvious that there was much difference over 60 years or so. Now, that’s not a good paper. It was a rule of thumb, rough idea. Because actually, one thing is the way we collect sperm now is much more sophisticated. The way we photograph sperm is much more sophisticated. So in fact, we’re able to see many more things. And now, of course, we do things like electron microscopy, which of course is able to look at the sperm in very, very high magnification.

But we don’t really fully understand all the chemistry in great detail. So there’s more to be done. And I think it’s true to say that that’s true of fertilization as well, because it’s different in different species. And it’s very difficult to get eggs to actually fertilize because obviously people, if they’re going to give eggs, want to actually have a baby or they want to have their eggs frozen. So there is a real ethical problem there as well, persuading women to give up some of their eggs for experiments which are going to help them get pregnant.

KONSTANTIN KISIN: (00:59:54 – 01:00:01): So a lot of the things we hear in the media, sort of these definitive narratives, is not, I think the data are fuzzy.

ROBERT WINSTON: (01:00:02 – 01:00:13): I’m not entirely persuaded that that is a serious issue. Fertility is unquestionably declining in the Western world, but there are so many good reasons for that.

KONSTANTIN KISIN: (01:00:13 – 01:00:14): And what are they?

ROBERT WINSTON: (01:00:15 – 01:01:17): Oh, well, I think women working later in life, clearly. I think people having fewer children. I think the changes in family finances where both couples need to get an income to make it justifiable. More and more people having single children. And many people perhaps deciding that it’s perfectly reasonable not to have children at all. Many people, I think, are starting to feel, “Do we really want to bring our child up in this world?” There are all sorts of issues that now were never thought about in the ’40s. After the war, there’s always a burst of fertility. There was in the early ’40s. Interestingly, after some wars, particularly after the Thirty Years’ War, in 1618, well, that’s when it started, finished in 1648. There’s some suggestion that not only did fertility increase in Europe, but more male babies were born.

KONSTANTIN KISIN: (01:01:17 – 01:01:30): Yeah, we heard the same. I’m from— I was born in the Soviet Union and I don’t know if it’s factually correct, but the narrative in Russia is there was a huge increase in male babies being born after World War I.

ROBERT WINSTON: (01:01:30 – 01:02:21): Yes, absolutely right. But it’s very difficult to do that retrospectively because unless you’re following up couples all the way through in their behavior. But yes, it’s an interesting question. But certainly it’s not just the First and Second World War. It goes right back to the 17th century and the statistics aren’t entirely reliable. Perhaps nature needed more males at that stage because of course males were depleted in society. Can that be true? Can there be something influencing whether you have more male-bearing sperm than female sperm? It must be on the male side. So it’s an interesting question. I don’t think the woman has any influence as far as we know on which sperm actually chooses the egg, but maybe we don’t know.

Fertility Through the Decades: A Public Information Announcement

KONSTANTIN KISIN: (01:02:21 – 01:02:43): So to tie a bow on the whole fertility conversation, because I want to move on to a different issue, if you were to just give a sort of public information announcement about fertility— one of the things we talked about is how it changes over time for men and women. What does it look like in your late teens to 20s to 30s to 40s?

ROBERT WINSTON: (01:02:43 – 01:04:33): Well, first of all, most couples will get pregnant without any treatment. And although a lot of my colleagues talk about infertility affects 1 in 5 couples, 1 in 6 couples, I think those are flawed figures. They’re based on a study which was done in Bristol University many years ago by a colleague of mine who I greatly admired and tried to test it. But actually, he was not looking at the underlying causes of the infertility. And I think that actually it’s probably much closer to about 1 in 10. So it’s not quite as common as we would boast. So you’re looking perhaps at really 1 in 20 people, because most of them will be from one or the other person.

