Dr. Michael Chapman is a very successful fertility doctor, having helped over 3000 pregnancies. As Chair of the IVF Directors Group he worked hard to make sure In Vitro fertilization remained clinically protected. He now hosts “The IVF Journey” podcast to share his expertise with the world.
Carl welcomes Dr. Chapman to talk about the developments in IVF field. They discuss how public opinion has changed in the 40 years since the first IVF baby was born, and Dr. Chapman shares strategies that couples can explore before turning to IVF to conceive. Finally, Dr. Chapman gives his thoughts on the proposed future of what we now call “Designer Babies.”
Prof. Chapman: Bacteria has the capacity to repair itself. The simple DNA that they have, if a virus enters the bacteria cell, they recognize it as abnormal and they have an enzyme like a pair of scissors, that can snip out a segment which is foreign to them, and then replace it with normal genetic material. That's now being applied to human cells, both in the cancer research area for obviously reasons, in embryos as well. The group in China, there's a group in China who, 18 months ago, published the first human embryos for this to be done to get rid of thalassemia.
Speaker 2: A wise man once said.
Speaker 3: A wise man once said.
Speaker 2: The best way to predict the future ...
Speaker 3: Is to create it. You're about to experience in [inaudible 00:00:50]. Scientists, entrepreneurs, thought leaders, you're listening to the Future of Humanity Podcast.
Speaker 4: Welcome to another episode of Future of Humanity Podcast. This is the show where we talk with thought leaders, scientists and experts, all about what is coming for humanity. Now today we have a absolutely fascinating episode, all about fertility and in vitro fertilization, commonly known as IVF.
I'll admit, as a 32-year-old male, I have very limited knowledge about this, as I personally have not tried to have kids, so this was a very foreign topic for me. However, what I learned in my research and in this episode, and the discussion with our expert was truly fascinating and eye-opening for me in very many ways, so I highly encourage everyone, no matter your age, sex or location, that you listen to this episode.
Who am I joined in this episode to discuss this topic? I'm joined by Professor Michael Chapman, who is one of Australia's most highly profiled and respected fertility specialists. He's actually a busy clinician so he's out there doing it. In fact, he actually came directly from a surgery just before we recorded the episode. He's also personally been involved in fertility care resulting in over 3000 pregnancies, personally. He is heavily involved in training and education at all levels, and is an examiner for the certificate in reproductive endocrinology and infertility for the Royal Australian and New Zealand College of Obstetricians and Gynecologists, of which he is a fellow. He not only does this, but he teaches it too.
Michael currently holds the following post, he's a clinical director for women's and children's health, George Hospital executive director for the Royal Hospital for Women, he's a Fertility Society of Australia president, he's The Australian and New Zealand Society of Reproductive Endocrinology and Infertility vice chairman, and the CREI subspecialty committee RANZCOG. Now don't ask me what RANZCOG actually stands for. I'm guess Australia and New Zealand is in there, but that's not something that I know, so check that out.
Today, we go deep into understanding exactly what IVF is. Where have we come from over the last 40 years, and what are the improvements that have occurred in the technology and success rates et cetera? Then we talk about the new technological opportunities that are in front of us, and in particular, in the IVF and reproductive space, as well as some of the ethical issues that they potentially raise, so really fascinating there.
We also talk about the falling fertility rates. Now this is an episode you definitely want to listen to is you are about to or you're actively trying to conceive. There is some great information that you may already be aware of, but if not, you definitely want to listen this. But I would also say if you're not actively out there or considering or even in need of IVF, I would still encourage both men and women who just better want to understand this incredible technology, as well as what's happening with both male and female fertility around the world, to listen in. Let's just get straight into it.
I'm really excited for today's episode because we are joined by Professor Michael Chapman, who has generously said I can call him Prof because that's how all his friends refer to him, so I'll be referring to him as Prof. Reason I'm excited is, at the time of recording, it is, I believe in a week or so, a month's time, the first IVF baby is turning 40. Is that right?
Prof. Chapman: Yeah. 40 years ago, this baby was born in the UK, it made front page headlines because it was the first test-tube baby. It brought with it huge amount of controversy that you could make a baby in a test-tube. At that point in time, probably the public was 80% against it, if you asked the public, that we were playing with nature and we shouldn't be doing it.
It was a culmination of nearly 20 years of research from two or three groups around the world, one in Australia who actually just missed out on having the first IVF baby. They had an ectopic pregnancy before this one, Louise Brown was conceived, and but the boys in Cambridge, Steptoe and Edwards made it all happen, and even at the Royal College of Obstetricians and Gynecologists, of which Steptoe was a senior member, he got howled down by other gynecologists saying it was a fraud.
