Event Review: A Question of Science – What's the future of fertility?

I was scrolling through my phone on my way to the Francis Crick Institute when I found a picture I had taken of a fertility clinic promoting an 'informative session' that looked more like a corporate egg freezing party, complete with champagne flutes and sleek furniture. Is this really what empowerment looks like for women today – long hours, frozen eggs and expensive childcare, wrapped in glossy marketing?

I was going to the Crick for the live recording of What's the Future of Fertility?, part of the podcast series A Question of Science, and Professor Brian Cox's first project as Crick scholar. It invites the audience to submit questions about a specific episode's topic, a handful of which are answered live by a panel of experts.

Upon arrival, I was surprised by a rather young audience, many of them students. Sitting next to me was a woman about my age (mid 30s), planning to relocate with her partner. It resonated with my own experience – in research careers, mobility is often valued, leaving many women delaying family planning, waiting for the elusive 'right gap' in their CVs.

The audience's first question was read out moments after crossing my own mind: 'What is the best age to freeze eggs, and does it empower or exploit women?' The panel did not sugar-coat the biology. As Dr Güneş Taylor, chancellor's fellow at the University of Edinburgh, explained, eggs age with us. Exposed to damage over time, they become less likely to result in pregnancy, even with IVF.

Freezing eggs before age 35 improves the odds, but only about one in three IVF embryo transfers results in a pregnancy between ages 35 and 40, according to the Human Fertilisation and Embryology Authority. Dr Lucy van de Wiel, senior lecturer at King's College London, suggested that 'freezing embryos can be more effective, since they survive thawing better' – an option I had never considered.

The conversation quickly broadened. Could delaying menopause help? Can we rejuvenate eggs to increase IVF success rates, or even create them from stem cells? The panel's balance of caution and enthusiasm captured both the promise and the current limits of technology.

One of the liveliest exchanges occurred when the conversation turned to sperm. Asked whether declining sperm counts should concern us, Professor Joyce Harper from University College London reassured the audience that the population-level impact may be limited. 'Men produce millions, after all.'

It might be worth considering the individual impact, though. Dr Taylor noted that many women undergo IVF for male fertility issues, prompting applause. Clearly, the burden of fertility treatment should not rest on women's shoulders alone. Dr van de Wiel, explained that men in heterosexual couples tend to be three years older than their partners on average, and jokingly suggested that heterosexual women turn their eyes to younger men!

Technology and artificial intelligence dominated much of the evening. Could machine learning improve IVF outcomes? The panel urged caution – 'garbage in, garbage out'. Without robust data, algorithms risk misleading rather than guiding patients. However, Dr Taylor raised the intriguing potential of AI to help translate embryo research from animal models to humans.

IVF add-ons came under fire, marketed to hopeful couples but often lacking evidence (see BioNews 1283). 'Advertising is being served as information,' Dr van de Wiel noted. Cost was another recurring theme. With IVF cycles in the UK costing around £10,000, many families are excluded. Private companies are experimenting with robotics to streamline treatment, but who will benefit? As public funding shrinks, equity of access looks increasingly uncertain.

Dr Naomi Moris, group leader at the Francis Crick Institute, also stressed the need for more research into early miscarriages, which affect up to two in ten pregnancies. Stem-cell-based embryo models, she argued, may offer valuable insights into early embryo development and implantation.

A Question of Science is distinguished from other science podcasts by its live format. There is something special about sitting in a research institute, surrounded by both scientists and the public, as the discussion unfolds. The podcast aims to tackle 'society's most pressing scientific questions', though I was not sure how the topics for this 12-part series were chosen. Wellcome's When Science Finds a Way feels more rooted in dialogue with affected communities, a different but complementary approach.

As I left, I reflected on how much of the discussion circled back to technology. Understandably, it sparks imagination. But what about other interventions such as diet and lifestyle, so often emphasised by the wellness industry?

'There is probably not much research funded that is not technology-related – who would make money out of that?' the woman beside me remarked. This is perhaps the most important takeaway for me. Knowing who funds advances in fertility, and their agendas, is key to understanding the future of fertility.