But I think I would say that it’s now undesirable, unfortunately, because it’s so expensive to investigate the causes of the infertility. But I think that we need to be doing that more often. I think unless we’re making a diagnosis, we shouldn’t be doing IVF so readily. Because so often if we do a diagnosis, we find there are other things we can fiddle with which are much cheaper and more successful. For example, if you have, let’s say, an abnormal uterus which is congenitally abnormal, a very simple procedure can often correct that without IVF. Same applies to a polyp inside the uterus. The same applies to many hormonal conditions which are associated with infertility, changes of sugar metabolism, for example, changes in your hormone output. So we’re not doing enough of that really in a sophisticated way. We’re doing routine spot tests, which is not proper diagnosis. Now, of course, the problem is it’s expensive. In the short term, it’s expensive. In the long term, it’s probably cheaper because IVF is so expensive.

KONSTANTIN KISIN: (01:04:33 – 01:04:55): Yeah, I see what you’re saying. I had a guy come around to my house to do some work and I got chatting to him. He was telling me they had 12 miscarriages in 11 years and then they went to see somebody who went, “Oh, you’re basically— her fallopian tubes are tangled. We need to sort that out.” They sorted it out and instantly had a child. So continuing to do IVF on someone like that, it’s crazy, right?

ROBERT WINSTON: (01:04:55 – 01:06:05): Well, it is. In fact, of course, tubal function has been one of my big areas of research. And I think we don’t understand tubal function at all. It’s another black box where the embryo is fertilized. That fertilization doesn’t occur in the ovary, doesn’t occur in the uterus, it occurs in the fallopian tube. And it’s not just a pipe. We spend, all of us, if we didn’t have IVF to produce us, about 48 hours in the fallopian tube at the beginning before we go into the uterus, which is even more dark. And that journey is something we completely ignore. So yes, I think that’s true. And certainly I think one of the reasons why we were a bit more successful at IVF early on was because we were looking at the fluids inside the fallopian tube. I was doing that with Henry Leese, who was working in the north of England in York. And certainly we looked at actually some things which might affect fertilization and development, which possibly were helpful. So I think that we don’t do that research enough. It’s not easy to do, but it’s certainly possible. Yeah. Where did your question start?

KONSTANTIN KISIN: (01:06:05 – 01:06:18): Well, my question started actually is I was hoping you would give a kind of consumer retail version of what the average person’s fertility, the average woman’s fertility, and the average male’s fertility looks like over time.

ROBERT WINSTON: (01:06:18 – 01:06:18): Okay.

KONSTANTIN KISIN: (01:06:18 – 01:06:21): In terms of the sort of decades in your life.

ROBERT WINSTON: (01:06:21 – 01:07:17): All right. Well, I would say the average couple will have a 1 in 4 chance per month for the first 4 or 5 months. Then it gets reduced because they obviously may have something more likely to be wrong. So certainly for the first 5 months, it would be wrong to do investigations unless you’ve had something clearly identifiable. For example, an operation which had infection. An appendix removed in somebody who’s of childbearing age might cause adhesions, that sort of thing. So that might be some reason. Then in that case, division of those adhesions might be more successful than IVF. But it’s not being done enough. And of course, the surgery to repair tubes is not done nearly enough because it’s more complicated, but actually in the long run, it is cheaper. So on the male side, I think we should be doing much more about male health. And I think also there’s still more need to look at female fertility from the point of view of looking at the hormones.

Lifestyle, Sex and Stress

KONSTANTIN KISIN: (01:07:19 – 01:07:24): And what about lifestyle? What are things that people do and don’t do that can improve?

ROBERT WINSTON: (01:07:24 – 01:07:25): They don’t have sex enough.

KONSTANTIN KISIN: (01:07:26 – 01:07:30): All right, I’m going home armed with that information tonight.

ROBERT WINSTON: (01:07:30 – 01:08:00): I don’t think changing lifestyle changes things much at all. I think sex on the hearth rug is a really good way of doing it. And of course, I’m not speaking from experience, I understand, but you’re speaking as a scientist, which is even more important. Yes, actually. Yes, of course. Pleasure is important. We don’t even know what effect human orgasm has, female orgasm, but it certainly seems to produce more sperm in the fallopian tube. But we can’t easily do those experiments.

KONSTANTIN KISIN: (01:08:00 – 01:08:02): Yes, imagine that’s quite a challenge.