Speaker 4: Wow.
Prof. Chapman: We've come a long way in that time. It's now estimated that over 7,000,000 babies worldwide have resulted from the IVF process.
Speaker 4: Wow, that's amazing.
Prof. Chapman: Here in Australia, we are over 200,000 babies, which when you think of a large provincial town like Hobart, we would have populated that city over that period of time. It's a major contribution, we have 4% of all births in this country.
Speaker 4: Wow.
Prof. Chapman: In Japan it's 5%. Many other countries it's only one or 2%, but even in the States, where there's not much funding from the public pocket, it's getting up towards 2% of the population, and that's a big population.
Speaker 4: Wow. You touched on a couple of things there, one, I know you've been involved in fertility care for, was it going on 35 years I think I read.
Prof. Chapman: Yeah. I put my first embryos back at the end of 1985.
Speaker 4: Wow. Which is before I was born. That's fantastic. The other thing that you touched on is just how much of a controversy it was back then. What are we seeing today? Is there still as much controversy, or even any controversy around IVF as it stands today?
Prof. Chapman: There's always controversy about IVF today.
Speaker 4: Got you.
Prof. Chapman: No, the basic concept of taking a sperm and an egg, fertilizing them outside the body and putting that back, I think everybody, well virtually everybody but the catholic church sees it as a major step forward in medical technology. It's enabling people who weren't previously able to have babies, to have babies.
Where we get into trouble, and I'm sure we're going to talk about it, is the ethical edges that there are going forward, but they were the ethical edges we had 30 years ago when, as I say, the vast majority regarded it as a biological experiment that would probably go wrong, and we were all terrible people to be involved in it. But that's evolved. The acceptance of IVF actually is, that change in attitude in the community is probably one of the rare of times that in a generation, you can move, or even half a generation, you can move a negative view to a positive view across a whole population.
It's probably not so surprising because fertility is an essential part of lives. To reproduce, that's why God put us on the world to start with, was to reproduce. We've evolved that way, and so to not be able to undertake that basic humanitarian or basic step in humanity, real disaster for individuals.
Speaker 4: Yeah. You mentioned that we were evolved to reproduce, but I remember I saw or read in some of my research before this episode, that you referred to the difference between rabbits and humans. We've evolved to reproduce, but not very efficiently. Let's talk a little bit about that. Can you tell us that analogy?
Prof. Chapman: Yeah. Rabbits and mice, when they come into season, the female comes into season and attracts by those pheromones, the male of their species, and they have intercourse, almost always a litter arises. That their fertility rate for that particular moment in time is almost 100%. But what happens is that they're dead within two to three years.
Speaker 4: It's a survival thing.
Prof. Chapman: You don't get a rabbit living for very long, and a mouse even less. What we, as humans however, and our reproductive life, well female reproductive life stretches from 13 to 45, a long period of reproduction, and a coming into season into sense, once every month, so that's 12 times a year. If we got pregnant every time, we wouldn't be here today.
Speaker 4: [crosstalk 00:09:27].
Prof. Chapman: The world would have been overrun at a time when technology wasn't able to produce food production line stuff, that we've caught with the capacity to deal with the current levels of population. Whatever it is that causes evolution, one of the things that we evolved in such a way that we were inefficient reproducers, that the odds of a pregnancy in any one month of an egg being released for a human, at most around 15%.
Speaker 4: In my view, that's probably a misconception. I think a general view, maybe this was taught to us in high school in sex ed, but if anything it was probably the other, that it was like, "Don't have sex because you'll fall pregnant." It made you feel as every time you had sex you were going to get pregnant. I think from an expectation, I'm sure what you do, very much has a lot of managing people expectation. There is an expectation that every time they have sex, unprotected sex while they're fertile, there's a high chance of getting pregnant, but what you've said here, it's only 10 to 15%. That must be quite shocking to a lot of people.
Prof. Chapman: It is, and I do have to say that. Probably in my fertility clinic, at least one in every three patients I'm making that statement, and I can see their mind ticking over and saying, "Well, that's not what I thought it would be." Patients are turning up to their general practitioners, at two or three months of trying, and saying, "It's terrible, I must be infertile. I've been trying for three months, and my sister got pregnant in the first cycle and my best friend was taking the pill and she got pregnant, and I'm three months." But in fact, by three months, the chances of being pregnant are not much more than 30%. If they stick with it, provided there's nothing else wrong with them, by 12 months, that'll grow to 90% chance of being pregnant. There is a degree of patience.
Speaker 4: I think that's an important message.
