The IVF Pioneer Who Says His Own Industry Is Lying - Professor Robert Winston

24:32And 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, you know, it sounds obvious, but it's important to understand the effect of infertility on a couple, it really changes their lives.

25:09They feel very guilty, very 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.

25:50And 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 shots. 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 four to five and a half months to get pregnant, something like that.

26:34That'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. I mean, 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.

27:13And 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 often is very minor, 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.

27:47But, you know, we're getting patients pregnant with not doing IVF. 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. 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.

28:37And 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?

29:16Just get in to get the treatment because people want to have IVF rather than losing weight. But, you know, 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. And various other research groups have shown the same thing.

30:03So 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. Oh, we will, but later. But 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.

30:53There 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 start development. All that sort of stuff has to happen. So the first thing is you need to have eggs which are ripe. You know, 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.

31:32But 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 percent of them probably won't fertilize. So half those eggs won't fertilize, and there may be 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.

32:12And for five 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 in memories. There are lots of reasons for 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.

32:49But you think about it, that's the first five days of life, which is critical to the development of a human being when genes are being switched on and being programmed by the environment. So they're actually responding to the environment. So that's been one of the research areas that we're working on at the moment. But you see, then you get to the stage when you've got an embryo, that precious embryo. And then after, you know, let's say, five, six 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.

33:28But 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 Fertilization Embryability Authority was set up with a statutory obligation to provide better information to patients.

34:10That'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 two or three times. For the clinic, if you fail, great, they'll come back again.

34:40If you treat them nicely and kindly, they'll come back. So, you know, 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 five different countries, including Britain, Switzerland, France, Germany. that actually after six attempts at in vitro fertilization, six attempts, separate attempts using the full cycle, only 34 % of patients have a baby after six 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.

35:17Francis Foster:So you're only looking at about 5 % success rate per attempt? 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. Yes. 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.

35:50Who knows exactly what?

35:52Francis Foster:And one of the things that, and correct me on this if I'm wrong, I'm just telling you from a kind of 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, I don't know, 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? I think it's a harsh, harsh thing to say. I think, you know, we were working on egg freezing malabarate free well before it was being done.

36:37And we were looking at, actually, not only freezing eggs, which have been collected, also freezing at ovarian tissue, which we think you could use, perhaps, to mature eggs, because you'd have better control. It's questionable that, but, you know, it's never really been a successful one or the other. If you look at really carefully conducted it figures. What you see, of course, is that freezing brings a huge... It's a massive change to the embryo. It's change in a fraction of a second is a vast change in temperature. It's called vitrification. And this process has been shown to disrupt all sorts of functions in the egg.

37:19Also, of course, the antifreeze which is used is not, in fact, it's not a liquid you drink for obvious reasons. In fact, it might be a very good way of getting rather simulating to the brain. I mean, not in the way you bought, you know, it would be sleepy at best. No, I mean, 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.

38:04Thereafter it's going to be frozen. And we know that, of course, a huge proportion of frozen eggs don't thaw. I have the figures going back from when they did collect them at the HVA. And I've looked at, literally, data from several hundred thousand patients. I mean, 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%. 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 can't just bring them because you take a lot.

38:47You have to thaw them because you're going to still want to get an embryo. So the problem is there, which has never been understood. 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.

39:20All 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 five or six 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.

40:04Francis Foster:The Trigonometry Merge Store is built on Shopify because the moment someone's actually ready to pay, Shopify makes sure they can. And if they've bought before, their details are already saved, so it's one tap and done. That's time back to grow the business instead of running it. If you want to start the same way, that's shopify.co.uk slash trigger. With Shopify, nothing stands between your idea and a real business. So go make it one. Start your free trial at shopify.co.uk slash trigger. Start your free trial at shopify.co.uk slash trigger. 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, I mean, like I say, companies offering egg freezing to women to induce them to delay having children.

40:55Francis Foster: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. It seems like a linear thing where you could do it now or you could do it 10 years from now. 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 than IVF. A woman of 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.

41:38But of course, so many women are in fact being encouraged to start before 35, but a huge number of women, a big proportion of them, are 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.

42:01Francis Foster: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 this is. Success rate is the same at any point. So you could have your children at 25, or you could have them at 40, and you just, you know, your freeze eggs at 25, and then 15 years later, boom, you're good. I mean, I had, 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.

42:38Francis Foster:We had a nice chat about the baby, and then we said to him, well, have you got, 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 two 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. No, it isn't quite right. And I mean, for example, I do have some statistics which bear some relationships. I've looked at some statistics which were, which I challenged the Minister in Parliament about of 40 ,000 eggs that have been thawed for the purposes of in vitro fertilization, all aged women, I don't know.

