This 40 minute documentary follows Juliet and Rob’s struggle to start a family, and how they turn to Pre-implantation Genetic Diagnosis (PGD) to help them in their quest. With an extensive history of miscarriages, Juliet reflects on how it feels when she falls pregnant “As soon as you find you are pregnant you just get this terrible feeling that, Oh God here we go again”. Due to this history, the couple opt for PGD, described in the programme as a “highly controversial treatment”, in order to select healthy embryos. Juliet is a carrier for a chromosomal abnormality in which large fragments of DNA have swapped places between chromosomes. Known as a ‘translocation’, this disorder does not prevent a woman becoming pregnant but the foetuses cannot develop correctly and a miscarriage is routinely induced. The couple describe how “absolutely terrible” it was when Juliet did actually give birth to a premature baby who was born with some abnormalities but later died (00:04:24 to 00:06:38). This programme provides an excellent insight into both the practicalities of PGD and the emotional hurdles the procedure brings.
In common with many women undergoing PGD, Juliet is concerned that she will not produce enough eggs, or that none of them will become fertilised or when tested they are all shown to be abnormal (00:01:37). The hormone treatment used to induce egg production often causes behavioural changes. “It feels like being continuously pre-menstrual”, comments Juliet, “so either I feel angry all the time or very emotional and tearful, there is no in between” (00:20:01). Rob expresses concern about both the possible consequences of the hormonal treatment for Juliet and his general feelings about PGD “I find it hard to believe that such an innovative or complex thing is as smooth as they say” (00:17:40 to 00:19:55 and 00:22:38 to 00:24:35).
The programme continues to follow the steps involved in PGD, including harvesting of the egg and their subsequent fertilisation in the laboratory (00:22:38 to 00:24:35). Between 00:25:56 and 00:36:05, the programme gives a particularly good insight into the remaining stages of the procedure, from fertilisation to screening the embryos for the genetic abnormalities and finally onto implantation. This section also illustrates how the couple have to undergo a series of agonising periods in which they just have to sit and wait for a set of results that are hopefully favourable and will allow them to continue onto the next part of the procedure. Stage by stage their dream unravels: not all the eggs become fertilised; not all the embryos are genetically normal; and then those implanted fail to establish (00:36:10). Overall, the episode is a reminder that even with the best science available, a healthy baby is by no means guaranteed. The couple are ready to have another go, with Juliet commenting that “as long as you are prepared to try long and hard enough it will work out in the end”. As it happens, the story does have a happy ending; Juliet conceives naturally and gives birth to a healthy child.
Bitter Inheritance: The Needell Family provides an excellent opportunity to observe the whole process of PGD from start to finish. The fact that Juliet is herself a genetic counsellor and Rob is a paediatric surgeon makes their comments particularly insightful. Other programmes (e.g. some of the A Child Against All Odds series) perhaps offer clearer insight into the ethical arguments, but this documentary would be a great tool for examining the process of PGD and the many practical issues associated with it.
This programme (TRILT identifier 0016B636) has been broadcast on 24th January 2002 (BBC2; 21:50) and 16th June 2003 (BBC2; 23:20). Further information regarding the ethical and practical considerations of PGD can be found via ‘BioethicsBytes Guide to Streamed Media 1′, ‘Designer babies-three documentaries’ and Bioethics Briefing 3.