Prof. Chapman: The younger society, I'll [crosstalk 00:11:26].
Speaker 4: Patience is growing smaller and smaller.
Prof. Chapman: Impatience. We want something, we want it now. we probably, we the medical profession, has probably helped that because what we can do now, which our parent, or my parents and your grandparents couldn't do, was contracept efficiently. The contraceptive pill in particular has meant that we can plan not to be pregnant, but the expectation is that we will be pregnant the moment we want to be, and that's not nature.
Speaker 4: [inaudible 00:11:56], yeah. As I say, I think that's a really important message for people to get because that leads to the question of you're heavily involved in IVF, but when every patient comes to you, do you instantly say they need IVF, or do you point them in other directions?
Prof. Chapman: Yeah, absolutely not. That singles out, I'm afraid across the world, IVF is being used far too soon. That little bit of patience will get exactly the same result for less money, less pain, and in Australia, less burden on the tax payer. It's a problem. As president of the Fertility Society, I am very conscious of the fact that we probably are doing too much IVF. That there are many other strategies, simply waiting is one of them, but simple therapies with tablets of with insemination, that really don't need to get patients straight into IVF. It's a problem, and going forward, well we'll talk about forward in a little while, but I do worry that we're going to go too far.
Speaker 4: Definitely. Well yeah, it does seem like, for a general population, as a male in the general population, I feel like when it comes to IVF, unless you have personally experienced fertility issues and you then started to investigate your options and you've looked in to IVF, I think a lot of people don't really understand and they think oh, I can't conceive, IVF is my only option. I think this is very interesting to know. I saw in my research and you mentioned it, there are tablets that women can take which can help ovulation. As you mentioned, insemination which can be for the men who maybe are having problems. That's really interesting, so let's maybe talk about that. How exactly does IVF works? Maybe let's talk a bit about the history as well, and how did we get to where we are now?
Prof. Chapman: Well it started out in animal husbandry. Interesting name for it. Helping farmers produce better animals, so that their prize bull, they were able to extract sperm and inseminate the cow with that sperm, and could fertilize multiple cows. Then it was discovered you could actually take the eggs out of cows and actually create the embryo in a laboratory. Back in the late 1960s, that first happened.
Speaker 4: Wow.
Prof. Chapman: Obviously then people thought well, if we can do it for a bull and a cow, and the other area was horses, getting your best race horses, why don't we see if we can do it in humans? People struggled because the human is not either a horse or a cow, and the number of eggs was a problem because we don't multi-ovulate normally, whereas those animals can, and their response to medication is different to the human. They struggle for 10 to 15 years before Louise Brown came along.
The things that have happened since then, in terms of technology, a woman going through IVF in 1980 would have had blood tests done every day of heir menstrual cycle. To collect the eggs, they would have had laparoscopic surgery, so significant surgery with risks associated with it, to find the eggs. We now have vaginal ultrasound, and really it's really a very simple procedure to actually extract the eggs. Tell my junior doctors that I could teach monkeys to do an egg collection.
From the patient's perspective, medications that they took were twice daily medications and injections, today there are still injections, but they are very minor, tiny needles, and there's even a drug now which is long-acting, so you don't need to take needles every day. There have been major steps to make the burden of treatment for patients so much better.
But in the laboratory, that's probably where the biggest changes have happened. If we think about it, what we're trying to do is mimic the fallopian tube where fertilization occurs naturally in the human, and also the conditions in the uterus when the embryo comes down the fallopian tube and lands in the uterus, so five days after ovulation, to attach and become a pregnancy.
Those conditions have really taken 50 year to work out, but we're getting better and better. We know for instance, that the embryo needs more sugar in the first day or two, and then should change over to ... Because it doesn't produce its energy itself, and then it changes over to a different energy processing after three days. We know that we breathe oxygen in the ratios, nitrogen to oxygen, of what's in the air, but in the uterus, there isn't the oxygen. Oxygen is only 8%, but we've been growing embryos at 20%, and surprise surprise, we get much better embryos if with grow them at 8%. They've been step by step, I suppose nothing hugely dramatic, incremental increase.
The uterus is a very stable, dark environment, and what we used to so was to take embryos in and out of incubators which were shared by 30 other embryos, where the carbon dioxide, oxygen ratio went up and down as you opened and closed the door, not to mention the temperatures, surprise surprise, when we developed an incubator that only took one person's embryos in a little box, pregnancy rates went up another 5%.
All of those technological advances, none has been vastly dramatic, but certainly when I started doing, well in 1985, we would say to a patient, "You've got less than a 10% chance of pregnancy," even in the young age group, but it was not nothing. Today we're saying 40% in the younger age groups. That's the incremental change in 30-odd years.
