He was off and running. All I needed to do was provide the odd prompt. I was glad I wasn’t his partner; I could just imagine how erotic his bedroom conversation would be. ‘So what are the mechanics of carrying out an IVF procedure?’ I asked.
‘OK. Normally, women release one egg a month. But our patients are put on a course of drugs which gives us an optimum month when they’ll produce five or six eggs. The eggs are in individual sacs we call follicles. You pass a very fine needle through the top of the vagina and puncture each follicle in turn and draw out the contents, which is about a teaspoonful of fluid. The egg is floating within that. You stick the fluid on the heated stage of the microscope, find the egg, and strip off some of the surrounding cells, which makes it easier to fertilize. Then you put it in an individual glass Petri dish with a squirt of sperm and culture medium made of salts and sugars and amino acids — the kind of soup that would normally be around in the body to nourish an embryo. Then you leave them overnight in a warm dark incubator and hope they’ll do what opposite genders usually do in warm dark places at night.’ He grinned. ‘It’s very straightforward.’
The food arrived and we both attacked. ‘But it doesn’t always work, does it?’ I asked. ‘Sometimes they don’t do what comes naturally, do they?’
‘That’s right. Some sperm are lazy. They don’t swim well and they give up the ghost before they’ve made it through to the nucleus of the egg. For quite a few years, when we were dealing with men with lazy sperm, there wasn’t a lot we could do and we mostly ended up having to use donor sperm. But that wasn’t very satisfactory because most men couldn’t get over the feeling that the baby was a cuckoo in the nest.’ He gave a smile that was meant to be self-deprecating but failed. Try as he might, you didn’t have to go far below the surface before Old Man reasserted itself.
‘So what do you do now?’ I asked.
But he wasn’t to be diverted. He’d started so he was going to finish. ‘First they developed a technique where they made a slit in the “shell” of the harvested egg,’ he said, waggling his fingers either side of his head to indicate he was using inverted commas because he was unable to use technical terms to a mere mortal. ‘That made it easier. Twenty-five per cent success rate. But it wasn’t enough for some real dead-leg sperm. So they came up with SUZI.’ He paused expectantly. I raised my eyebrows in a question. It wasn’t enough. Clearly I was supposed to ask who Suzie was.
Disappointed, he carried on regardless as the impassive waiter delivered our main courses. ‘That involves passing a very fine microneedle through the “shell” and depositing two or three sperm inside, in what you could call the egg white if you were comparing it to a bird’s egg. And still some sperm just won’t make the trip to the nucleus of the egg. Twenty-two per cent success rate is the best we’ve managed so far. So now, clinics like ours out on the leading edge have started to use a procedure called ICSI.’
‘ICSI?’ I thought I’d better play this time. Even puppies need a bit of encouragement.
‘Intracytoplasmic Sperm Injection,’ he said portentously. ‘One step beyond.’
I wished I hadn’t bothered. ‘Translation?’
‘You take a single sperm and strip away its tail and all the surrounding gunge until you’re left with the nucleus. Then the embryologist takes a needle about a tenth the thickness of a human hair and pushes that through the “shell”, through the equivalent of the egg white right into the very nucleus of the egg itself, the “yolk”. Then the nucleus of the sperm is injected into the heart of the egg.’
‘Wow,’ I said. It seemed to be what was expected. ‘So is it you, the doctor, who does all this fiddling around?’
He smiled indulgently. ‘No, no, the micromanipulation is done by the embryologist. My job is to harvest the eggs and then to transfer the resulting embryo into the waiting mother. Of course, we keep a close eye on what the embryologist does, but they’re essentially glorified lab technicians. I’ve no doubt I could do what they do in a pinch. God knows, I’ve watched them often enough. See one, do one, teach one.’ It’s hard to preen yourself while you’re scoffing curry, but he managed.
‘So, does the lab have to be on twenty-four-hour stand-by so you’re ready to roll the minute a woman ovulates?’ I’d been presuming that Sarah Blackstone did her fiddling with eggs and microscopes in the watches of the night when the place was deserted, but I needed to check that hypothesis.
‘We don’t just leave it to chance,’ Gus protested. ‘We control the very hour of ovulation with drugs. But big labs like ours do offer seven days a week, round-the-clock service so we can fit in with the lives of our patients. There’s always a full team on calclass="underline" embryologist, doctor and nurse.’
‘But not constantly in the lab?’
‘No, in the hospital. With their pagers.’
‘So anybody could walk into the lab in the middle of the night and wreak havoc?’ I asked.
He frowned. ‘What kind of article are you researching here? Are you trying to terrify people?’
Furious with myself for forgetting I wasn’t supposed to be a hard-nosed detective, I gave him a high-watt smile. ‘I’m sorry, I get carried away. I read too much detective fiction. I’m sure people’s embryos are as safe as houses.’ And we all know how safe that is in 1990s Britain.
‘You’re right. The lab’s always locked, even when we’re working inside. No one gets in without the right combination.’ His smile was the smug one of those who never consider the enemy within.
‘I suppose you have to be careful because you’ve got to account to the Human Fertilisation and Embryology Authority,’ I said.
‘You’re not kidding. Every treatment cycle we do has to be documented and reported to the HFEA. Screw up your paperwork and you can lose your licence. This whole area of IVF and embryo experimentation is such a hot potato with the God squad and the politically paranoid that we all have to be squeaky clean. Even the faintest suggestion that we were doing any research that was outside the scope of our licence could have us shut down temporarily while our lords and masters investigated. And it’s not just losing the clinic licence that’s the only danger. If you did mess around doing unauthorized stuff with the embryos that we don’t transfer, you’d be looking at being struck off and never practising medicine again. Not to mention facing criminal charges.’
I tore off another lump of nan bread and scooped up a tender lump of lamb, desperately trying not to react to his words. ‘That must put quite a bit of pressure on your team, if you’re always having to look over your shoulder at what the others are doing,’ I said.
Gus gave me a patronizing smile. ‘Not really. The kind of people employed in units like ours aren’t mad scientists, you know. They’re responsible medical professionals who care about helping people fulfil their destiny. No Dr Frankensteins in our labs.’
I don’t know how I kept my curry down. Probably the thought of being tended by the responsible medical professional opposite me. Either that or the fact that I wasn’t paying much attention because I was still getting my head round what he’d said just before. If I was short of a motive for terminating Dr Sarah Blackstone, Gus Walters had just handed me one on a plate.
Chapter 15