ROBERT WINSTON: (01:08:02 – 01:09:28): Yeah, but actually there’s a lot of reason to suppose that that can help. But of course that requires perhaps a different approach to one’s lovemaking. And I did start to do years ago when IVF was in its very infancy— I’m sorry, there’s a pun, but you know what I mean— I had a wonderful young woman who was medically qualified who wanted to look at this. And so we set up an experiment where we asked patients where they had unexplained infertility what their background was with sex. And of course, if she as a woman was able to really go through their sexual experience, she thought that what she saw was that women who were having orgasm during intercourse certainly were slightly more likely to have infection in their fallopian tubes sometimes. It’s interesting, but also overall were more likely to get pregnant with unexplained infertility. So that is something which we’ve never published, and it would be dangerous to publish it with the data I’ve got because actually we should have done much more study. But it’s a complex thing to do. You need a large cohort of women and you need some very sensitive people to go through those things. And you still don’t know whether people are going to tell you the truth.

KONSTANTIN KISIN: (01:09:30 – 01:09:49): And of course, when I said lifestyle, I meant lots of different things because I know anecdotally things like acupuncture sometimes will help people get pregnant or talking therapies can help people address emotional blocks and whatever. And so stress levels and all sorts of other things, I just anecdotally seem to—

ROBERT WINSTON: (01:09:50 – 01:12:04): It’s a very interesting question, because I used to think stress was important. And then I went to a lecture in San Diego by a very, very famous endocrinologist who was then in his late 80s. He’s now dead. But he was doing work on stress. And he said, “One of the most important things to help ovulation is stress.” He said exactly the reverse. He said, “People who are stressed actually are more likely to get pregnant.” And he said, “It depends on the kind of stress, and we don’t really understand that.” And I think actually, on the other hand, I’ve seen so many women who, when they’re no longer stressed, have got pregnant. And you do wonder about that.

One story, it’s a long story, but I’ll try and keep it as truncated as possible. Years ago, when we were not very good at identifying the cause of infertility, I had a woman who came to see me who’d been trying for a pregnancy very conscientiously for about 4 years, and she’d not got pregnant. And I was sure that there was nothing wrong with her. We looked at her husband, there was nothing wrong with him. And she said to me, “It can’t be my husband. It’s got to be me because in fact my husband was responsible for a pregnancy, which he never told me about until recently.” And I said, “Well, that doesn’t necessarily mean it’s your husband. What we’d expect, he would be fertile. It means that actually there’s something else going on that we don’t understand.”

Anyhow, she continued to see me and she never got pregnant. Then finally one day she came into my clinic. She said, “I’ve got a boyfriend. Our marriage is breaking up and we’re quite serious. And I wonder whether that will make a difference to my fertility.” And I said, “Well, I don’t know.” And she was having regular sex with this man for 2 years. And she came back and she said, “I’ve had 2 years of regular sex with my boyfriend and he’s been pregnant. He’s had his wife pregnant as well. Are you telling me it’s not my fault?” I said, “I really don’t know.” She rang me from an airport. “I’m off to Australia. We’ve decided to go to Australia.” She was pregnant 3 weeks later with that man.

KONSTANTIN KISIN: (01:12:06 – 01:12:10): So it was the country. It was England that was making— England was ruining her fertility.

ROBERT WINSTON: (01:12:10 – 01:12:13): But she had decided to change her life.

KONSTANTIN KISIN: (01:12:13 – 01:12:15): Yes. I was kidding. Of course.

ROBERT WINSTON: (01:12:15 – 01:12:25): She was changing who she slept with regularly. There was no guilt, I suppose. And there was a new period, and she got pregnant quickly.

KONSTANTIN KISIN: (01:12:25 – 01:12:26): Yeah, yeah.

ROBERT WINSTON: (01:12:26 – 01:12:32): I don’t know whether she got pregnant a second time because I lost contact with her, but those stories are not uncommon and they’re interesting.

KONSTANTIN KISIN: (01:12:33 – 01:12:35): It’s fascinating how little we know about it.

ROBERT WINSTON: (01:12:35 – 01:12:52): Yes, it is. I quite agree. It’s why the research is so important, because at the moment it’s all anecdotal. So much of this stuff is left to sort of anecdotes. But actually, there should be much more identification of where we do have things to test and the things we can investigate better.