Speaker 4: Has it come just from trial and error that's made these incremental changes, or has it been high level research that's done it?
Prof. Chapman: Culmination of both. Some of it has been serendipity. One classic example of that is the technique which is now used by the majority of women, well they don't use it, but we use for them, called intracytoplasmic sperm injection, ICSI. It's where a single sperm is injected into the actual egg mechanically, just after we've collected the eggs, four hours after we've collected the eggs. There was a technique which had been used in animals for 25 years, where we used to put several sperm just under the egg shell and allow them to penetrate the egg. That was called SUZI, subzonal injection. We're very good with the acronyms.
Speaker 4: Yeah, I can see that.
Prof. Chapman: A scientist in Belgium, Columbo his name was, junior doctor at the time, junior researcher, was a bit clumsy and pushed a sperm into an egg, and low and behold, SUZI became ICSI, and got a pregnancy published in the Lancet in 1992.
Serendipity. It's now the technique used by [inaudible 00:19:13] in Australia. About 65% of all [inaudible 00:19:16] are fertilized using the ICSI technique, which gets over male problems. If you get 10 eggs, you only need 10 sperm, not 15,000,000 sperm.
Speaker 4: Yeah. As I understand it, one of the issues that faces fertility from the men's side is a low sperm count right? Being able to have, only needing 10 sperm probably gets over that issue for a lot of people.
Prof. Chapman: Absolutely. Because previously we were saying, "Sorry, you're going to have to use donor sperm. Good sperm from another man."
Speaker 4: That makes a big difference then, because it's now your child as opposed to a donor sperm's child.
Prof. Chapman: Correct. That was a huge step forward, and as I said, it was a chance event initially. The laboratories, but as I say, that's one part of the laboratory, but there's understanding the culture medium. A lot of that's been at high level science behind it, understanding how embryos grow and what the best conditions are.
Speaker 4: I'm sure along that way that there has been greater awareness or a changing in the culture of population. As we mentioned, already touched on before, it was highly controversial, now it's quite accepted, except maybe by some religious groups. Has that had an impact on more funding and other things happening in the space of IVF? How has that impacted, this change, how has that impacted maybe funding into improving the technology?
Prof. Chapman: Well certainly getting governments onboard in terms of supporting people, and it still happens in the United States, there are some states where there is some funding, but the vast majority it's now, so they have to pay the full fare.
Speaker 4: How much does IVF cost? I've no idea. What are the costs involved?
Prof. Chapman: In a well resourced service, in other words, good number of nurses, counselors, laboratory people, scientists, we're talking, in Australia, the cost is around 10 or $12,000. In the States it's probably more like $15,000. I'm not quite sure why the different, but that's ... Oh, I know, part of it's the drugs. That's right. We're lucky in Australia that PBS pays for the drugs. It's a significant amount of money for someone who's earning an average income. Getting governments onboard to subsidize has been a major step.
In Australia since 1990, the government has accepted that infertility is a medical condition, and of course that's the big step. Then secondly, that IVF is no longer experimental, it's mainstream treatment, so why shouldn't it be treated like any other medical benefit treatment, or treatment for which Medicare will contribute? The government puts in about 50% of that cost.
Speaker 4: That definitely makes it more accessible I'm guessing, for many people. I think it's interesting, as you said, around the was it 12 to $15,000 mark there, and that's just for one attempt right? There's no guarantees. Is someone requires multiple attempts, it can really add up to a lot. Is there any different in price based on the age of the woman?
Prof. Chapman: No. A cycle is a cycle is a cycle. Going back to the numbers again, while it's 10 to $12,000, the patient will actually get back five and a half, 6000.
Speaker 4: In Australia?
Prof. Chapman: Yeah, in Australia. In other countries as I say, it's much more expensive where there's no government subsidy, and then there are the Scandinavian and Holland and Belgium who offer three free cycles.
Speaker 4: Oh wow.
Prof. Chapman: If you're under 40 years of age and you've been trying for at least 12 months to get pregnant. They've put in boundaries for that subsidy and it is only three cycles.
Speaker 4: That's a really interesting way to do it, and I think that's great, making it accessible for people. This leads, I suppose, into we've talked a lot about why people are going for IVF, and we've talked on the fact that it's not necessarily needed in all cases, and some people just need to be patient or look at some other options. Let's talk a little bit now about where things are headed. If we think about these micro incremental chances that I'm sure have reduced the cost, have improved the rates of success, what's happening in the industry right now? What do you see? Do you think we could ever get to a guaranteed 100% success rate many years in the future, or do you think that's not medically possible? Where are we headed?