43:26And 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, you know, 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 do, to 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.

44:04They want to do things. Women want to use their unique credentials to do different things as late as possible. and as indeed my own wife did before she died. I mean, she produced three children, but she was already in the late stages of, you know, of fertility, but she was relatively lucky. So, I mean, I think that that is the problem that we, there's the inevitable pressure, which women impose on themselves, but society doesn't help to actually try to come to do this. But, you know, 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.

44:47Sometimes 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, it's because they're not good enough. We've lost the science. We're not doing good science.

45:30We're not producing good projects. were 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 five or six times what you'd earn in the public sector. So, I mean, 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 and analyzable research comparing one treatment with another treatment because patients want the best treatment they think, quite rightly.

46:05So 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 cultural embryos, is negligible. Very few projects looking at culturing human embryos in Europe at the moment. But that is clearly five 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.

46:44We'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.

47:27So 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, you know, for very good reasons. That brain is an advanced brain and now doing primate research in this sort of field would be unacceptable, quite rightly. 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.

48:07Yes, 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 know, you have genes for blue eyes. who 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...

48:34Francis Foster: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. Working. So basically, the amount of, let's say, message the gene is giving to the cells. So it's not binary. No, it's not binary. Exactly so. So, for example, you can get genes to overexpress and underexpress. Yes, and we can do that by changing the chemistry of the gene, and that happens. So epigenetics is partly how the genes are affected by the environment, because obviously it's the environment. What we forget actually, we've been thinking for years about development.

49:15Development is either

49:20nature or nurture. 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're young, you may have all sorts of things happening later on in older age.

49:57So, 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, as it was nonsense, where they showed that little boys aged nine, if they were in a good environment in one part of Sweden, where there was a good harvest in the 19th century, at the beginning of the 19th century, the end of the 18th century, their male grandchildren were more likely to die young. Having had a good environment at the age of nine, that made no sense at all. And truly being to we 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.

50:40So possibly the reason why heart disease and hypertension and other diseases were common in that cohort might be due to changes in the body 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 expressed, 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.

51:28for 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 pass that trait on to the next generation when they in turn are pregnant.

52:04Francis Foster: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 oestrogen. So it's intergenerational. So it's not, you know, you were neglected as a kid, you had a bad life, you pass it on. Well, of course, it doesn't help either. No, no, no, of course. But actually, of course, it's relevant. Of course, it's really complex because we should argue, of course, that we should not be so absolutely intense on Janine's, but much more about what we can do for the environment with our children. That certainly includes, of course, Sure Start, for example, primary education, because once primary education is finished, that brain is no longer quite as plastic as it was, for example, when the child was three or four.

52:49So 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 they don't... 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. It 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.

53:28Much 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 the government's relating to apprenticeships at a later stage. But in my view, we should be offering manual skills of all sorts much early on. There's a lot of experimental evidence in music, for example, that music actually can use. Certainly, it improves dexterity. Secondly, you can show that some people who are exposed to music early actually become much more appreciative of music later on.

54:17You can show also that it improves memory. It certainly changes actual physical views at certain analytical observations. Musicians and scientists actually have quite a lot of similarities. 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 in a musical who were some of the best scientists, much better than me, actually, far better. You know, 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 all have is collaboration.

55:06And collaboration is what actually is really important. But we don't teach that in school either. And of course, music does teach collaboration. And so do we know what the long-term effects of this technology are for the people who are the product of it? 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've 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 Pembry, Dr.

55:49Pembry, who's in Bristol. He pointed out to me, he said, you know, there may be something out of this is nonsense. He said, no, no. Marcus Pembry said to me, you know, 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. The people who watch this show have generally done more thinking about how governments operate the most. But there's a difference between understanding the problem and having actually built insulation against it.

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57:08Mikkel has put together a free report called Plan B Residencies and Instant Citizenships. It covers five routes to a second passport, including one that almost never gets discussed. How a foreign residency functions as genuine political insurance, which countries actually make sense depending on what you're trying to protect and what it realistically costs. Go to expatmoney.com slash trigger or click the link in the description of this episode to download the report. There's no charge, no catch. That's expatmoney.com slash trigger. 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.

57:48Because 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. 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 you know, so actually male fertility is very important. We don't look at that nearly enough.

58:24I think 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 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.

59:07We 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 how we've left it.

59:40Francis Foster:There's a narrative in the media that the quality of sperm is declining. Yes, I know. Is that accurate? Well, you know, it's very difficult to understand that. You know, there are a lot of very good papers on this now which show that in fact… But the problem, I think, this decline in fertility, has 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 of Hammersmith Hospital, because that was one of the first clinics that collected sperm over 60 years ago. So we have a lot of experience.

