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Interview with Professor Dr Geeta Nargund

18th February 2016
Interview with Professor Dr Geeta Nargund

Professor Dr Geeta Nargund – for she is both Professor and Doctor – is the award-winning Medical Director of CREATE Fertility. She is also a Senior Consultant Gynaecologist and Lead Consultant for Reproductive Medicine services at St Georges Hospital, London.

A prolific commentator on fertility and womens health issues in the media and a participant in panel discussions, Dr Nargund is a pioneer the field of Natural and Mild IVF.

As the company she began in 2000 is about to set up its first fully fledged site outside of London, she kindly took some time to speak to me about her stellar career, her passions and ambitions, and what she hopes for in the future.

Can you tell me about your background – a brief life history of how you came to be Professor Dr Nargund?

I was born in India in a state called Karnataka, in the south of India. I undertook both my school and basic medical education in India before moving to the UK where I worked as a junior doctor both here and in Ireland. I worked my way up from being a junior doctor to being a consultant and was appointed a Senior Lecturer/ Hon consultant at St Georges Hospital Medical School and NHS trust in South London in 1996. I will be celebrating twenty years this year.

My interest was in fertility right from the beginning when I chose to specialise in obstetrics and gynaecology. Its a field I enjoy because the creation of life is a wonderful thing and I embarked on doing IVF a long time ago, when it was quite new. Ive been very fortunate to work with some renowned professors who trusted me and gave me the opportunity to research and try new things, for which I am very grateful.

We set up CREATE Fertility, as a company in the year 2000. Initially, I worked with Professor Stuart Campbell, who is a pioneer in ultrasound, obstetrics and gynaecology. So we did advanced ultrasound in the CREATE Health Clinic and then developed further in IVF. The growth of CREATE has been enormous: we now have five clinics, with our flagship centre of excellence based in St Pauls and we have another large clinic opening in the Midlands in the spring of this year.

Is that the first one outside of London?

The first full clinic, yes, because the ones we have in Hertfordshire and Bristol are satellite clinics.

What drew you to the field of IVF?

Ive always been committed to promoting womens health, womens choices and gender equality. Equality in general, and womens economic and political empowerment have always been extremely important issues for me and are very close to my heart.

As a junior doctor when I first came to know about the complications of ovarian hyperstimulation syndrome (OHSS), a side effect of ovarian stimulation drugs in IVF treatment which can be potentially fatal in severe form because of the overstimulation of ovaries, I felt that it was unacceptable to put women through such complications. When were trying to create life, we cannot take away life. As a junior doctor I was made aware of a young healthy woman dying of OHSS and that was a seminal moment for me. I was not involved in her treatment – it had happened even before I had joined the unit – but it seemed completely unacceptable to me that a woman would die as a result of fertility treatment.

Men dont suffer during fertility treatment, why should women suffer? At that moment I made it my mission to do everything possible to make fertility treatment safer for women and reduce the discomfort, the burden of treatment – physical, emotional, mental, and financial – and make treatment more accessible. I then started working on Natural IVF and published a first paper – Cumulative conception and live birth rates in natural (unstimulated) IVF cycles – back in 2001. This raised the profile for Natural IVF globally.

I continued with my work in making natural cycle IVF more successful and went on to set up an international scientific society of which Im President, called ISMAAR (International Society for Mild Approaches in Assisted Reproduction) which brings together renowned scientists from all over the world. Together weve made significant progress with mild IVF –a form of IVF treatment which uses fewer drugs for a shorter period of time within a womans own cycle.

Im very fortunate to have been trained in by Professor Stuart Campbell in advanced ultrasound and have used advanced ultrasound technology to identify the quality of eggs and the quality of the lining of the uterus which is an essential part of Natural and Mild IVF. My commitment to natural and mild IVF is fundamentally scientific – making it safer, making it more physiological and accessible – but there is also an ideological commitment from the point of view of ensuring choice for women, safety for women, and equality for women.

