Pioneer in the laboratory of life: Fertility specialist Ian Craft prefers making miracles to moralising over who should be able to have babies. Angela Neustatter met him

Angela Neustatter
Monday 02 August 1993 23:02 BST

FORMALITY is not something that concerns Ian Craft. This eminence grise of the infertility business positively bursts with ebullience and warm greetings - recalling the last time I went to interview him and arrived on a bicycle; regaling our photographer with the lowdown on his latest work on fertilising eggs by injection, to help men with 'a lousy sperm count'. Then, before we had time to marvel at such a thing, he's on to camera lenses, describing his role as amateur photographer at the recent wedding of his son Simon.

All this before we've even reached the consulting room in Professor Craft's London Gynaecology and Fertility Centre, which he opened three years ago at a Harley Street address - although the entrance is actually in Devonshire Street. Large busts of his parents ('marvellous people - these busts make me smile every morning') stand dark and imposing among the display of colour photographs showing babes in arms, engaging toddlers, bright-faced children of different nationalities - the fruits of his prodigious labours to enable infertile women to become mothers.

During the past couple of weeks Professor Craft's name has been in the public arena thanks to the case of a 58-year-old woman who has become pregnant with twins in Italy. He denies emphatically that he referred her to Dr Severino Antinori, as the Italian doctor treating the woman has alleged. He is also fed up that, because he is the press's first port of call on such matters, he's been labelled the doctor specialising in older women.

'I'm just as interested in the 25-year-old who has never menstruated and wants to become pregnant,' he says.

He has treated women in their fifties, although his oldest patient who received fertility treatment and who went on to give birth was 49. The techniques he has developed make it theoretically possible to impregnate an 80-year-old woman, and he opposes legislation to impose an upper age limit.

Is he saying, then, that it would be fine to help a super-fit 70-year-old to have a baby? Does anything go?

'No no. It would be possible with an egg donated from a young woman - because it is the quality of the egg that is significant. But I imagine it would be stupid to do it. That said, I don't believe it is my position as a doctor to moralise about who should or shouldn't be treated. I don't think it's our job to say we shouldn't treat her because she's had gonorrhoea or been a prostitute. It's not our job to moralise about a woman's past.'

And yes, he would help a single woman become pregnant. 'I absolutely believe cases must be decided individually and on their merits. If the Human Fertilisation Embryology Authority brings in an upper age limit, it is going to deny somebody the chance of being helped, and that would be very sad.'

The professor's courteous attitude, the way he calls me 'dear', his enthusiastic schoolboy manner and the revelation that he is 'indebted' to his wife, Jackie, whom he met when she was 13 and he 16, for most of the upbringing of their sons, Simon, 28, and Adrian, 24, hardly make him the archetype of a women's rights campaigner. But from his position as a clinical iconoclast, he does voice some of the considerations many have felt were overlooked in the brouhaha over Dr Antinori's patient. He takes Baroness Warnock to task for her pronouncement that 'it is inherently wrong and offensive that a woman of 55 should have a child'.

'It is a terrible thing for a woman to be barren all her life if she desperately wants a child, and as a doctor I feel I should do everything I can to help that woman. If the parents are sensible and surround the young baby with lots of people of younger years, I would contend that those children will not necessarily be brought up abnormally. I don't suppose Baroness Warnock would have said what a terrible thing it would be if a 55-year-old woman had a child naturally.' He is outraged by Joan Bakewell's article questioning whether it was selfish for a woman of 55 to have a child. 'Why,' he demands, 'is it so irresponsible of a woman to want to do this but all right for a 70-year-old man, who may drop dead in a few years, to father children?'

He is less convinced, however, when I suggest that perhaps counselling (for which his clinic's ethics committee is responsible) should be as much concerned with asking why having a child is so important to a menopausal woman as with the medical issues and welfare of the child. Shouldn't he be exploring whether it is a desperate bid to make an unsatisfactory life better, what the implications of that are, what expectations are built around the potential child, and whether there might be a better resolution for the woman?

'It's a consideration, but not the paramount consideration,' he says.

He does agree, however, that his zeal to try to help anyone who wants it should be measured against the 'major responsibility' fertility clinics have to let patients know that, taking women of all ages treated at Professor Craft's clinic, slightly less than 30 per cent succeed in getting pregnant, and that the chances diminish with age. Ultimately, far more women will pay for costly treatment (NHS treatment is increasingly rare) and end up without a child, than will become a mother.

Professor Craft became interested in infertility 20 years ago. Nowadays he is a PR company's dream consultant. A slim, silver-haired 56-year-old, he has considerable charm. The public face of his clinic is affectionate and benign - he is referred to as 'Prof' by all who work with him - 'even his wife calls him that', the smiling, blond receptionist confides. He has learnt a small amount of Arabic to make patients from the Arab states feel at home, and mentions that he knows the words for sperm and ova in a number of languages.

He is eager to answer questions, and his words strain to be released the minute a question is asked. He talks hard and fast, his hands constantly dipping, diving and swooping like a small plane. After about an hour, he pauses just long enough to say: 'I know what you're going to say, you're going to say 'Professor Craft, you're being garrulous.' ' Then he's off again.

He describes himself as 'innovative' and 'someone prepared to stand up for his principles', but others say he wants to push the boundaries of what is possible and acceptable ever further. When I suggest (and he acknowledges) that he has been called maverick, he returns over and over the word, arguing, persuading, almost begging that the idea should be wiped from the slate.

