There is now abundant evidence that events around the time of conception have a major impact on the health trajectory of the person who is conceived. While the developmental origins of health hypothesis has been around for a long time, it is largely concentrated on events later in pregnancy that may lead to adverse health outcomes. It is now apparent that even before the sperm and egg meet, there can be significant effects that alter the destiny of the embryo, fetus and baby. The end of one stage of physiology in gamete production is where we start the next epoch of life.
Reproductive biology and medicine has taught us that the intersection between our DNA, which has evolved over millions of years, and the environment in which conception occurs, which can be an extremely short period of time, ultimately lead the way that an individual starts life. We understand that environmental cues, smoking, poor nutrition, disturbances in vitamins such as folic acid and vitamin D and environmental chemicals, among others, can dramatically change the potential destined by our DNA. Outcomes can include infertility, miscarriage, pregnancy complications and long-term health problems.
Getting the periconception environment correct is critically important and yet little dialogue has occurred between reproductive biology and medicine. Infertility treatment in humans is now big business and reproductive biologists who work in the industry have often lost a voice amid the tumult of IVF, sperm injection and the introduction of techniques and medications that are either unproven or potentially dangerous. Clinicians and companies that have little understanding of the implications of interfering with normal physiology and the health of an embryo often take up questionable science in reproductive biology. In turn, reproductive biologists have not often used methods such as randomised trials, statistical planning and systematic reviews to inform their experiments.
In this lecture I wish to look at the lessons learned in reproductive biology and medicine that currently dominate our thoughts in human fertility. I hope to illustrate some of our spectacular successes as well as highlighting major dangers that face us as we allow unrestrained use of powerful new technologies in the hands of industries that often choose to ignore dangers and promote unwarranted interventions. I will look at examples of preconception care that work and then discuss how to engage with the community to get positive change.
“The end of all our exploring will be to arrive at where we started and know the place for the first time” (TS Eliot).