Prof. Chapman: No, we'll never get to 100%, and the reasons for that is basically biology. Why is it only 15% per cycle? What are the breaks that are in there, that prevent from being less fertile in nature? That starts with the egg and almost finishes with the egg in fact, because the sperm contribution in terms of success or causing failure, is actually a small part. Probably 5% we can blame the sperm. Almost always it is the genetic makeup of the egg, that we know that the eggs, even of women in their 20s to 30s, 50% of them are genetically abnormal.
Speaker 4: Wow.
Prof. Chapman: For some reason we've evolved of having a slightly more complicated process to get to the right number of chromosomes, and that's one of the areas of academia that is really high tech, and has exploded since we've been able to do genetic testing, so down to the level of the DNA and the bits that make up the DNA. What we increasingly are finding is that if you've got 50% chance of, talk about a 30-year-old, 50% of her eggs are abnormal, now they may fertilize, or they may not if they're really bad, but if they do fertilize, they still will carry that genetic abnormality which will declare itself either by the embryo not growing on, fertilizing but not starting to divide its cells, or getting to a blastocyst, which is the stage just before attaching to the uterus, and when we biopsy those embryos, even then 50% of them are abnormal at that age. How do you change that? Unless you can pick an egg from the patch that is of genetically good quality, that will be the only way, and at the moment we don't have the technology to be able to pick that.
Speaker 4: Could we have the tech one day in the future, to actually change the genetics of an embryo and fixing the problems?
Prof. Chapman: Yes we do. That's on the cusp at the moment. There's something called, I don't know whether you've talked about it yet, but it's something called CRISPR.
Speaker 4: We haven't talked about it yet, but yes, I'm aware of it.
Prof. Chapman: Yeah, so in bacteria, bacteria has the capacity to repair itself. The simple DNA that they have, if a virus enters the bacteria cell, they recognize it as abnormal and they have an enzyme like a pair of scissors, that can snip out a segment which is foreign to them, and then replace it with normal genetic material. That's now being applied to human cells, both in the cancer research area for obviously reasons, in embryos as well. The group in China, there's a group in China who, 18 months ago, published the first human embryos for this to be done to get rid of thalassemia. A single gene defect that we know about, and they were able to chop it out and replace it. The only problem was the scissors were a bit more random and they caused a whole pile of other abnormalities, but they did-
Speaker 4: Technology's not there yet. If we think about where it's going to head to, we're already on the cusp of doing that, so it could happen.
Prof. Chapman: Yeah, so it could happen, absolutely. We may move towards the perfect egg, but then there's also the uterus itself, and the lining of the womb plays a vital part in that process. Again, we're learning more and more, again, through genetics. We're understanding there are now fingerprinting of the cells at the time of implantation of the egg, that seem to be more optimistic in an ongoing pregnancy situation, but again, that's technology that's not yet at its development stage that really can be properly applied, although around the world, there are people selling tests for these desperate couples. When everything else seems fine, you can send a sample of your lining of the womb to Spain, and $1500, they'll tell you whether it was in synchrony or not with the timing that the doctor thought. Randomized controlled trials have not yet proven a benefit, but-
Speaker 4: Yeah, for those listening, the look on his face shows that he's skeptical and not recommending that you necessarily go and do that.
Prof. Chapman: [inaudible 00:28:12] do it. No, absolutely not. Sadly, one of the serious issues in infertility is that the desperation couples have to have that wanted baby, means they will do things that are unproven and expensive, on the basis that somebody said it might work. There's a classic example at the moment, again, the immunology side of things, the is half foreign to the mother because it carries the father's genetics, so the body does something very strange in allowing it to be there. There's an interplay in the immunological system, between tolerance.
Speaker 4: I'd never thought about that. Yeah, that's very true.
Prof. Chapman: That balance, we really have never understood quite why it happens. But we're learning. The genetics of today are showing us the way, because we can actually not measure the cells, but measure the products of the cells and have some idea about what that interplay is. But at the back immunology, there are people giving drugs, giving intralipid infusion for instance, charging $1000 for an emulsion that costs $14 on the pharmacy shelf, on the basis that it suppresses the immune cells. Does it work? There's no randomized controlled trial, but I'm very upset at how many women will believe this.
Speaker 4: Last chance maybe? As you mentioned, emotions are high.
Prof. Chapman: Yeah, and if you're spending 4000, why not spend 5000, and maybe it might work for you, but the medical profession, I'm afraid we are breeding off that insecurity and that frustration of not getting the pregnancy.