Designer Babies and Sex Selection

FRANCIS FOSTER: (01:13:43 – 01:13:56): Robert, there’s something that I really wanted to talk to you about, and it’s this term— again, it’s a media term— which is designer babies. Is this something that is widely discussed, as in it’s going to be the future of—

ROBERT WINSTON: (01:13:57 – 01:16:32): Well, don’t forget, we were responsible for that because, of course, we were the first team to identify genetic defects in a couple that might cause a hereditary problem which would cause an abnormal baby which would be likely to die. That defect. And with Alan Handyside, the two of us spent— and Kate, I should say, also Kate Hardy— we spent 5 years trying to work out how to do the chemical tests on the genetics, and also how we could work out whether or not taking a cell from the embryo to make a diagnosis of the genetics was a safe thing to do. And then transferring an embryo which would be free of that particular defect in that family, and putting it back. And the first babies were born, oh, 1980, yeah, in 1989, I think. I’m trying to, 1980, must be, that’s right. They must be over 40 years old because they’ve had children. So that’s now used worldwide. And it’s still limited because at the moment you’re looking at defects which are causing death in the baby. And that’s allowable by law.

However, there’s no question that increasingly a lot of clinics are looking at what’s happening in America, and some are looking in England, looking at genes which might affect hereditary and whether you could test that in the embryo. It’s sort of intelligence, for example, what might cause particularly good health or desirable characteristics. Will that happen? Yes, I think it will happen. I think it’s inevitable it’s going to happen because I think we are getting to the stage when we will be able to analyze a complex number of genes and with big data, we’ll be able to actually identify characteristics which we think are associated with that sort of individual. Is that wise? No, it’s not wise. It’s really dangerous because of course we might well make people much more intelligent, possibly who get born slightly more intelligent because actually intelligence is not nearly as important as genetics as the environment in which you’re brought up in. But actually nonetheless, it is important because of course eventually somebody will make a mistake. They’ll find a baby that is more intelligent but also highly aggressive and/or autistic or something else. So I think this is tampering in a way that’s really not wise, but I think it’s very difficult to control because there’s massive money involved in this. And certainly in the States, I think will be the first place for it to happen.

FRANCIS FOSTER: (01:16:33 – 01:16:58): And it’s also not particularly great as well, because if you think about a lot of the people who actually push humanity forward, in a scientific sense, or great artists, these are people who invariably are quite flawed psychologically, or they have, they’re highly autistic. If we eliminate those traits we’re also going to eliminate the outliers who actually, yes, provide us with wonderful technology, art, etc.

ROBERT WINSTON: (01:16:59 – 01:19:18): Well, look at Beethoven, perhaps the man who more than anybody else has changed Western music. This is a man who’s completely antisocial, who sits on his own with a broken piano, is going badly deaf and actually going deaf from quite an early age. And he becomes, as he feels, a failure. At one stage in his later life, he’s hardly producing anything. And now he’s on the alcohol, he’s got liver damage, and he’s wheeled into the police station in Vienna in a wheelbarrow because they found him in the wood and they wonder who he is. And the policeman says, “Oh, that’s Beethoven.” He was known, he had form. And those sorts of things occur in art hugely. You look at Picasso and you think those images, I was recently looking at the Picasso Museum in Lucerne and it’s amazing to look at those images. They’re so improbable. Are they human? And yet when you look at them for long enough, you start to see what he seems to be thinking. It’s an amazing experience to see how little we understand about our nature, about our whole way our brain works.

We don’t know how the brain works. We tamper at it with great risk, I think. And certainly you mentioned particularly, for example, people who are different, classically autism, the number of autistic people who have been rejected in the past. But now I’m glad to say, for example, at Imperial College, we’re suddenly taking people like that really seriously as good candidates for doing science. It’s very different. That’s changing very much. I think we could do much more by being less attitudinous about what we see and recognizing that people have all sorts of abilities that we need to nurture. And nurture again comes back again and again, but nurture obviously is going to be better when you’re young. It’s much more difficult later on. But unfortunately, if you’re autistic in a young class where teachers are under pressure, very difficult to give that child the kind of environment that he or she needs, because of course they’re disrupting the class and they’re disrupting what is needed by the curriculum.