1:00:19And 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 it was much different over 60 years or so. Now, that's not a good paper. It's not a good, 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 not able to see much more things. And now, of course, we do do things like electron microscopy, which, of course, is able to look at the sperm in very, very high magnification.

1:01:00But 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, you know, for experiments which are going to help them get pregnant.

1:01:29Francis Foster:So a lot of the things we hear in the media is sort of these definitive narratives. I'm not, I think, I think the data are fuzzy. I think it's very, I mean, 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. And what are they? Oh, well, I think for the women working later in life, clearly, I think people having fewer children. I think the changes, you know, I think the changes in family finances where both couples need to get an income to make it justifiable. More or more people having single children.

1:02:07I mean, I think many people perhaps deciding that it's perfectly reasonable to have children at all. Many people, I think, are starting to feel, do we really want to bring a child up in this world? I mean, there are all sorts of issues we're never thought about in the 40s. So I think those things are, you know, after the war, there's always a burst of fertility. There was in the early 40s. Interestingly, after some wars, particularly after the 30 Years' War, the 30 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.

1:02:52Francis Foster:Yeah, we heard the same. 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 II. Yes, absolutely right. I think that that is, but it's not been, it's very difficult to do that retrospectively, because unless you're following up couples all the way through in their behavior. But yes, I think it's so, you know, 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, you know, perhaps nature needed more males at that stage, because of course, males were depleted in society.

1:03:34Can 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.

1:03:55Francis Foster: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, I mean, 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? How does it look? Well, first of all, most couples will get pregnant without any treatment. And although a lot of my colleagues talk about infertility effects, one in five couples, one in six couples, I don't think there's a flaw. I think there's a flaw, because 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 tested.

1:04:45But actually, he was not looking at the underlying causes of the infertility. And I think that actually, it's probably much closer to about one in ten. So it's not quite as common as we would boast. So you're looking perhaps at really one 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 fertility. 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 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.

1:05:29For example, if you have, let's say, an abnormal uterus which is congenitally abnormal, a very simple procedure can often correct that without IVF. The 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.

1:06:07Francis Foster: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 and went, oh, you know, you're basically her fallopian tubes are tangled. We need to sort that out. You sort it out and instantly had a child. So continuing to do IVF on someone like that, it's, I mean, it's crazy, right? Well, it is. I mean, 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.

1:06:44Fertilization 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 this, spend about 48 hours in the fallopian tube. At the beginning, before we go into the uterus, which is even more darker. 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 than IVF early on was because we were looking at the fluids inside the fallopian tube. I was doing that with Henry Lees, 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.

1:07:28So I think that we don't do that research enough. It's not easy to do, but it's certainly possible. Yeah. Where do your questions start?

1:07:39Francis Foster: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, in terms of the decades in your life. All right, well, I would say the average couple will have a one in four chance per month for the first four or five months. Then it gets reduced if they, because they obviously may have something more likely to be wrong. So certainly for the first five months, it would be wrong to do investigations unless you've had something clearly identifiable.

1:08:14For example, an operation which had infection, an appendix might be an appendix removed in somebody who's of childbearing age, might cause adhesions, that sort of thing. So that might be some reason. And 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.

1:08:53Francis Foster:And what about lifestyle? What are things that people do and don't do that can improve? They don't have sex enough. All right. I'm going home armed with that information tonight. I don't think changing lifestyle changes things much at all. Really? I think sex on the hearth rug is a really good way of doing it. And, you know, because I'm not speaking from experience, so I don't understand. 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.

1:09:34Francis Foster:I imagine that's quite a challenge. But you know, 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, you know, I did start to do years ago when IVF was in its very infancy. I'm sorry, that'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, she as a woman was able to really go through their sexual experience.

1:10:19And she thought that what she saw was that women who were having orgasm during it, of course, certainly were slightly more likely to have infection in their fallopian tubes sometimes. interesting. But also, overall, we're 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.

1:11:04Francis Foster: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... It's a very interesting question, you know, because I 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. He's no longer alive. But he was doing work on stress. And he said, one of the most important things to help ovulations is stress.

1:11:47He 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 gotten 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 four years, and she'd not got pregnant.

1:12:24and I was sure there was nothing wrong with her. We looked at her husband, there was nothing wrong with him. And she said to me, you know, 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 at all recently. And I said, well, that doesn't necessarily mean a judgment of what we'd expect. He would be fertile. It means that actually, you know, there's something else going on that we don't understand. And she continued to see me, and she never got pregnant. Then finally, one day she came into my clinic, she said, you know, I've got a boyfriend, our marriage is breaking up, and we're quite serious.

