15 August 2016
ByAppeared in BioNews 864
BBC Radio 5, Sunday 24 July 2016
Presented by Anna Foster
'I thought I would never know what pure happiness felt like.'
Anna Foster's introduction to her striking BBC Five Live documentary, 'The science and stories behind pregnancy', includes an emotive flashback to her own journey through pregnancy loss and fertility treatment. In this 90-minute radio programme, she combines the voices of scientists, clinicians and patients to describe the medical, technical and emotional elements involved in infertility and miscarriage.
Foster takes care to describe both the female and the male perspectives. Drawing on her own experience, she explains that, while she wanted to make a programme about what happened to her, it took her five years to get to the point where she was emotionally able to do so. Her description of leaving hospital with a cardboard box, following a second trimester miscarriage, should almost carry a trigger alert for vulnerable listeners.
The science of the title is mostly explained directly by clinicians and scientists in lay terms. But sometimes the patients also explain it – a neat twist that enhances the programme's accessibility. The first part of the programme is all about fertility, and a significant contributor is Dr Simon Fishel, from Care Fertility Clinic in Nottingham, who makes evocative use of statistics. His opening fact – that nearly six million babies have been born globally as a result of IVF – sets the scene. Later in the programme we learn that around one in ten men – or one man per football team – has fertility problems.
Current IVF methods are contrasted with older techniques that involved invasive in-patient procedures and low egg yields. And we're taken on a revealing tour of the laboratory, where we learn about the journey the egg makes to the culture plate.
Research, and with it the hint of hope and happy endings, is a thread running throughout. The possibility of creating sperm in the lab (in-vitro derived gametes) is mentioned optimistically as a solution to male factor infertility that is just on the horizon. We also learn about a gene mutation, C4M2, that is associated with miscarriage, and the surprising fact that it is the first time male transmission of a gene mutation has been implicated in miscarriage. Towards the end, the documentary takes us to Tommy's National Centre for Miscarriage Research, where Professor Arri Coomarasamy walks us through ongoing clinical research trials.
Maintaining her balanced approach, Foster also talks to Professor Allan Pacey of the University of Sheffield about his research on the male experience of miscarriage and receiving bad news.
The documentary also dabbles in some of the weighty issues in fertility care – including increasing maternal age, the IVF postcode lottery, and the relationship between private and NHS care. At one point, Foster asks Dr Fishel if patients in the private sector are offered false hope by the use of non-evidence-based methods, but this is the closest the programme comes to a critical analysis of UK fertility care.
While the science is well described and understandable, it is the inclusion of patients' stories that brings the documentary to life. Sam and Roberto thought their difficulty conceiving was related to Sam's cerebral palsy, and then found out that there was a male-factor cause. They talk us through the procedures involved as they undergo their first round of ICSI treatment, and seem upbeat and positively hopeful about its success.
Their experience is contrasted with that of Theresa, who is 40 and has been trying for a baby for ten years. She recalls that on her first IVF cycle she felt 'full of fear and full of hope … a lot to learn and a lot to take in'. Her voice cracks as she tells her story. She is now on her seventh round of IVF, this time with a donor egg. An interesting additional perspective comes from Toni, an egg donor.
Rebecca describes her experience of suffering a miscarriage at 12 weeks of pregnancy. Foster, referring back to her own experience, explores what happened in the moment the sonographer broke the bad news. Rebecca describes how unhelpful it was to have medical staff tell her that 'it's just chance' and that there would be every chance of a successful pregnancy in future. This resonated with me as a gynaecologist, as I've had similar conversations many times with my own patients.
The inclusion of Matt Burton, who blogs about his experiences as a father suffering pregnancy loss, adds to the emotional depth. 'Lots of people think of miscarriage as a physical thing a woman goes through … but it's also the death of a child,' he explains.
The documentary treats its subjects sensitively, and builds a comprehensive picture of UK fertility and miscarriage care. Foster allows her participants to speak freely, with gentle, empathetic questioning. The patient experience is illuminated in a useful way for those working in the field while the technical details are understandable for a lay audience. The focus on the male perspective is a bonus in a field in which women are, understandably, the primary focus.
However, there is little about the downsides of IVF – even the risk of failure is presented as the chance of success. I had the impression that it is almost a fan's eye view of IVF. The patients' stories are revisited at the end, and we find out what happened to those undergoing IVF. Despite some sadness, there remains an overall optimistic tone to the programme.
As a doctor in obstetrics and gynaecology, I expected this programme to be basic, but I found it surprisingly illuminating, with value to clinicians and scientists in the field. As someone with personal experience of some of the subject matter, I was touched by Anna Foster and her interviewees bravely sharing their deeply personal stories. I hope they found it as beneficial as her listeners should.