"Did you know that a woman can now have children without a man?"
"But what on earth for?"
"You can apply ice to a woman's ovaries, for instance. She can have a child. Men are no longer necessary to humanity."
At once Ella laughs, and with confidence. "But what woman in her senses would want ice applied to her ovaries instead of a man?"
—Doris Lessing, The Golden Notebook
In a German woodcut from the sixteenth century, a woman is giving birth. She squats on a birthstool, something that looks like a portable three-legged toilet, various models of which turn up in mosaics, drawings, and paintings all the way from Rome until the early 1800s in America. This German woman (or rather girl: the flesh of her placid face is rounder and firmer than the saggy jowls on the midwives who attend her) grasps with her left hand the bottom of the stool while with the right she presses down on the swelling under her clothes. She is fully dressed, like the others in the picture, one midwife (perhaps the assistant) standing behind her, holding her up by the armpits, while the senior hag sits on a very low chair facing the girl's spread legs, her arms thrust up the girl's voluminous skirts, giving the artist a chance to show off his technique with light and shadow on folds, and exposing the girl's feet.
These feet—they are bare, muscular, contorted. They are in contrast with the rest of the picture, which is stylized, with little except formal lines of tension. They are just about the only sign that in real life the scene was not serene, but hectic, noisy, painful, with sweat and juices running, screams, moans, and curses, and in the air a possibility of death. If this girl died in labor, or her child from infection in the first few days of life, it was as unremarkable as the father of her child being slaughtered in the wars of religion.
Other animals don't seem to feel pain or run much risk in giving birth: their bodies take on a casual attitude, the mother doesn't need help. The human mother is an exceptional case that it took the whole progress of evolution to produce. For almost as long as Man has been human, birth has been a big event, disturbance, and more or less a shock, so much so that at least one mythology has accounted for the pain of it as punishment for an original sin against Almighty God. Considering how long Man has been human-defined biologically or mythologically—it is just yesterday that childbirth began to be mitigated. For thousands of years the experience of women was pretty much that of the German girl. It was against the law to dissect, and no one undersi the reproductive organs. Obstetric tools were scarce and clumsy, and midwives relied on the cunning of their (dirty) hands. There was no pain-killer, so women went through the thing wide-awake, unless they were lucky enough to faint. An ordeal, and one which thoughtful men must have been happy to be spared.
Yet the transformation of childbirth from painful and dangerous event to safe and efficient routine was thanks to men, to the energy of males. The beginning of this transformation dates only from a little before the time when drawings and paintings start to show men, instead of women, working around the swollen body of the woman in labor. What part of this male energy, channeled into ingeniousness, derived from a curiosity separate. from feeling, what part from compassion, or guilt? Leonardo's drawings of the fetus may well be just an expression of his need to find nature out and record it; yet without such anatomical study, childbirth could not have changed. Peter Chamberlen, inventor of the forceps in the year Shakespeare published Love's Labour's Lost, kept the details of his simple and great invention secret, haggling for a price with his colleague-rivals while women suffered. In contrast to him, there have probably been any number of doctors of whom we could think that their sympathy for women was at least as active as their desire to get rich or be famous. Maybe it is true that the motives of most of the doctors were mixed, and that only the humble practitioners were pure.
In 1842, James Young Simpson, professor of midwifery at the University of Edinburgh, at the age of thirty became the first to use anesthesia to help women in labor. Before he got any honor for it, he had to contend with the gloomy abuse and doubt of the people who ran the medical and religious Establishments-that is, other men. Ministers, for example, objected to Simpson because:
Pain during operations is, in the majority of cases, even desirable! Its prevention or annihilation is, for the most part, hazardous to the patient. In the lying-in chamber, nothing is more true than this: pain is the mother's safety, its absence her destruction. Yet, there are those bold enough to administer vapor of ether, even at this critical juncture, forgetting it has been ordered, that "in sorrow shall she bring forth."
This combination of bad moralizing and bogus medicine was not considered stupid or cruel; it sounded convincing to most people, even women. Some of the letters Dr. Simpson got from his colleagues were better informed, but even agnostic medical men were apt to believe that (a woman's) pain was somehow necessary, without bothering to prove it. While women couldn't have begun to be liberated from the special pains and dangers of their biology without the help of certain men, there have always been, at each "critical juncture," other men opposing this liberation, or at least the technical means of achieving it.
Simpson's answers to the reactionaries and the skeptics radiate good sense and also concern for the suffering of women. He has to remind a Dr. Meigs of Philadelphia, one of his critics, that the fact is "the contractions of the uterus, and not pain, is the essential to the progress of labor." But aside from the medical facts, he is obliged to go in for some moralizing, too:
Like other physicians you deem it, I doubt not, your duty to wield the powers o your art, in order to free those that submit themselves to your medical care, from these and from other similar sufferings. But if it is right for you to relieve and remove these pains, why is it not right for you also to relieve and remove the pains accompanying the act of parturition? I cannot see on what principle of philosophy, or morality, or humanity, a physician should consider it his duty to alleviate and abolish, when possible, the many minor pains to which his patients are subject, and yet should consider it improper to alleviate and abolish, when possible, pains of so aggravated a character, that, in your own language, they are "absolutely indescribable and comparable to no other pains," "Pains for which there is no other name but Agony."