One issue we must talk about, about the future, is the sociological change that's also occurred in the last two decades. No, three decades we'll call it. I put the blame at the feet of Germaine Greer, but the freedom of women to do more of what they want has led to women's careers. We can argue this, I'm very pro women, but its consequences I think, need to be thought through. My grandmother almost certainly had a job, got married, had a baby at 22, 23, 24, when it was very easy to get pregnant and there wasn't much choice, because marriage, there was intimacy with marriage and there wasn't contraception of any note. What we can do today is put that fertility of and off and off as you become a school teacher, head mistress, oh now at 37, I probably should think about having a baby.
In addition to that, man are also responsible, and certainly the research shows that the decision making in terms of a couple having a baby is actually more importantly driven by the male. They want their car, they want their house, they want their career to be sorted out before we embark on having a baby. There's a statistic that says that 50% of men are still at home at the age of 27 in Australia, so they're not going to link up and have babies at 23, 24. We've got this whole host of women and men moving through the 30s and into the 40s.
Speaker 4: Do you think people are doing that because they see IVF as a solution? They're like oh, I can wait that long because I've got options like IVF available to me.
Prof. Chapman: Unfortunately yes, and media doesn't help that. Media enjoys Janet Jackson having a baby at 50. Now whether it was her egg or not, they don't tell you, but I'm almost 99.99% certain that it was a donor egg. She carried the baby, so it looked like hers. False hope is there, and as I say to patients who come to me at 40, "The odds are you're never going to have a baby. I can do everything I can, you can throw every resource at this that you can, but you've got less than a 40% chance of going home with a baby." People don't know that. I try to educate, I have a podcast that goes out every week, and I'm sure every third week I talk about older women and their chances of success, because education, for me, is everything.
Speaker 4: Yeah, and so for those listening, if you want to check out his podcast, you can find it, it's called The IVF Journey. You can find it on iTunes, all the different places. Highly recommend you check that out for sure, especially if you're ... Is it really for people who are in the middle of trying to conceive, or who is the ideal audience?
Prof. Chapman: From the beginning. No, people who are even thinking about when should I start to try? We try and cover preconception, pre-fertility even, because that's [inaudible 00:32:52] as well.
Speaker 4: We're talking about some really important things here. I hadn't really thought so much about that society change, but you're right, with people delaying, putting it off, that is they're putting their hope I suppose ... I mean we all did it. I remember as a kid I was like, "oh I won't need to drive because we'll have driverless cars and cars will be flying and stuff by the time that ..." Obviously when it came time, I had to learn to drive because it's not happening now, but it didn't happen as fast as I thought it would.
There are probably people thinking, maybe some of them are listening or they know people, who are thinking oh, even if the technology's not there now, I'm 30 now, but by the time I'm 40 the technology will be there to improve my chances of conceiving. I think you've pointed out that we can't rely on that. It's small, incremental changes that happening, especially when we're talking medical field, there's a lot of regulation, there's a lot of things that have testing that needs to go on, it's not quite like the tech boom we've seen in the business space if you like.
Prof. Chapman: We can't make mistakes. It would be a horrible event to do some form of treatment that ended up with children with two heads. It would just destroy the word for everybody, and not only that individual affected people, but all those people that have criticized IVF over the years would be in there like [inaudible 00:34:14].
Speaker 4: They'd be proved right. It's horrible. I think there's some important things we do need to touch on before we start to wrap up. Designer babies right? The ability for people to choose gender, but then going past that, because I know that technically the ability to choose genders is possible as of now. In Australia I believe it's not legal, you're not allowed to do it.
Prof. Chapman: For social reasons. You can do it for medical conditions that are carried through one sex or another, like hemophilia, but not as well I've had two boys, I want a girl.
Speaker 4: Got it. Right. That's a trend that society is, probably over time, going to change its stance on that and possibly demand it. There's ethical questions there. The other one that I want to touch on is I read that, I think it was over in Europe or somewhere, there, some scientists have actually tried to conceive, or they successfully conceived with using three donors.
Prof. Chapman: Yeah. In fact there's a senate inquiry going on at the moment, driven by the mitochondrial disease lobby, which are very fairly saying there is a way to avoid these metabolic diseases that kill infants in the first year or three of life, that can be diagnosed at the carrier states. What can be done is that the mother and the father contribute their gametes, but the mother who's the carrier potentially, of the disease, her mitochondria gets swapped for a woman who is not affected by the disease. That's why the three parent comes from, the mother, the father, and then this small amount of mitochondrial DNA, which comprises less than 2% of the baby's total genetic makeup. They're 98% their mother and father, and but the extra 2% means that they avoid these terrible diseases, the mitochondrial diseases.