Im proud to say that in the 15 years of the existence of this company not a single patient has been admitted to hospital with severe ovarian hyperstimulation syndrome, whereas in a normal IVF unit a woman can get admitted every 50 cycles of treatment. To me thats a major achievement.

Youd think that the kind of work that youre doing is a win-win across the board because youre making women healthier, youre giving them the treatment that they need; its safer and its more economic as you say. Have you met with some resistance from other practitioners to this approach, and if so why?

Ive been running the world congresses since 2006 in this field and sadly I have met with much scepticism along the way. Pioneering a form of IVF treatments less reliant on expensive drugs is not in everyones commercial interest!

Fortunately, while we were the first dedicated Natural and Mild IVF unit established in Europe – and remain the only dedicated unit in Europe – Natural and Mild IVF are becoming more popular now – particularly in countries like Japan, South Korea, and also Scandinavian countries where there is more public funding. Reducing drugs automatically reduces 35% of IVF costs so countries like Belgium and France where theres good public funding, have adopted it for this reason as well as a means preventing health complications.

The scientific evidence supporting natural and mild IVF is getting stronger and recent studies show that high levels of oestrogen in womens blood during stimulated IVF cycle are not only detrimental to womens health, but also to the health of the baby that is conceived. If you transfer a fresh embryo in IVF cycles where more than 15 eggs are collected, the baby is more likely to have a reduced birth weight and more likely to be premature. It was Mahatma Gandhi who said that when you try to do something new, you always come across resistance; first people will laugh at you, they wont take you seriously, then people will try to obstruct you; then when they realise its the right thing, they will join you. I can see that joining phase is happening now, and while its taken a long time, when you know youre doing the right thing or something in the public interest, you just have to pursue it.

Youve mentioned elsewhere that when you were growing up in India, medicine was an acceptable profession for a girl to enter into. Ive heard other Indian women say the same thing – that medicine or the law were the acceptable professions. Was there anything else you considered doing or was it always medicine?

No, medicine was always my first choice. I think for me the only alternative paths might have been to become a lawyer or to go into politics. There were some quite successful lawyers and judges in my family and I was fascinated by how they could effectively change the justice system. Ive always personally been interested in the bigger picture rather than just my job – do the job and go home. And politics because you can change policies for the wider public. So those would have been my alternative options, but I think you know why I went into medicine: because it was seen as an acceptable profession for a woman…and a safer one.

Youre one of the most respected fertility specialists in your field. Did you always set out to be a pioneer or did it happen by accident?

I think its happened by accident. Ive always wanted to do something bigger for society, because I believe that when you are privileged or when you have the opportunity and you are in good health, you should do things, because not everyone gets the opportunity. So Im grateful for the opportunity and Im glad that Im able to help. But the pioneer thing – its only because I have been fortunate enough to work with some really renowned professors who believed in me and trusted me and gave me the opportunity, which is why I was able to do it. And even when we decided to do the first world congress in 2006 on natural cycle IVF, I knew what resistance we would face. We did not receive big support from drug companies who usually fund our congresses and bring their delegates in, and I knew the backlash I would face. But some top scientists and professors said do it. And I just felt as a woman I had an obligation to do it for other women.

What do you think about surrogacy, commercial or otherwise – is it an important option for women who cant conceive or is it exploitative? The law relating to surrogacy is very complex in England and Wales.

Reproductive technology is important to develop and Im pleased that its progressing. But we have to be very cautious about how we use it. You specifically asked about surrogacy: to me, surrogacy is only for when theres a very good medical reason. For example for a woman who has had her womb removed, or her life is at risk if she gets pregnant because of some existing condition, surrogacy provides the chance for her to have a baby.

However, how surrogacy is now being used in some countries – as a lifestyle choice – is a concern and one has to be extremely cautious about such developments. IVF is not a lifestyle choice. But where theres a good medical reason that has been discussed with a multidisciplinary team and carefully thought out, and then yes, surrogacy is an option.