Even Simpson was not entirely altruistic, however. During the time it took for pain-killers to be accepted by the medical Establishment and acquiesced in by the Church (about twelve years, until Queen Victoria's much-publicized labor under chloroform), he fretted, not only about the women who continued to go through childbirth cold-sober but also about his professional reputation and whether he would get the glory coming to him. Innovators, great benefactors of women like Simpson, have generally had complicated feelings, their sympathy being sharpened by ambition. Only women. once they have realized the meaning for themselves of these innovations, have displayed uncomplicated enthusiasm, which finally proves more effective than anything else in overcoming tradition. The first woman on whom Simpson tried chloroform, in 1848 (until that time he had been making do with ether), was so grateful, and perhaps unconsciously clear about the improved future of her half of the human race, that she had her girl-child christened "Anesthesia."
Other men made further advances: antisepsis in surgery, antibiotics, refinements in diagnosis and delivery. Because of this accumulation of knowledge, to have a child in an industrial country today is no longer dangerous. The process may be bothersome and uncomfortable for many, but very few women die in childbirth anymore. However, despite this, i is still not possible to say that we take birth as casually as animals do. A tinge of mystery remains; the thing still seems formidable, perhaps least to obstetricians, more to women, and most to men.
As long as men have had the artifice to represent, they have made the image of the beatific Madonna and Child, an image that speaks to some profound need, love, guilt, fear, or reverence, or all of these together subsumed under awe. Today, medical knowledge has grown, and conception and childbearing are apparently less mysterious than they once were. It is understood that the egg when it bursts from its follicle in the ovary is about as big as the period at the end of this sentence; that if it happens to be fertilized during its journey down the fallopian tube (in Latin, oviduct), the genetic material from it and the sperm combine and rearrange, and the new organism (an embryo) divides, and divides again, and again, until it arrives in the uterus looking something like a segmented soccer ball, and implants itself into the mucus lining of the uterus, where about two weeks after fertilization there begins to arise between the embryo and its mother one of the most complicated structures in nature: the placenta. This is an entire environment, a universe for the embryo alone, separating it from and connecting it to its mother by membranes so fine that blood cells pass through undamaged, bringing the embryo nourishment and carrying away poisons. For the next eight months, so long as she eats, breathes, and excretes for herself, the mother eats, breathes, and excretes for the embryo, then fetus, which develops from a plasm with creases, to a mollusk, to a fish, to a. pig, and attains the morphology (Greek, morphe, "form") of a human being, with two clear and open jelly eyes which rapidly move in movements associated with dreaming. Then, in a normal pregnancy, about nine months after conception, the gigantically stretched uterus begins to contract and expel, and birth takes place.
All this is known today, yet the process of childbearing, with its final event as if something were coming to inexorable term, still has about it a sense of prehistory, savage and elemental, even though it is surrounded by rubber gloves and stainless steel. It is a spectacle that impresses the civilized no less than the savage mind as awesome, and together with the other striking biological events associated with a woman's body, may lead a man like Sigmund Freud to write, "Anatomy is destiny." However, this epigram, with its numerous social, sexual, economic, and political implications, has had its portion of incontrovertible truth reduced in the years since it was written, and again, this has been thanks to men. The female's circular, periodic, excitable, "destined" biology has been brought closer to the linear biology of the male as a result of new knowledge of the chemistry of sexual differentiation and functioning, and the technology that this knowledge has made possible—above all, the Pill.
But a stubborn remnant of biological fact and cultural myth, that men and women alike are affected by, persists. So long as we reproduce ourselves, we also reproduce the spectacle of a woman withdrawing into herself, becoming huge, and in blood and tumult bringing forth the succeeding generation.
This is the stuff myths are made of, customs (such as the French custom of kissing a lady's hand, which originated not as a compliment to her but a symbolic gesture of gratitude to all women together for what they endure in childbirth) and practice (such as the practice of the mother, rather than the father, caring for children, because for nine months it was impossible to decide whether she and the child constituted two organisms or one).
Even the mother may experience this mystic awesomeness, so strange and somehow at odds with the present and the future. Yet it is only the remnant of a myth, and technology, which has gone part of the way toward destroying it, may yet destroy the rest.