1:13:06And 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 two years, and she came back and she said, I've had two 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 three weeks later with that man.

1:13:40Francis Foster:So it was the country. It was England. It was England. England was ruining her fertility. But, you know, she had decided to change her life. Yes. I was kidding. Of course. She was changing who she slept with regularly. There was no guilt, I suppose. There was a new period, and she got pregnant quickly. 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. It's fascinating how little we know about it scientifically. Yes, it is. I quite agree. It's why the research is so important, because at the moment it's all anecdotal.

1:14:15So much of this stuff is left to anecdotes. But actually, there should be much more identification of where we do have things to test and the things we can investigate better.

1:14:27Francis Foster:None of us plan our lives around insurance. We plan around whatever life actually throws at us. We had our second child this year, which quickly reorders your priorities, let me tell you. Nobody sent a warning. That's exactly the type of situation where you'd want to use PolicyGenius. They're not an insurance company. They're a marketplace. PolicyGenius is a free service that compares life insurance quotes from America's top insurers side by side. Their licensed team handles the paperwork. No guesswork, just clarity on coverage, price and terms, backed by thousands of five-star reviews on Google and Trustpilot.

1:14:58Francis Foster:With PolicyGenius, you can find 20-year life insurance policies starting at just$276 a year for$1 million in coverage. Head to policygenius.com slash trig to compare life insurance quotes from top companies and see how much you could save. That's policygenius.com slash trig. 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... 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 like that defect.

1:15:45defect. And with Alan Handyside, I mean, the two of us spent, and Kate, I should say, also, Kate Hardy, we spent five 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 in 1989, 1980. 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.

1:16:43However, 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 tech teams, and with big data, we'll be able to actually identify characteristics which we think are associated with that sort of individual.

1:17:24Is that wise? No, it's not wise. It's really dangerous because, of course, we might well make people much more intelligent, possible, who get born slightly more intelligent, because actually intelligence is not nearly as important of 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, or find a baby that is more intelligent, but also highly aggressive, or autistic, or something else. So, you know, 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.

1:18:04And certainly in the States, this, I think, will be the first place for it to happen. And it's also not particularly great as well, because if you think about a lot of the people who actually push humanity forward, or in a scientific sense, or great artists, these are people who invariably are quite flawed psychologically, or they have, you know, they're highly autistic. If we eliminate those traits, we're also going to eliminate the outliers who actually provide us with wonderful technology, art, etc. Well, look at Beethoven. You know, perhaps the man who more than anybody else has changed Western music.

1:18:40You know, 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 that 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 you think, you know, those sorts of things occur in art hugely. And you look up Picasso and you think, those images.

1:19:26I 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 sort of seems to be thinking. It's an amazing experience to say how little we understand about our nature, about our whole way our brain works. You know, 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, for example, we're suddenly taking people like that really seriously as good candidates for doing science.

1:20:15You know, 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 it really needs, he or she needs, because, of course, they're disrupting the class and they're disrupting what is needed by the curriculum.

1:20:53How 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 can dial this up, this particular gene up, you can dial this gene down, and even just go, well, you know what, we've got two girls who would really like a boy, I want a son. I think 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 HFAA would not give approval or a license. But I don't believe that it's not happening even in this country. It's certainly worth sending patients to other countries, Spain particularly, Cyprus particularly, where they can get sex selection.

1:21:34Francis Foster:If you're a billionaire in America, you're picking... And, you know, I have to say, when we, 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 illegitimate. And we decided, you know, 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 election. 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, you know, I need a sum.

1:22:15I mean, that was really quite a... It was, and I, you know, it was obviously we're not going to do that because once you start doing that, you bring the whole technology into disrepute, and yourself, eventually. But there are a lot of people who would just say, you know, 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. I'm providing a service people want. Yeah, exactly. Well, you know, don't forget, of course, that the first manipulation of a human egg was done in China several years ago.

1:22:49And, of course, the guy was pilloried, Dr. Hay. he 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, you know, 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. You know, 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 we should be teaching people. Be useful. Yes. Be learning.

1:23:29Yes. 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. You know, 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, you know, I feel very sorry for Keir Starmer, actually, who I think was treated abominably by his own party. But he would have awfully gone to that stage in that job thinking, finally, I can do something for society. But it's that famous greasy poll which has been described again and again by every politician that gets into the cabinet pretty well.

1:24:11You know, fame is meaningless. Doing something which actually might help other people. And what we're not doing, and it's really important, is to 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. You know, 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.

