Reproductive health: when the wish for children needs support

“The courage to persist — that’s what’s needed more than anything”, says Colin Howles. To persist on the path towards having your own baby, because that path can for many hopeful couples be much rockier than they ever expected or imagined: “For instance because, on average, we are significantly older in Western countries nowadays when we want to have our first child”, says the expert in reproductive health. Endocrinologist Howles has been working in this field of medicine for 25 years, and at Merck Serono in Geneva it is his core area of activity.
   
However, Howles is more than “just” an outstanding expert in the background of this aspect of medicine and in the myriad ways of treating fertility problems: he and his wife have also been affected by it. Until the birth of their son, Ewan Michael Alexander, they had — unexpectedly, as in most cases — had to travel the long and arduous route themselves: “We needed six treatment cycles”, says Howles, “and that’s a real challenge. But it also showed me how massive the advances we have already made over the decades in fertility medicine really are. Knowing what it is like, as a patient, to be able to rely on our help, spurs me to work even harder on coming up with more innovations.”

Consequently, Howles also demonstrated particular courage and took a risk that many people would find hard to take — he publicly “outed” himself and spoke to a large audience about the journey to fatherhood: at a meeting in the spring of 2008 attended by several hundred colleagues, Howles impressively mapped out the emotional highs and lows, the physical rigours and the power of hope that a couple experiences during fertility treatment. Every member of the audience believed that Howles was taking about somebody else. However, it was a big surprise — and the spontaneous applause even bigger — when the couple being described turned out to be Mai and Colin Howles, the now three-strong family of their own work colleague: “Suddenly you have a child, your own child that’s no different from other children, loved, a source of joy! The long journey, the effort, they’re not forgotten. But compared to the immense happiness, their significance wanes.” 
   
In Merck Serono’s portfolio, drugs for the treatment of fertility problems occupy a significant position: alongside drugs to treat cancer or multiple sclerosis, they are one the biggest fields of business for this division of Merck. As well as in Darmstadt, the company has its main base in Geneva, where Howles works. “Hormone treatment isn’t necessary in every fertility problem”, says the expert, “but it plays a very important role and therefore it has to be designed to be as gentle and practical as possible.”
   
When Colin Howles began working in his field — five years after the first “test tube baby”, Louise Brown, was born (on 25 July 1978) — there was a lot to do: “Often, for instance, the patients had to take hormone preparations to stimulate maturation of the egg on a daily basis, making them up fresh from a dried powder. That can be a real stress factor: “Have I spilt something, did I measure it wrong? Have I stored the preparation incorrectly?” One key development goal in our work is to reduce this type of additional stress. The preparations need to be easy to use, and our injection technique is the leader in this area.”
   
The options in fertility medicine have now broadened and become differentiated: “Nobody nowadays harbours the prejudice that it must be the woman who’s at fault if pregnancy remains elusive. Today, we know that both partners need to be investigated thoroughly, and that the difficulties can be very varied, but we know that there are also are a wide number of different, individually adaptable possibilities that doctors can use to offer help, even in complex cases.” These options range from the simple stimulation of the ovaries using tablets to trigger ovulation, right through to the recovery of a single, vital spermatozoon that can be implanted into an egg cell using precision-mechanical medical equipment. Using this or similar methods, the route to parenthood can be created even if both partners are affected by fertility problems.