It's legal in the United Kingdom, and we're going through a process at the moment, of reviewing whether it should become legal in Australia. We have the technology, and while it's a relatively rare condition, it's something we could eradicate.
Speaker 4: Where do you fit on this? Where do you stand? Obviously it's your personal opinion, not necessarily maybe what the medical representation are, but do you believe that, as society, we should have the choice, or do you think that we should keep it just for medical reasons? Where do you feel that?
Prof. Chapman: Well the mitochondrial [inaudible 00:36:39], I think all doctors would believe that that's a way forward, provided it's proven to be safe. There is still a little question mark about that. Can you really get rid of all the mitochondria that were affected, and are the ones coming in really going to be all of them? We need that safety issue to be finally resolved. It will come.
On gender balancing, I've been a public advocate of gender balancing for the last five years. I personally wrote to the NH and MRC when they called for submission, saying that I see patients who will not have another baby unless they can choose that opposite sex. I think with full counseling in clinics that are controlled well, and that's my worry because people go overseas to sub-optimal clinical areas, expecting a great success, but either they don't come back with the sex they want, but more important, they don't come back at all with a baby because the technology's just not as good, but they've spent a lot of money on it. We can do it in Australia.
Going beyond that, certainly the technology into the future, if we can, if we can get CRISPR working, we could be taking the genes that control eye or hair color, and substitute those in. It could be possible, but A, it'll be expensive, and we've got a long way to go, I think, in terms of that. But it's there, but again, society's got to make those decisions. At the moment, society is against gender balancing. A Morgan poll showed 80% said no.
Speaker 4: In Australia are we talking about? Yeah.
Prof. Chapman: Yeah. Society determines the progress of these things. The scientists and the doctors throw out the challenges as science progresses, society has to decide whether it's okay or not.
Speaker 4: Yeah. That's with all the technologies right? It's all driverless cars, we're having the same debate about the technology's there, are we going to do it? My concern, wherever you may sit, is that society changes its views over time, as every new generation comes in, so it's hard. How do you set the rules? Because they'll probably change over time anyway.
Prof. Chapman: But then what's the problem?
Speaker 4: It's true. Well it depends on where that ... As someone who likes to think multiple steps ahead, I wonder if everyone starts picking their eye color, hair color, I don't know how I'd feel about it if I had the option, but I just think if all of a sudden, every human on the planet was doing that, how does that impact the evolution of man? I'm sure maybe it does it in a good way, but then there are many things, if we go through history, there are many times in history that we did things like introduce foxes, and all sorts of things that we thought was a great idea, and then in hindsight we've gone, "That was a terrible idea."
Prof. Chapman: I'm an optimist, and the society will work itself through these things, and if there are problems, it will set new boundaries, if that's what is thought to be the case. I still think the majority of people will, or the population will determine, in the fertility area and the adjuncts around it, they'll determine the boundaries and they'll be given every opportunity to. I'm fine, I don't have a problem.
Speaker 4: Which I fantastic to hear that you're so vocal and public about that. There are some that probably wouldn't, they'd keep their opinion to themself, so thank you so much for sharing. I think that we've talked a lot about the history of where we've come from and what's happening, we've now talked a bit about where we're headed, if we bring it back to today, if here is someone listening who is right now trying to conceive, or they know someone trying to conceive, what are the action steps? What is available to them today? What is the steps that they should probably look to go through? Apart from start listening to your podcast of course.
Prof. Chapman: Of course.
Speaker 4: What should they do?
Prof. Chapman: They need to find a general practitioner who is knowledgeable, and I'm afraid I churn out medical students, thousands over the years, you I would say very few of them have the depth of understanding to deal with infertility. If you are trying and you've been trying for six, 12 months, that'd be my first comment, don't rush into believing that it's going to happen tomorrow.
Speaker 4: Six to 12 months is the timeframe, and then consider your other options?
Prof. Chapman: Where to go, yeah. Then go to your GP and ask the GP to be referred to a fertility specialist. That's not just any general obstetrician, gynecologist, there is a difference between people who are experienced in the field and the people who've just done their basic specialist training. Indeed in Australia, we have something called the certificate in reproductive endocrinology and infertility, CREI, and around Australia there are 70-odd of us who have done an extra three years of training, purely in infertility and hormones in the female. If you have an opportunity to have someone who's accessible to you, that's where I would be saying your GP should be sending you, and you can find those through the Royal College site, or even on the website of the CREIs. But they're the people with the depth of knowledge to give you the right answers, not rush you into IVF. Not say, "Go away and do nothing," but to actually lead you through a rational stepwise approach to getting pregnant.