FRANCIS FOSTER: (01:19:19 – 01:19:37): How long do you think it’s going to be, Robert, before people walk into a clinic and they’re given the menu and say, “Look, we dial this particular gene up, you can dial this gene down,” and even just go, “Well, you know what, we’ve got 2 girls, we’d really like a boy. I want a son. Tick that box.”

ROBERT WINSTON: (01:19:37 – 01:19:59): That’s already happening. We’re not saying it’s happening, but I’m sure it is happening. I don’t think it’s openly happening in this country because the HFEA would not give approval or a license. But I don’t believe that it’s not happening even in this country. We’re sending patients to other countries, Spain, particularly Cyprus, particularly where they can get sex selection.

KONSTANTIN KISIN: (01:20:00 – 01:20:02): If you’re a billionaire in America, you’re picking.

ROBERT WINSTON: (01:20:02 – 01:20:51): And I have to say, because of course we were the first people to choose the sex of a baby because we were interested in sex-linked disorders. So we were worried about a particular muscular dystrophy where babies die, males die. And so we realized this was legitimate and we persuaded parliamentarians that this was a good thing to do and they agreed and we did. So that would be the first sex selection. That was the first in the world. And yeah, I had so many offers of massive sums of money from certain countries, and you can guess which countries they were, for, “Well, I need a son.” That was really quite a— and obviously we’re not going to do that because once you start doing that, you bring the whole technology into disrepute and yourself eventually.

FRANCIS FOSTER: (01:20:53 – 01:21:07): But there are a lot of people who would just say, who are very good at what they do. They’re very, in one word, reputable, who think to themselves, “Well, I can earn a fantastic amount of money doing this. I’m not doing anything wrong, in inverted commas, providing a service people want.” Yeah, exactly.

Fame, Kindness and Emotional Intelligence

ROBERT WINSTON: (01:21:07 – 01:23:26): Well, don’t forget, of course, that the first manipulation of a human egg was done in China several years ago. And of course, the guy was pilloried. Dr. He Jiankui ended up, of course, in prison. So it was possible for him to learn the techniques that we were doing in labs in America and here. And he copied them in China, but of course he used them purely because he wanted to be famous. I don’t think he wanted money. I think he wanted to be famous. We have this ridiculous society that we think being famous is really important. It’s terrible, actually. Being famous is not important, actually. It’s something which we should understand that it’s not what we should be teaching people. Be useful, yes. Be learning, yes. Be famous? Because eventually you’ll not be famous.

Every person who goes into Parliament at the moment thinks they’re going to be more than they are. We have a new prime minister. Like every other prime minister, he’s going to end feeling he could have done something totally different. Actually, I feel very sorry for Keir Starmer, actually, who I think was treated abominably by his own party. But he would have gone to that stage in that job thinking, “Finally, I can do something for society.” But it’s that famous greasy pole, which has been described again and again by every politician that gets into the cabinet pretty well. Fame is meaningless. Doing something which actually might help other people.

And what we’re not doing, and it’s really important, is teach our children to be kind, to be able to listen, not to argue without actually listening to the argument. And we don’t do that well. I don’t do that well enough either. We need to do it much more. But actually ending up with emotional intelligence is going to be as important as being famous. It’s actually going to be as important as being successful at science or successful at the art. Emotional intelligence is the key to improving society. And kindness is one example which we don’t talk about very much. But I feel when I talk to graduate students, PhD students, bear in mind you’re in your lab, just find a lab that’s kind, because actually that environment will be helpful to you.

Sex, Gender and the Science Behind the Debate

KONSTANTIN KISIN: (01:23:28 – 01:24:12): Robert, there’s one other area we wanted to discuss before we wrap up, which is something you’ve commented on frequently. I remember famously a conversation you had on Question Time with Fiona Bruce, who I like and I think actually is generally pretty balanced in my experience having done Question Time a few times. But you were trying to explain the science of sex and what makes someone male and what makes someone female. You did it, and she concluded by saying, I think something like, “Some people may disagree with this.” It seems to me that we’ve lived through this strange period where in the area of the trans debate, science has just gone completely by the wayside and people’s feelings have come to the fore. Is that a fair assessment?

