Health February 17, 2019
Transforming the lives of parents-to-be

By Sarah Cartledge - World Healthcare Journal

As populations begin to fall in some areas of the globe, a British charitable trust is at the forefront of research into reproductive health.

Based at Imperial College London, the Genesis Research Trust is the only charity of its kind investigating why and how things can go wrong with conception, pregnancy and birth, delivering real evidence-based results for medical treatments and outcomes of worldwide significance.

More than 130 scientists and doctors contribute to Genesis’ work under the chairmanship of Professor Lord Robert Winston, who developed and refined gynaecological surgical techniques to improve fertility treatments in the early 1970s. The team investigates the causes of infertility, miscarriage, stillbirth, and premature birth and finds better ways to diagnose and treat them.

Other medical advances pioneered by the Trust include hormonal cures for infertility, treatments that help reduce the chances of miscarriage, a revolutionary treatment for womb cancer, and ways to screen embryos for fatal genes. The Trust also funds science and has donated £27m to Imperial College.

The importance of bacteria

“Understanding the causes of miscarriage, the causes and management of growth problems in babies and preventing preterm birth are the main areas the charity funds,” says Professor Phil Bennett who also runs the obstetrics unit at both Hammersmith and Queen Charlotte’s Hospitals in London. “Much of our research focuses on the relationship between a pregnant woman and her so-called microbiome of the reproductive tract which can affect whether or not she can become pregnant. ”

“We have identified that certain bacteria which are not conducive to preventing the growth of pathogenic bacteria increase the risk of preterm birth”

– Professor Phillip Bennett, Genesis Research Trust

Until the 21st Century bacteria were viewed negatively in medicine, but now it’s understood they are important for normal physiological function to the extent that colonisation with healthy bacteria is vital. “Mothers in the Middle East can be prone to polycystic ovary syndrome which is a cause of infertility and is associated with the metabolic syndrome which encompasses people at risk of diabetes,” says Professor Bennett. “We have identified that certain bacteria which are not conducive to preventing the growth of pathogenic bacteria increase the risk of preterm birth. Patients are more likely to have such abnormal bacteria if they are overweight or if they have the metabolic syndrome because they change the nature of natural microbiomes. ”

There is growing evidence that there is a significant ethnic and genetic aspect to the research, understanding why different ethnicities have different microbiomes. Another key area of research is focused on glycan biology, looking at the sugar molecules on the surface of the cells of women who are at risk of preterm birth and on the surface of the bacterial cells to understand the relationship and interaction between them.

Unexplained infertility and IVF

There are a wide variety of reasons why a couple may not achieve a pregnancy, including blocked fallopian tubes, low sperm count, problems releasing eggs in the first place – common in women with polycystic ovary syndrome and metabolic disease – and also the question of whether the womb is receptive to the pregnancy which is affected by bacteria.

“Unexplained fertility is not a diagnosis,” says Professor Winston. “In some cases, this simply means the clinic or healthcare facility has not investigated the issue properly. IVF is explained as a treatment for infertility, but without any investigation, the chances for pregnancy are actually lower because the treatment each time is inadequate. So the diagnosis of unexplained fertility is a failure, not a success, in my opinion. ”

Professor Winston developed and refined gynaecological surgical techniques to improve fertility treatments in the early 1970s. Later he revolutionised many treatments to improve in vitro fertilisation, and subsequently developed pre-implantation diagnosis which allows the diagnosis of fatal genetic disorders in embryos. This work enabled many families to have a child free of fatal illnesses, including those with sex-linked disorders, single gene defects such as cystic fibrosis and chromosomal abnormalities. Chromosomal abnormality is an important cause of miscarriage so this work has had a wide impact.

“Genesis is the only unit I know of that looks purely at research into all aspects of women’s diseases and reproductive disorders”

– Professor Lord Robert Winston, Chairman, Genesis Research Trust

“If you look at the HFEA (Human Fertilisation & Embryology Authority) website you would get the impression that your chances of getting pregnant with IVF are really very high but the mathematics are much worse than that,” he says. “If you have 6 treatment cycles at a £5000 cost each time your overall success rate from the start of the cycle to live birth is just about 20 per cent in Britain, 20 per cent in Australia and about 20 per cent in America. I don’t think that’s ever explained to any patient anywhere. In my mind that is a criminal lack of information. ”

To date there are an estimated 5m babies born from IVF, but the rounds of failed IVF treatments are thought to be more than 20m. As a result, the research work undertaken by the Genesis Research Trust is vital to help couples become pregnant. The Trust raised £13m to establish the Institute of Reproductive and Development Biology which not only conducts research into women’s health and babies, but also aims to improve human transplantation.

Phil Bennett’s work is regarded as being some of the best science on prematurity, and given that it is the single biggest cause of babies’ deaths and brain damage it’s a very big issue,” says Professor Winston. “Professor Steve Franks is one of the world’s leading experts on ovarian physiology so his work on ovulation is very important, and Catherine Williamson’s work is on obstetric disease. Genesis is the only unit I know of that looks purely at research into all aspects of women’s diseases and reproductive disorders, and working at Imperial College which is Britain’s largest research university is key to our success. ”

Professor Lord Robert Winston

Robert Winston is Professor of Science and Society and Emeritus Professor of Fertility Studies at Imperial College London.

In the 1970s Robert Winston developed gynaecological surgical techniques that improved fertility treatments. He later pioneered new treatments to improve in vitro fertilisation (IVF) and developed pre-implantation diagnosis. He now runs a research programme at the Institute of Reproductive and Developmental Biology at Imperial College that aims to improve human transplantation.

Professor Phillip Bennett

Phillip Bennet trained at St George’s Hospital in London. In 2014 he became Imperial College Healthcare NHS Trusts Research Director for Women’s and Children’s Health, a clinical division which includes laboratory sciences and medical imaging. He has worked extensively over 25 years with industry undertaking basic science and preclinical studies to identify new targets in preterm labour, and developing novel drugs from discovery through to phase three trials and clinical application.

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