Tim Child is hardly Oxford’s only consultant to be spending time working in China. But when you realise that Dr Child is one of the UK’s leading researchers into the causes of infertility, whose fertility unit in Oxford has helped with the conception of thousands of children, it comes as something of a surprise to learn his services are in such big demand in the People’s Republic.
After all, didn’t that country impose a one-child system on millions of people to control a population of some 1.3bn, with all pregnancies monitored. Boosting fertility with asssisted reproduction techniques such as IVF, you might think, would not be the Chinese government’s priority.
But it now seems that the one-child policy is being relaxed because of a growing demographic imbalance.
And as Dr Child points out: “For couples unable to have a first child, the need is exactly the same in China as it is here.”
So, Dr Child, who recently opened a new centre for research into infertility on the Oxford Business Park in Cowley, is now busily seeking to deliver something similar for the Chinese.
The new £3m development in Oxford brings together under one roof the university’s world-class research into reproductive medicine and the Oxford Fertility Unit, a research-led IVF clinic known for new treatments.
Clearly, its fame has quickly spread far and wide, with the Chinese looking to have two units.
“We were approached by the Chinese to recreate what we have here in Chengdu and Shanghai. So this month we will be opening an IVF centre in Shanghai and some Chinese students will be coming over here.”
In the UK, infertility is said to affect about one in seven couples, about 3.5m people, at some point. And while many of these will become pregnant naturally given time, a significant minority will not.
Since the Oxford Fertility Unit was founded in 1984, it has gone on to assist in the conception of more than 5,000 babies. But progress since the early years of IVF (in-vitro fertilisation) has been impressive.
Totals of about 100 attempts (IVF cycles) performed annually in the mid-1980s at Oxford only rose to 500 a year in the 1990s. Now the total has passed the 1,000-a-year mark, with the number of IVF cycles set to double this year to more than 2,000.
“Our success rates are good,” Dr Child told me during a tour of the impressive new premises with the immaculately clean reception areas and laboratories, fitted with windows so visitors can observe what is going on. Demystifying the business of intra-cytoplasmic sperm injections and gamete micromanipulation is taken seriously here.
“Our pregnancy success rates are among the highest in the country,” said Dr Child. “For women under 36 our live birth rate is 40 per cent. Nationally, the average is 30 per cent.”
With rapid successes across so many fronts, it is sometimes easy to forget that in the world of medical sciencies, clinical embryology is itself only a youngster.
Louise Brown, the world’s first ‘test tube’ baby was, in fact, only born in 1978. Since then, infertility treatment has become a highly specialised field, involving interventions known collectively as assisted reproductive technology (ART).
Today, the Oxford unit offers an extensive range of treatments, including IVF, IVM, IUI (intra-uterine insemination), surgical sperm recovery, donor insemination and sperm and embryo storage.
As he points out tanks storing frozen embryos and we walk past signs proclaiming ‘egg collection points’, you have to be struck just how much better this place must be for anxious would-be parents than the unit’s former home on the John Radcliffe site.
Apart from becoming increasingly cramped, it also meant that for years men and women desperate for children of their own were obliged to walk through the maternity unit of the hospital to reach the unit.
The pain caused to some people by the prospect of being childless cannot be overstated, believes Dr Child. “People go through childhood and teenage years simply assuming that they will one day have a family. When it doesn’t happen it is very difficult for them. They talk about a big hole being left in their lives.
“It is not always easy for people with children to be conscious about just how important children are. You have only to talk to people with infertility problems to see the strain it can put on their relationship and all aspects of their lives.”
The former Foreign Secretary, David Miliband, admitted the last time he cried was when he realised that he and his wife Louise could not have children.
Trying IVF proved emotionally exhausting for both of them, he says. “You don’t want to talk about it to people because you are going through this very intense thing and you don’t really want everyone saying, ‘oh, how is it going?’ or ‘I am so sorry’ or ‘what is the latest news?’.”
Some couples do find their relationship cracks under the pressure.
With IVF cycles costing between £3,500 and £5,000, finding money for the treatment can become an added strain. The extent to which the NHS should be funding fertility treatment was already an issue, even before the current squeeze on public sector spending.