ROBERT WINSTON: (01:24:12 – 01:25:33): Yes, I quite agree with that. I think Fiona did an injustice to the argument actually on that occasion. She didn’t listen to what really I was saying. I’m not in any way prejudiced against people who are transgender. It’s not the issue at all. The fact of the matter is that there’s a difference between gender and sex. Sex cannot be changed because it is inherent. All your cells, every cell in your body, the trillions of them will have the Y chromosome. Mine too. And that actually fundamentally changes our development. The same for women who have 2 X chromosomes. And we should celebrate that.

Now, of course, there may be some people who feel uncomfortable with their sex and they want to change it. But they’re changing their gender. They’re not changing their sex. They’re changing what’s kind of acceptable by manipulation. And that is a big problem. Sometimes, in fact, I found in my clinic so many women who came in infertile, who were desperate because they changed their sex and now felt they made a big mistake, were deeply depressed. And that was with men as well. And we forget that because, of course, we’re doing this sort of thing because we don’t understand this. And so I think remarks like that were deeply unhelpful, actually. I think Fiona Bruce didn’t help the conversation.

KONSTANTIN KISIN: (01:25:33 – 01:25:43): No, I don’t think she did, but I understand why she did it. People are so sensitive about the subject. Okay, no one cares about what the truth is anymore. It’s about— let’s just make sure we don’t offend anyone.

ROBERT WINSTON: (01:25:43 – 01:26:01): It’s interesting though, I used to come on Question Time pretty regularly. I’ve never been asked on since that time. Really? Yeah. Do I care? No, of course I don’t, because actually I don’t think if a program can’t listen to a sensible argument, which I think it was a reasonably sensible— it was a very brief statement.

KONSTANTIN KISIN: (01:26:01 – 01:26:09): Yes. And you’re a fairly eminent scientist, so your contribution to this debate should be indexed quite highly in my view.

ROBERT WINSTON: (01:26:09 – 01:26:12): Well, fairly eminent, as you know, I’m a scientist.

KONSTANTIN KISIN: (01:26:12 – 01:26:51): Sorry, sorry, sorry. Hold on a second. Sir Lord Professor Robert Winston. It’s not irrelevant. No, it’s a serious point. When we’re having a public debate about something that involves scientific facts, the contributions of people who are scientists matter more than the contributions of media personalities and politicians and other people who don’t understand any of this. And what I’m getting at is, I think, without personal animosity towards Fiona in that situation directly, I’m just talking about the broader issue and the debate and the way it’s being had is we are prioritizing people’s sentiments over scientific truth.

ROBERT WINSTON: (01:26:51 – 01:27:38): Of course, it’s popular. It’s the current trend. And I would say one thing, though, in her defense or indeed in anybody’s defense, scientific facts are only relevant at the time when they are there. When I look back at the papers I published, within 4 years they’re out of date because actually we realized what I was thinking was factual is different. And so often I got it wrong. And I think we have to be much more aware of that. However, I do think it’s difficult to define sex in the way that’s being defined because I think it’s very clear there. So whether it’s a scientific fact or not, we have to understand that facts are not the only way that you make legislation, of course.

KONSTANTIN KISIN: (01:27:38 – 01:27:39): Of course.

ROBERT WINSTON: (01:27:39 – 01:28:37): And that’s something that we have to consider because it’s also what is supported by a democratic society, what is, let’s say, ethical and so on, a whole range of things. But in particular, of course, I’ve no doubt that Fiona was considering some people who are desperately worried about their sexuality, and who actually are going through a tough time with their parents. And of course, maybe at school and all sorts of, with their friends and other, as we found, for example, with homosexuality. You look at that wonderful program recently with Ian McKellen discussing his homosexuality and you think, what an amazing man, but to have to go through that, not to be able to tell his parents that actually he was gay. It was a great thing, the way he presented that. And he’s done that for a long time, of course, but it was wonderful to see that on the BBC.