1:24:47And 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, you know, because actually that environment will be helpful to you.

1:25:02Francis Foster: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. I mean, you've mentioned Kathleen Stolk and that's a trans issue. But obviously academic freedom has been talked about in a number of areas in recent years.

1:25:40I was rather hoping that you'd be interested in my opinion as a biologist, which seems rather more important.

1:25:45Francis Foster:Well, I'm just saying only because the issue of academic freedom isn't solely limited to trans. I'm about to say something which will mean that you'll probably want to edit the programme when I finish. But basically... Right. OK, we're all braced for it. I will say this categorically, that you cannot change your sex. Your sex actually is there in every single cell in the body. You have a chromosomal sex, you have genetic sex, you have hormonal sex, you have all sorts of different kinds of psychological, brain sex, they're all different. And we are very confused about this, unfortunately. And regrettably, it's got into this argument that people will now accuse me of being transphobic.

1:26:24Francis Foster:Well, look, there are trans people who say you absolutely can do that. Well, unfortunately, you can't say this publicly. This is one of the big problems. And even saying this on this programme undoubtedly will result in my getting a huge amount of hate mail. It always does. But I do think it's a big issue about the attitudes. There are, of course, issues which are important about young people who are confused about their sex, but we won't go down that route here. But it does affect a whole lot of issues in schools and elsewhere in our society. Of course we should accept people as they are. Overall, I think it's a very sad thing that we can't discuss biological science without actually getting completely caught up emotionally with something which is really completely wrong.

1:27:07Francis Foster:Well, as I say, there are people who would vehemently disagree with you, so I'm just going to make that clear. 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? Yes, I quite agree with that. I think Fiona did an injustice to the argument on that occasion. She didn't listen to what I'm 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.

1:27:48Sex cannot be changed because it is inherent. All your genes will carry the Y chromosome. 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 two 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 a 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.

1:28:33And 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 Fiena but Bruce didn't help the conversation.

1:28:50Francis Foster:No, I don't think she did, but I understand why she didn't. This is my point, which is people are so sensitive about the subject. No one cares about what the truth is anymore. It's about, let's just make sure we don't offend anyone. It's interesting, though, that 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 sensitive argument. It was a very brief statement. Yes. And you're a fairly eminent scientist, so your contribution to this debate should be indexed quite highly, in my view.

1:29:26Well, fairly eminent, you know, I'm a scientist.

1:29:29Francis Foster:Sorry, sorry, hold on a second. Sir Lord Professor Robert Winston is not irrelevant. It's a serious point. This is 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.

1:30:08Of course, it's popular. It's the current trend. 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 four 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.

1:30:55And that's something that we have to consider, because it's also what is supported by a democratic society, which is, let's say, ethical, and so on, a whole range of things. But in particular, of course, I've no doubt that the theatre was considering some people who are desperately worried about their sexuality, who are, and who are actually going through a tough time with their parents, and of course, maybe at school and all sorts of other, with their friends. As we found, for example, with homosexuality. You look at that wonderful programme recently with Ian McCullen discussing his homosexuality, and you think, what an amazing man, but have to go through that, you know, not be able to tell his parents that actually he was gay.

1:31:44It 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.

1:31:54Francis Foster:But I think that's very, very different to this issue. Yes, it is. It's very different. It is, but we muddle up those issues. Yes. And 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. Could be a different issue. So can you explain what sex is and what gender is in a simple way? Yeah, I mean, your gender is really basically, if you like, your visual phenotype, how you look, how you are.

1:32:37How you present. How you present, 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 of them will be extremely feminine in the way they talk. Others will be very masculine. I went to the Orosia yesterday and there's Agamemnon, who's a giant man. I think it's important that we don't think about nuance enough. And that's probably why I was mistaken on question time. But to some extent, you want to give a clear 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.

1:33:31We really, 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, you know, it was interesting.

1:33:40Francis Foster: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 four had to fight for 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 that issue. It's very difficult too, because it's very difficult to legislate effectively for that.

1:34:17And 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.

1:34:27Francis Foster:Yes. And that's not the fault of the lawyers. It's because actually both are important systems of how we make judgments. 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?

1:34:48Wow. I think maybe political correctness maybe 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 is 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 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.

1:35:30We've become quite tribal in our politics. And I see Parliament more tribal now than at any time in the past, and 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.

1:36:06Francis Foster:Thank you so much for coming on. Head on over to triggerpod.co.uk where we continue the conversation with your questions. Housing before AI helps with embryo selection, or even editing to optimize human ability, health and longevity.