‘I know someone at St Mary’s. He used to be a research gynaecologist, now he works part time in the subfertility unit. I bring him in to do a seminar on my course on the ethics of interference with human fertility.’
‘Would he talk to me?’ I asked.
‘Probably. He likes to show off what a new man he is. Nothing he loves more than the chance to demonstrate to a woman how sensitive he is to our reproductive urges. What is it you want to know, and why?’
‘I need the five-minute crash course in IVF for beginners and a quick rundown on where the leading edge is right now. What can and can’t be done. I’m not asking for anything that isn’t readily available in the literature, I just need it in bite-sized pieces that a lay person can understand.’
‘Gus is your man, then. You didn’t mention why this sudden interest?’
‘That’s right, I didn’t. Is he going to want a reason?’
Beth thought for a moment. ‘I think it might be as well if you were a journalist. Maybe looking for nonattributable background for a piece you’re doing following women’s experiences of being treated for subfertility?’
‘Fine. How soon can you fix it?’
‘How soon do you need it?’
‘I’m free for lunch today,’ I said. The devil finds work for idle hands; if you can’t manage any other exercise, you can always push your luck.
‘So I’ll lie. I’ll tell him you’re young, gorgeous and single. Gus Walters, that’s his name. I’ll get him to call you.’
Ten minutes later, my phone rang. It was Gus Walters. Young, gorgeous and single must have worked. I hoped he wouldn’t be too disappointed. Two out of three might not be bad, but none ain’t good. ‘Thanks for getting back to me so quickly,’ I said.
‘No problem. Besides, I owe Beth a favour.’
‘Are you free for lunch today? I know it’s short notice…’
‘If you can meet me at half past twelve at the front entrance, I can give you an hour and you can buy me a curry,’ he said.
‘Deal. How will I know you?’ I asked.
‘Oh, I think I’ll know you,’ he said, voice all dark brown smoothness. Definitely a doctor.
It’s a constant source of amazement to me that the staff at Manchester’s major hospital complex don’t all have serious weight problems. They’re only five minutes’ walk from the Rusholme curry parade, as serious a selection of Asian restaurants as you’ll find anywhere in the world. If I worked that close to food that good, cheap and fast, I couldn’t resist stuffing my face at least twice a day. Richard might be convinced that the Chinese are the only nation on earth with any claim to culinary excellence, but for me, it’s a dead heat with the chefs of the subcontinent. Frankly, as soon as I had sat down at a window table with a menu in front of me, I was a lot more interested in the range of pakoras than in anything Gus Walters could possibly tell me.
He was one of the non-rugby-playing medics: medium height, slim build, shoulders obviously narrow inside the disguise of a heavy, well-cut tweed jacket. His hands were long and slender, so pale they looked as if they were already encased in latex. Facially, he had a disturbing resemblance to Brains, the
On the short walk to the nearest curry house we’d done the social chitchat about how long we’d lived in Manchester and what we liked most and least about the city. Now I wanted to get the ordering done with so we could cut to the chase. I settled for chicken pakora followed by karahi gosht with a garlic nan. Gus opted for onion bhajis and chicken rogan josh. He grinned across the table at me and said, ‘The orifice I get closest to doesn’t bother about garlic breath.’ It rolled out with the smoothness of a line that never gets the chance to go rusty.
I smiled politely. ‘So tell me about IVF,’ I said. ‘For a start, what kind of technology do you need to make it work?’
‘It’s all very low tech, I’m afraid,’ he replied, his mouth turning down at the corners. ‘No million-pound scanners or radioactive isotopes. The main thing you need is what’s called a Class II containment lab which you need to keep the bugs out. Clean ducted air, laminar flow, temperature stages that keep things at body temperature, an incubator, culture media. The only really specialized stuff is the glassware — micropipettes and micromanipulating equipment and of course a microscope. Also, when you’re collecting the eggs, you need a transvaginal ultrasound scanner, which gives you a picture of the ovary.’
He was off and running. All I needed to do was provide the odd prompt. I was glad I wasn’t his partner; I could just imagine how erotic his bedroom conversation would be. ‘So what are the mechanics of carrying out an IVF procedure?’ I asked.
‘OK. Normally, women release one egg a month. But our patients are put on a course of drugs which gives us an optimum month when they’ll produce five or six eggs. The eggs are in individual sacs we call follicles. You pass a very fine needle through the top of the vagina and puncture each follicle in turn and draw out the contents, which is about a teaspoonful of fluid. The egg is floating within that. You stick the fluid on the heated stage of the microscope, find the egg, and strip off some of the surrounding cells, which makes it easier to fertilize. Then you put it in an individual glass Petri dish with a squirt of sperm and culture medium made of salts and sugars and amino acids — the kind of soup that would normally be around in the body to nourish an embryo. Then you leave them overnight in a warm dark incubator and hope they’ll do what opposite genders usually do in warm dark places at night.’ He grinned. ‘It’s very straightforward.’
The food arrived and we both attacked. ‘But it doesn’t always work, does it?’ I asked. ‘Sometimes they don’t do what comes naturally, do they?’
‘That’s right. Some sperm are lazy. They don’t swim well and they give up the ghost before they’ve made it through to the nucleus of the egg. For quite a few years, when we were dealing with men with lazy sperm, there wasn’t a lot we could do and we mostly ended up having to use donor sperm. But that wasn’t very satisfactory because most men couldn’t get over the feeling that the baby was a cuckoo in the nest.’ He gave a smile that was meant to be self-deprecating but failed. Try as he might, you didn’t have to go far below the surface before Old Man reasserted itself.
‘So what do you do now?’ I asked.
But he wasn’t to be diverted. He’d started so he was going to finish. ‘First they developed a technique where they made a slit in the “shell” of the harvested egg,’ he said, waggling his fingers either side of his head to indicate he was using inverted commas because he was unable to use technical terms to a mere mortal. ‘That made it easier. Twenty-five per cent success rate. But it wasn’t enough for some real dead-leg sperm. So they came up with SUZI.’ He paused expectantly. I raised my eyebrows in a question. It wasn’t enough. Clearly I was supposed to ask who Suzie was.
Disappointed, he carried on regardless as the impassive waiter delivered our main courses. ‘That involves passing a very fine microneedle through the “shell” and depositing two or three sperm inside, in what you could call the egg white if you were comparing it to a bird’s egg. And still some sperm just won’t make the trip to the nucleus of the egg. Twenty-two per cent success rate is the best we’ve managed so far. So now, clinics like ours out on the leading edge have started to use a procedure called ICSI.’
‘ICSI?’ I thought I’d better play this time. Even puppies need a bit of encouragement.
‘Intracytoplasmic Sperm Injection,’ he said portentously. ‘One step beyond.’
I wished I hadn’t bothered. ‘Translation?’
‘You take a single sperm and strip away its tail and all the surrounding gunge until you’re left with the nucleus. Then the embryologist takes a needle about a tenth the thickness of a human hair and pushes that through the “shell”, through the equivalent of the egg white right into the very nucleus of the egg itself, the “yolk”. Then the nucleus of the sperm is injected into the heart of the egg.’
‘Wow,’ I said. It seemed to be what was expected. ‘So is it you, the doctor, who does all this fiddling around?’
He smiled indulgently. ‘No, no, the micromanipulation is done by the embryologist. My job is to harvest the