KONSTANTIN KISIN: (01:28:37 – 01:28:40): But I think that’s very, very different to this issue.

ROBERT WINSTON: (01:28:40 – 01:28:44): Yes, it is very different. It is. But we muddle up those issues.

KONSTANTIN KISIN: (01:28:44 – 01:28:44): Yes.

ROBERT WINSTON: (01:28:44 – 01:29:06): And sometimes it’s probable, according to psychiatrists who one respects, who’ve got a good background, who feel that actually some of the people who are requesting sex change actually, of course, are probably really homosexual in the background. I don’t know whether it’s true or not, but it’s a different issue. It could be a different issue.

KONSTANTIN KISIN: (01:29:06 – 01:29:10): So can you explain what sex is and what gender is in a simple way?

FRANCIS FOSTER: (01:29:10 – 01:29:11): Yeah.

ROBERT WINSTON: (01:29:11 – 01:29:21): Your gender is really basically, if you like, your visual phenotype, how you look, how you present.

KONSTANTIN KISIN: (01:29:21 – 01:29:22): Okay.

ROBERT WINSTON: (01:29:22 – 01:29:56): Yes. And your sex is actually something which is inherent in every cell in your body and may cause differences which are very wide. So some people, for example, many women will be extremely feminine in the way they talk. Others will be very masculine. I went to the Oresteia yesterday and there’s Agamemnon, who’s a fairly masculine giant man. I think it’s important that we don’t think about nuance enough.

KONSTANTIN KISIN: (01:29:56 – 01:29:56): Yes.

ROBERT WINSTON: (01:29:57 – 01:30:23): And that’s probably why I was mistaken on Question Time. But to some extent, you want to give a fair point. The number of emails I had after that statement was phenomenal. The number of women who wrote to me saying, “Thank you so much for sticking up for women.” And it was literally hundreds of emails, which I’ve not had for anything else I’ve done on the media. And I’ve done a lot of media work. So it was interesting.

KONSTANTIN KISIN: (01:30:24 – 01:30:56): Oh yeah. Well, the trans issue is something we’ve discussed a lot on the show. And the reason I think it’s such a hot-button issue is that many women feel that the particular privileges and protections that they’ve been afforded for very understandable and rational reasons, and they had to fight for a long time, are at risk when people who present as female, or as women rather, but are actually male, go into certain spaces which are women-only spaces and so on. And a lot of women feel very concerned about it.

ROBERT WINSTON: (01:30:57 – 01:31:10): It’s very difficult too because it’s very difficult to legislate effectively for that. And of course, that’s one of the things that courts have had a problem because, of course, unfortunately, no matter how good a lawyer you are, you can’t define sex as you can as a scientist. It’s different.

KONSTANTIN KISIN: (01:31:10 – 01:31:10): Yes.

ROBERT WINSTON: (01:31:11 – 01:31:16): And that’s not the fault of the lawyers. It’s because actually both are important systems of how we make judgments.

The One Thing We’re Not Talking About

KONSTANTIN KISIN: (01:31:18 – 01:31:27): Professor Lord Sir Robert Winston, thank you so much for coming on. Our final question, as you know, is always the same, which is what’s the one thing we’re not talking about that we really should be?

ROBERT WINSTON: (01:31:29 – 01:32:49): Wow. I think maybe political correctness is something we could be looking at. We are a society now increasingly where we’re making statements which are politically correct. Government does that all the time. The new prime minister’s doing that all the time. I hope he doesn’t make a mistake in that respect, but some of the things that are being said at the moment may seem helpful to society, but they may not be. And I think we have to recognize that when we legislate, we legislate for many people who are not necessarily in the same party. And actually within a party, there will be people with widely differing values. We’ve become quite tribal in our politics. And I see Parliament more tribal now than at any time in the past that I’ve been there, what, 32 years. Too long, probably, of course. But nonetheless, I think that tribal effect of thinking is not always helpful. Of course, there are great differences between Tories and Labour Party and Social Democrats, but they all have useful values to remember. But often we actually ignore that completely in the arguments we’re putting forward.

KONSTANTIN KISIN: (01:32:49 – 01:32:55): Thank you so much for coming on.

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