The vast majority will get pregnant. I followed up 500 patients that I saw for now nearly 10 years ago, and nearly 80% of them have ended up with babies, if they were under 40 when they came to see me.
Speaker 4: Wow.
Prof. Chapman: It happens. Many times I will do IVF eventually, and still not get a pregnancy, and they'll ring me three months later and say, "I'm pregnant." 25% of women in fact, who go through IVF, will be pregnant on their own in the next two years.
Speaker 4: Wow. That's an interesting statistic. All right, so basically patience, we've talked about patience, then go to your doctor and ask to be referred to an actual specialist who knows what they're doing, who can give you a plan and review your case, and look at what's going on. Because I think one of the most important things you mentioned. Either earlier or in previous research I did, that one of the first steps is to diagnose what's the cause. Why? Is there an actual medical issue here, or is there not? That's really great, for anyone listening, I know it's probably a very emotional time if you're going through those challenges or if you've been through it, that's fantastic that you've shared that. Thank you so much Prof.
I want to touch on a question I ask everyone. You've already touched on it, but when we look at the future of humanity, so we can look at and talk about your space of where you're in, IVF and fertility, but also on the grander scale, when you look at all the changes happening around the globe with humanity and society and technology, are you optimistic and excited? Are you cautious and possibly pessimistic? Where do you fit and why?
Prof. Chapman: Well I've always been an optimist, so I always look on the bright side. There are some clouds on the horizon. I think reasonably convincing now, that for instance, male fertility is declining. Sperm counts would appear to be falling over the last 30 or 40 years, and increasingly, data is mounting that environmental factors, our carelessness in society and in relation to plastics in particular, some of the pesticides potentially are having an impact on our fertility. If that slippery slope continues, then we've got a real problem. I'm not sure that that will be the case because we're now becoming aware of it, but there are things like you probably shouldn't be drinking out of plastic bottles.
While each one is a minuscule effect, mounted over time, there is evidence that there is a relationship between semen quality and the mounting of these up in your body. Interfering with, they're called endocrine disruptors, they interfere with the receptors for male hormone, and some of them bind the same way as male hormone and therefor block the normal effects of androgen. To me, that's a worry, and if it's happening in men, I can't believe it's not also happening in women and the quality of their eggs, although nobody's really documented that trend to date.
I suppose the other is the sociological issue of getting together as a partnership later on in life, and then putting off child bearing until later on. That's another area, but on both of those fronts, as an IVF doctor, I see a very optimistic future for IVF, because we can overcome many of those problems. But that's being perhaps too materialistic, but in general across the world, there are worrying birth rates around the world. In Europe it's way below replacement, and so you're getting this top heavy, because we're getting better at keeping old people healthy, I'm very much in favor of at my age, what we're getting is a top heavy demographic with very few children.
China's recognized that. They've moved from the one China policy to allow two, and which has produced an amazing growth of IVF in the last five years in China. Just astronomic because couples who have got a 20-year-old child, who are now 40, are desperate to have that second child they always wanted and are heading off to IVF units.
Speaker 4: Interesting. To put a counter to that thing, episode four of our season one, we talked with Dr. Mel Hart about an overpopulation issue we have on the planet, so I can see on multiple sides that some would argue that this declining birth rate and not replacing everyone may actually everybody a good thing.
Prof. Chapman: I'm not totally convinced by that. I think, I can't remember, as a university student there was something called the zero population. It was a movement Derek Llewellyn-Jones ran out of Sydney. We said we were going to be, I can remember, we were going to be starving by the turn of the century, which was 30 years later. We're still not starving, so we actually are capable as a humanity, to provide for increasing numbers by agricultural advances, some of which are genetically engineered. I'm not so sure that's a problem, my concern is there won't be the people, the 20 to 40s that actually run organizations, to make life okay for me in my old age.
Speaker 4: Absolutely. Well thank you so much for sharing, and it's been fantastic chatting with you. If people want to find you, apart from your podcast, where else can they find you?
Prof. Chapman: Consult privately in the fertility arena with IVF Australia at Kogarah in southern Sydney, and you can contact me through IVF Australia. Go to the website, IVF Australia, and you will find me there.
Speaker 4: Perfect. Well we'll make sure there's links to all that in the show notes. Thank you so much for joining us, it's been an absolute privilege, and we could have kept talking probably for another hour or more, but I know you're a busy man, you just came from a surgery before this, so thank you so much for your time. We'll hopefully maybe talk to you soon and hear about the latest updates in the industry.
Prof. Chapman: Happy to. Thank you.
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