Dr Child said: “We are aware that some people in the NHS who decide on funding say ‘infertility is not a disease, so why should we be funding it because it takes away funding for other services?’. From my point of view, I see people with fertility problems on a daily basis and I know it dominates people’s lives.”
About 50 per cent of the IVF cycles carried out are done on the NHS.
“The unit is expecting to carry out 1,000 IVF cycles on the NHS this year and has contracts with some 21 NHS primary care trusts across the South of England.”
The Oxford Fertility Unit is, however, an independent organisation and Dr Child said a substantial loan had to be taken out to secure the new premises, which though leased, cost £3m to fit out with its laboratories and treatment rooms.
The premises are shared with up to 40 researchers and associate researchers from the Nuffield Department of Obstetrics and Gynaecology, whose work ranges from understanding fundamental cause of infertility to identifying factors that control how embryos implant in the womb.
“We find that couples want to come to a cutting-edge unit with research affiliations,” said Dr Child, who is a senior fellow in reproductive medicine at Oxford University and co-director of the Institute for Reproductive Medicine.
“All IVF couples are offered the opportunity to become involved in research studies going on at the university, and people do get involved and interested in the science that could benefit others as well.”
Dr Enda McVeigh, co-director of the new institute, said: “Couples have access to latest treatments, such as embryo-screening techniques that have been actually developed here. We expect this concentration of research will lead to further advances that will benefit more couples in the future.”
In 2007, Dr Child delivered the first IVM babies in the country.
IVM (in-vitro maturation), a less established treatment than IVF, has a lower pregnancy rate. But, unlike IVF, it does not require daily injections of drugs to stimulate the ovaries before egg collection.
And as well as removing the discomfort and inconvenience, it removes the risk of ovarian hyperstimulation syndrome, which occurs in about one in a 100 standard IVF cycles and usually requires admission to hospital.
The Oxford unit is still the only UK centre to offer this treatment.
The Oxford researchers recently completed a major study comparing fertility drugs given by mouth (clomifene) and by injection (FSH) for women with polycystic ovaries trying to conceive naturally, which showed higher success rate with injections.
Shortly before my visit came the news that an Oxfordshire mother had given birth to six babies after taking the same fertility drugs she had used for the pregnancy of her first child five years ago.
The story reopened the debate on the use of such drugs, with the added risk of women now buying them on the Internet.
Dr Child believes there is certainly cause for concern.
“Many studies have looked for any long-term implications of fertility drugs. At the moment the use of the drugs within the dose and timeframe of the drug licence does not appear to be linked to any long-term problems, such as cancer.
“But one of the main risks of any fertility drugs is an increased chance of multiple pregnancy. Ultrasound monitoring is required to ensure that there are not excessive numbers of ovarian follicles. A problem with buying drugs on the Internet is that patients will be unmonitored. The same may be true for GP-prescribing since access to the required scanning may be limited. Consequently, most GPs ask the fertility clinic to prescribe.”
A new method to screen embryos for abnormalities before they are implanted has been pioneereed by Dr Dagan Wells, who is based at the new institute. The new technique, now available as an option at the Oxford Fertility Unit, should reduce the chances of miscarriage and can check for conditions like Down’s syndrome.
Couples who go into the unit for IVF are asked if they want to become involved with stem cell research and donate spare IVF embryos, a key source of stem cells.
“There is a lot of stem cell work in Oxford. Some are happy for embryos to be used to make stem cell lines,” said Dr Child.
The modern new facility houses teaching laboratories for a master’s degree course to train the next generation of scientists and clinicians in this important area of medicine.
Couples are considered to have infertility problems after failing to conceive after 12 months’ unprotected sex. Two thirds of cases are put down to low sperm count or ‘female factors’, such as blocked tubes. But a third of cases cannot be explained, and the unit received a £600,000 grant to try to learn more about these cases.
This will include re-examining theories about whether ‘natural killer cells’, the dominant type of immune cell in the uterine lining during formation of the placenta, impact on reproduction.
“We are not just here to offer treatment, we are trying to understand what is going on.”
After helping assist with thousands of conceptions Dr Child, with the support of China, is better placed than most to find out.
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