Yet it is his determined iconoclasm that has made him master of what he calls 'fertility milestones'. His team was responsible for the first test-tube IVF (in-vitro fertilisation) twins in 1982, then triplets in 1984, and the world's first birth following egg and sperm transfer into the uterus, in which a sample of sperm is taken, then washed and put into the uterus. Two years later came Britain's first Gift births (gamete intra-fallopian transfer, where the egg is fertilised in the fallopian tubes and transferred to the uterus). In 1987 there was Europe's first donor-egg birth. Three years ago he succeeded in bringing to birth the first frozen donor embryo, and this year saw Britain's first pregnancy pioneering the ICSI technique (for which he was granted the first licence), in which a single sperm is injected directly into the egg.

After working at several NHS hospitals, he was made Professor of Obstetrics and Gynaecology at the Royal Free Hospital in north London in 1976. Then he moved into the private sector. He spent three years leading the infertility clinic at the Cromwell Hospital in west London and five years doing the same at the Humana Hospital Wellington, also in London. Three years ago he set up his own centre.

He is aware that critics probably believe commercial gain pulls his strings, and it upsets him. 'I haven't heard it expressed overtly, though no doubt it's said under the breath. It's not the reason I function at all. My whole philosophy of life is about being creative. I clearly see that it is possible to use creativity to make people happy in my work.'

The gratitude of the 44-year-old woman who lost her two sons in a traffic accident and was enabled to give birth to a son and daughter with eggs donated by a young woman, is clearly visible in the photograph on his mantelpiece. And it is difficult not to be moved by the case of a woman who was without arms because of exposure to Thalidomide, and was enabled to have a child. Jackie and Peter Brown, who went to Professor Craft after more than a decade of trying for a child and infertility treatment, and now have a son, Oliver, cannot speak highly enough of his efforts.

But it has not all been uninterrupted success. A few years ago he was criticised for using egg donors known to the patient, but that is now accepted practice. During Professor Craft's tenure, in 1987, the Humana was temporarily removed from what was then the Voluntary Licensing Authority's (superseded by the Human Fertilisation Embryology Authority) approved list of clinics because of disagreement over the authority's decision to insist on a rigid limit - of four - on the number of eggs or embryos being transferred to a patient.

Dame Mary Donaldson, then chair of the authority, was sharp in her criticism: 'Everyone was working very hard to do a good job and you have one man out of step who is prejudicing the whole issue - although he insists everyone else is out of step.'

The business of how many eggs should be used - the limit is now set at three - is highly contentious because with the use of up to 10 eggs, which is the maximum Professor Craft has used, there is a chance of multiple births that can put the mother as well as the foetuses at risk. Professor Craft, on the other hand, argues that using a small number of her own eggs is sensible with a young woman, because it is in young women that the chance of multiple pregnancy is greatest. However, he says that the blanket ruling seriously limits the chance of women over 40 being able to become pregnant using their own eggs, because the chances of success are lower at that age.

He is irritated by what he sees as media hyping of the risks of what he regards as the miracle of creating life because he is sure it will deter people from donating eggs. The more eggs available, he argues fiercely, the higher the success rate can be pushed.

Professor Craft's relentless battle to fulfil his patients' desires may be admirable, but it begs uncomfortable questions about how far medical practice should follow individual interests. Already there are a handful of clinics offering sex selection, with very little success. Professor Craft can see nothing unethical about making babies of a given sex; and, no, he doesn't see the danger of a government ever deciding to create more men. Nor is he unduly concerned about where manipulating the human embryo might lead. 'Of course these things can be misused,' he says, 'but a lot of the worries are alarmist. They are used to fire people up to read the newspapers. But it raises another question - is it wrong for someone requesting donor sperm insemination to request a donor who has a particular interest in sport as opposed to in music? I don't see that as inherently unethical.'

By now he's had enough of futuristic speculation, the stuff which, he fears, earns him the maverick label: he wants to talk about the latest work being done on fertility. The need for eggs is great, and he would like to see a system where donor eggs are given to a centre like his, fertilised with the partner's sperm, and frozen ready for use; or they could be frozen with non-related sperm and made available to other, infertile, couples. 'There are too many abortions and no children to adopt now so why not adopt an embryo?' he asks.

Then it's back to hope and optimism. There have been 2,500 babies born through his infertility programme; and last year 34 per cent of his patients up to the age of 35 became pregnant. Then there are the new possibilities being offered through the microinjections of sperm into the egg, SUZI (subzonal insemination) and ICSI, making pregnancy possible in cases where the male partner has an obstruction that prevents sperm getting through, or a vasectomy that cannot be reversed. .

The Professor is very enthusiastic about all this. But then, as he remarks several times, he's a very enthusiastic man, full stop. He often works seven days a week and Jackie, the woman who, he eulogises lavishly, gave him confidence, and whom he married aged 19, has had to get used to doing without him much of the time. When there is free time he enthusiastically listens to music at their north London home, engages in serious social conversation - 'I am not someone who likes the superficialities of life' - and is very keen on art. He bounds across the consulting room to find a picture he has commissioned of a curlew: 'I've always loved curlews, that haunting sound' and another of swallows: 'I've always loved swallows because I like liberal things and freedom.' Perhaps this explains why his enthusiasms do not, in the present climate, extend to politics.

The business of being a creative man, a man whose mission goes deeper then simply personal success and gratification, is something he is at pains to communicate. He returns to an earlier theme. 'Destructive things appal me and upset me. Television pictures of news items or pictures of bodies leave a vivid impression on my mind, they're so abhorrent they hurt and hurt again. So I am interested in being creative. I'm a creative person, that's me.'

Angela Lambert will be back next week

(Photograph omitted)

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