What did you think about the news that certain companies such as Facebook and Yahoo were offering senior female employees the chance to freeze their eggs as an employment benefit?

Firstly I think that egg freezing is here to stay because scientific advances have made it more successful. Using the modern vitrification technology – which is the fast-freezing technology – has increased the chances of success and the survival of frozen eggs can be as high as 90%. Of course the age at which women freeze their eggs is important. As women get older, their success rate goes down whether IVF is undertaken with fresh or frozen eggs, but studies have shown that the success of fresh and frozen eggs can be the same once they survive.

In my view, if women are not ready to have children – for example because they dont have the right partner, or their partner is sick, or they are pursuing a career or they are not financially stable – egg freezing gives them a real choice. It is by no means a guarantee, nor is it an insurance policy – but it provides them with a choice to put their eggs on ice. Nature has created a gender inequality when it comes to reproduction. So age matters and as women get older the chances of having a baby decreases significantly and the miscarriage rates increase and the risk of Downs increases.

Therefore, if companies like Facebook and Yahoo are willing to help give women that choice – that doesnt mean it is in place of maternity benefits or childcare benefits, they should go hand in hand – then I think this can only be a benefit for women.

Youve spoken before about young women being aware of their fertility dropping off as they reach their mid-thirties. What would you like people to take away from your advice on the matter?

Take a fertility MOT and know your own biological facts. You can then take action on the basis of medical facts. We are very proud of the one-stop fertility MOT we have developed. We published a peer-reviewed scientific paper back in 2001 where, for the first time we used the advanced ultrasound technology including 3D scanning to assess the egg reserve, the womb and the blood flow to eggs and the lining of the womb. Within one hour, a lunchtime, we are now able to give women critical information about their egg reserve and their fertility status. To me, getting something like a fertility MOT done for peace of mind or to know where you are with your fertility, is critical.

Would you say that having the facts and the knowledge is the most important thing?

Knowledge is power. It allows women to make decisions and plan their lives, plan their families. This is why I am campaigning for fertility education and infertility prevention to be included on the sex and relationship education curriculum for secondary schools at the moment. Teaching girls and boys about infertility prevention is critical. As I have mentioned previously, taking advantage of Fertility MOT is another means whereby women can make an informed decision either that Im absolutely fine, I can wait, or my egg reserve is going down, I need to do something about it.

And of course I would say to women that if they want to freeze their eggs, try to do it before the age of 35, between late twenties or early thirties is the ideal time, because the quality of eggs is at their best. And if they freeze around twelve eggs before the age of 35 then the data shows that they have about a 50% chance of having a baby from those eggs later in life, because the age is frozen in eggs so it doesnt matter what age they are when they thaw them.

Thats really interesting, because I think a lot of women know that their fertility declines at a certain age, but I dont think that many would know that you could have an individual assessment that tells you how your body is doing. I had never heard of that!

Dont you think thats empowering? And it only costs £200. Can you imagine the information you get about your fertility that you can make decisions based on that. We pioneered that test and Im very proud of it, that were able to offer that to women, to help them make decisions and plan their lives.

Can you talk about your work with charities involved with womens development and equality around the world?

When we started this company CREATE Health Ltd, at the same time we also set up HER Trust – the Health Education Research Trust – a charity to promote womens health, education, and we funded it from our company. Its now called CREATE Health Foundation and the charity has gone on to fund educational programmes in Africa, once again promoting womens reproductive health education. In the UK we run public and scientific seminars from the charity and have funded research into both female and male infertility.

The other charity I am involved in is called ISMAAR, which I mentioned earlier, which is also a UK registered charity. Its the scientific international platform thats looking into developments in natural and mild assisted conception.

