Fertile with ideas for the infertile

May 14, 1999

Men can get pregnant, but can they give birth? Fertility studies pioneer Robert Winston talks to Alison Goddard about new ways to make babies.

In the future men will give birth to children. Or so professor and TV presenter Robert Winston was recently quoted as saying. In his study at the Hammersmith Hospital in London, where he is professor of fertility studies, I ask him whether he honestly believes this prediction. "I think that male pregnancy is perfectly possible already," he replies matter of factly.

It is a startling statement. Yet coming from Winston, whose avuncular moustachioed face is familiar from several TV science series (most recently BBC1's The Human Body), it sounds inevitable. For this is the man who helped pioneer test-tube babies.

Surrounded by hundreds of photographs of the babies that his work has helped to create, Winston outlines how a male pregnancy could be achieved. "A man would first need to have doses of female hormones to make him receptive to pregnancy," he says. Then an embryo, created in vitro - by inseminating an egg with sperm in a test-tube - could be implanted in a man's body. But where? Men are not noted for their wombs. "Well, it would have to be into a space big enough to accommodate a developing pregnancy and the placenta that goes with it," Winston says. The ideal place is the abdominal cavity.

Once implantation had occurred, the man could stop taking hormones. "The pregnancy would secrete sufficient hormones to maintain its own growth," Winston says. But the real problem would be birth. Delivery would require an open operation and the danger would be when the placenta needed to be removed. "The placenta forms such intimate connections with the surrounding vessels that its removal would be likely to produce massive haemorrhage."

Winston is no mad scientist. Clear-headed and pragmatic, he is passionate about moral and ethical issues. There are serious reasons for contemplating the notion that men give birth, he insists. "There are women who carry a Y-chromosome and do not have a uterus," he explains. "They are brought up as females, they look female, they have intercourse like females, they have normal female sexuality. They feel very dispossessed when they find they are sterile. If you could make it reasonably safe for them to have an ectopic pregnancy, they would want one."

Inevitably, such unconventional views have provoked comment. James Le Fanu, a fellow medic and columnist for a national newspaper, wrote: "Claims that before long, male pregnancy will be possible serve a double purpose: to impress the public with how brilliant scientists such as Winston must be, and to persuade us that the allegedly limitless possibilities of science undermine conventional moral values. The only problem is that it is tosh."

Winston hit back, attacking the comments in his book - The IVF Revolution - published last month. "It is a pity that Dr Le Fanu appears not to have reserved his comments until he had read fully what I had written," Winston sniped. "Had he done so, he might have recognised that his comments are all too typical of those ready to take attitudes about issues involving reproduction. What makes it particularly depressing is that Le Fanu is a qualified medical practitioner."

Winston's rebuttal appears in a chapter devoted to possible future techniques in reproductive medicine. But he is wary of making predictions. "I believe that you cannot seriously predict the future. When you do, you are wrong," he insists. "When I was a seven-year-old, my grandparents had a Victorian children's encyclopedia that had pictures of what London would look like in 50 years' time. There were people whizzing around in motorised balloons and curious pedalled vehicles on the road. There was a set of pneumatic tubing under the pavement that would send post. We are not there yet." For a second, a smile illuminates his pensive face.

Yet Winston's work is even more futuristic - it could ultimately lead to a new method of creating transgenic babies. A transgenic animal is created by injecting a foreign gene immediately after the egg is fertilised in vitro and before the embryo is transferred to the womb. But the chances of the embryo implanting, developing and being successfully delivered are low.

"We can introduce genes but it is an incredibly inefficient process," Winston says. "In mice, with which we have had the highest success rates so far, only 2 per cent of transplanted transgenic embryos survive birth. The embryo is often miscarried or destroyed."

There are two problems with the technique. "Often the DNA is not inserted correctly and the gene mutates so you get an abnormal animal. This is a serious problem.

"The other problem is that as soon as you start meddling with the genome, you introduce the unpredictability that accompanies gene insertion or gene integration in transgenic animals. You might insert a gene for better growth into a mouse but it will end up having no tail or it will be blind. That risk is so high that it seems unlikely that we would start experimenting in this way on people." This despite the fact that there are many illnesses with a genetic basis that could theoretically be cured by modifying a foetus.

Winston and his colleagues are developing a technique to overcome these obstacles: they are researching the effectiveness of inserting genes into sperm rather than into embryos. It is all hush hush at the moment because the results have yet to be published - but the implications seem enormous. All he will say is: "There may be strategies that might change transgenic technology."

Winston, 59, is a pioneer of fertility studies and reproductive medicine, having developed the subjects virtually from scratch. Married with three adult children, he is hugely sympathetic to the anguish of the infertile. "I suppose the reason I got into the field was that reproductive problems were common, badly treated and poorly recognised," he says. "There was a huge amount of science out there that had obviously been neglected, except in veterinary medicine. If you looked at some of the operations that were being done on women in the 1960s and 1970s, they were nothing short of barbaric. They had no chance of success at all. It was cynical. That was quite an influence on me."

Even now, he criticises "considerable injustice" in the provision of fertility treatment on the National Health Service. "Only a fraction of couples who might benefit from in vitro fertilisation actually do," he says. "Despite the existence of the NHS, IVF is by and large a treatment for those who can afford to pay for it. Probably less than 10 per cent of IVF in Britain is done through the NHS."

Fortunately, Winston sees this proportion rocketing with the development of new technology. "One of the things that we are doing is trying to mature eggs from ovarian tissue," he says. "At present you can only collect an egg for fertilisation when it is mature, and that requires an injection of hormones at a precise time in the woman's menstrual cycle, which can mean months of unpleasant and expensive drugs.

"Clearly if you could take ovarian tissue and dose that (with drugs to produce eggs), you would need a much smaller amount of drugs (about Pounds 20 rather than Pounds 1,000 worth) and you would avoid the expense and inconvenience. You would reduce the cost of IVF massively. I think that will happen within ten years."

How does he feel about the position he holds, as a beacon of hope for infertile couples? "People have such high expectations of me," he sighs. "I do not like being thought of as a paradigm of virtue. Or of vice. The need to reproduce is strong. For virtually all of us, the only thing that we will really achieve is the production of the next generation. Other contributions are so insignificant."

Recently voted the 121st most powerful figure in Britain in a list compiled for Channel 4 and The Observer, Winston has developed parallel careers in the media and Parliament. He is a Labour life peer. But it is his TV work that has most recently made headlines. The last episode of The Human Body caused controversy by showing the death of Herbie Mowes, a German antique dealer who had settled in Ireland. "Can it be right that we have spent the evening happily watching a soap opera, a comedy show, a football match - and now we are gawping at a fellow human being's agonising death?" was one typical journalistic response.

But Winston defends the programme with his typical robustness. "A man came up to me a few weeks ago and said: 'I must tell you. I had made up my mind not to watch that programme, because my father died of cancer ten months ago. I was going to switch the television off but I did watch it I and it changed my whole attitude towards my father's death. Since watching the programme, I feel much more at ease about the whole process.' If anyone says that to you, it is a wonderful accolade."

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