Im also a director of a charity called The Walking Egg Foundation, a Belgian charity, which is a charity dedicated to global access to fertility care, and we have developed a new method of low cost IVF – doing IVF without the full laboratory – and were now trying to bring that to Africa as well as to the UK to reduce the costs.

I also work quite actively with the British Red Cross: I am on the steering committee of the Tiffany Circle once again, working more towards womens projects. I am also involved with some charities in India.

Youve published over 100 medical research papers including chapters, many of which are exploring ground-breaking territory. You also write pieces for the Huffington Post. Where do you find the time? Do you get up at five in the morning and work massive days?

All my work has got one theme around it – which is about womens health, womens education, womens empowerment – also I care deeply about social mobility. So its all work on one thing which is why it works for me. Its just from different angles: scientific angle, medical angle, social angle, political angle. For example, Im trying to get a National Tariff for IVF accepted at the moment because currently for the Clinical Commissioning Groups of the NHS, it can cost £6,000 in some areas or £2,500 in other areas, so were trying to make sure that theres one, lower cost. This is an initiative that touches on a range of interrelated issues – womens health, accessibility and improving NHS efficiencies.

I dont get up particularly early but I work quite late in the evening and I try to squeeze in things in between, because I quite enjoy doing different things. Sometimes I ask myself why is it that more people dont do more than one thing? Because most people have a talent in something other than their job – theyre good at something, maybe more than one thing. And its a question of actually releasing that and using that in order to do something. To me, changing something, or doing something different is like taking a rest; its refreshing…

Energising?

Exactly, youve got the word!

Vardags is female dominated, founded by a woman and with a female managing director, whom youve met through your associations with Management Today. As a result its also very committed to women being able to balance a career with motherhood and it has a very progressive maternity and paternity package. What social, legal or economic changes do you think could be made to make this balance easier for women (and indeed men) generally?

I think its very important that both men and women are able to balance career and family lives. It has a different dimension for women because they have babies and they have a lot of responsibility in bonding with children. So one of the things for me is to make sure that women are aware of their fertility and improve their knowledge so that they can then make active decisions.

Then of course, if youre looking at political, economic decisions, of course we have to ensure gender equality. Gender equality is not here yet. We talk about it, but its not here yet. And I think its extremely important that we achieve that, and by that I mean: maternity leave, childcare and of course I would include egg freezing in it, so that you give the opportunity to women who are not ready to have children. So for me, politically, I would definitely like to see a change in gender equality, promoting gender equality at all levels and increasing maternity benefits and childcare benefits. Flexible working for women, because its extremely important to allow women to work flexibly – working from home where it is possible to manage both because children are the future citizens and they are the people who will pay for pensions in the future – and at the same time increasing accessibility for fertility treatment on the National Health Service. And, where it is possible, supporting them with egg freezing as well.

I think overall, with equality policies at all levels, that reproduction needs to be part of it. Several countries have achieved it and we need to get there.

Do you think it would help if men were encouraged to take more paternity leave?

If we want to achieve gender equality and to promote women, men have to be part of it. This is why I support the He For She campaign. I think it would be good if men were encouraged to help by taking paternity leave – and men should not be compromised either for taking more paternity leave or helping out – so men should have the opportunity to work flexibly as well. If a woman is working flexibly and if the partner is needed to help, the partner should have that opportunity as well. Its got to go hand in hand.

Finally, what are you most proud of, so far, and what would you still like to achieve?

I am proud that I have managed to build a career and a family and am very proud of my husband and son.

I am proud of the fact that I am shifting the paradigm in the world of IVF towards using fewer drugs – better for women, better for babies, better for embryos, better for children – and of course making it more accessible so that more people can afford to have treatment. Im proud that I stood up for it despite the opposition and that I took the moral high ground – when you believe you want to do something its extremely important that you take the moral high ground.

Personally I would like to continue with more research in reducing complications for women in fertility treatment, making it more accessible, giving greater choice for women. Ill continue professionally with this work, but on a personal level Id like to do more humanitarian work.

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