According to the Nobel Prize Committee, the great advances in the science of biology in the years from the middle fifties to the middle sixties involved advances in knowledge of the genetic code. The most famous hypothesis put forward and confirmed was Crick and Watson's model of DNA, but also of importance was later work, identifying, under tremendous magnification, individual genes. Biologists say that with the cracking of the genetic code and the visualization of the smallest unit in genetics, a period of intense exploration and significant discovery has come to an end; the work remaining is not speculative, but by way of filling in and reconfirming. There is a sense, among younger Len, that the "excitement" has gone out. Many have shifted their attention to the closely related field of embryology, which is rich in tantalizing problems. For example, the knowledge of how the basic genetic material reproduces itself has been helpful to the embryologist, but he still does not know exactly how the genes themselves dictate the orderly development of a fertilized egg into a complicated and highly differentiated / multi-celled organism: what makes an eye an eye, and an arm not an eye, and what puts together limbs and organs so as to make an individual creature? Not only are such questions of "pure" interest, but since they go to the center of the reproductive process, the answers to them promise to have practical application to problems of genetic defect and birth control, two worldly matters much on the minds of scientists and nonscientists alike.
The research of the last few years in embryology, or molecular and reproductive biology, has already yielded a number of interesting hypotheses, as well as laboratory experiments, such as the one called "cloning." Theoretically, since every cell of an animal carries a load of genetic information unique to that individual, it ought to be possible, by destroying (with radiation) the female complement of chromosomes in the nucleus of an unfertilized frog cell, say, and implanting in its place an entire nucleus lifted out from another cell of a second frog, to fertilize the first cell and fabricate an embryo which would grow, be born, and mature into an adult frog that would not merely resemble the donor frog but would be its absolute replica. In cloning, this theory has living proof. A whole crowd (or clone; Greek, "a throng") of identical creatures has been bred in the laboratory, literally and predictably identical in every way to the donor frog except that some of the copies are older than others. Among other things, this shows that an individual creature, previously unique and mortal, may be rid of its uniqueness and have immortality conferred on it. The experiment is dazzling, and some of the knowledge gained ("spinoff") may eventually have practical human application, but so far the major interest has been "pure": no one suggests that humans can be immortal, or that there is any good reason why they should be. Much the same thing can be said of experiments in parthenogenesis, or the asexual fertilization, by mechanical means, of mammalian eggs. The first reports of such "immaculate conception" in lower animals in the laboratory came many years ago, when the French biologist Jacques Loeb caused "traumatic parthenogenesis" by touching a sea urchin egg with dry ice, but recently the accuracy of the method has been improved, and it has been made to work on mammals such as rabbits. Again, however, the direct human application is not apparent for many reasons, among them that human eggs fertilized by parthenogenesis always deteriorate and die; that because of the chromosome business, only females are conceived; and that, taking a long view, parthenogenesis is undesirable because the machinery of adaptive evolution requires sexual reproduction.
There are many embryologists at work in many laboratories, and much going on besides cloning and parthenogenesis. Some of it focuses right on the human egg, sperm, and embryo. This work has closer applicability to human affairs; indeed, the money that pays for it comes mostly from funds allotted not for "pure" research, but for applied-specifically, research to be applied to real and actual problems of contraception, fertility, sterility, and birth defects. To gain knowledge which would lead to new and better technology and social programs in these areas of daily concern, embryologists have needed to observe, measure, and experiment with the first phases of human reproduction, which they have long suspected are crucial in many respects (such as genetic defect), but which they have had mostly to speculate about, since the events were hidden in the female body. Now, these first phases, including culturing of the human egg, its fertilization by sperm, and development as an embryo, have been carried out under the microscope, or in the scientific terminology, in vitro, "under glass."
There were an unusual number of obstacles that had to be overcome before this was accomplished. The first and by no means least was that human eggs suitable for experimentation were hard to get. While there has never been a problem getting sperm (the current rate of remuneration for a sample by masturbation is $25), eggs could only be obtained, until very recently, either from fresh cadavers or from ovarian tissue cut out during gynecological surgery and given by the surgeon to the embryologist as a favor. Both methods were unsatisfactory, yielding few and often damaged, stale, or immature eggs. It was much easier to get eggs from mice, rabbits, and hamsters, which could simply be killed at the right time in the egg-maturing cycle, and their eggs picked out of the follicles of the ovary or flushed from the oviduct. The first experiment of this kind was conducted by the German Schenk, who in 1878 put some rabbit eggs in a culture dish and added sperm; nothing happened, however. For about fifty years a small number of biologists in scattered laboratories fitfully persisted in trying to fertilize mammalian eggs outside the body. In 1934 an American, Dr. Gregory Pincus, later one of the developers of the Pill, published findings that suggested he might have succeeded in fertilizing rabbit eggs. In 1940, Dr. John Rock, another American, who was to play an important role in legalizing and propagandizing birth control, said that he had put some human eggs, which he had managed to get, into the presence of sperm, and that a small number of the eggs had been fertilized and had actually divided. Ten years later, Landrum Shettles, an obstetrician at Columbia-Presbyterian Hospital in New York, also claimed to have gotten fertilization and growth of the human egg in vitro, this time to a stage where the embryo was a solid mass of cells.
There was considerable skepticism, however, about the validity of Pincus', Rock's, and Shettles' results. One of their fellow scientists who was most skeptical, and offered the most persuasive criticism, was M. C. Chang of the Worcester Foundation for Experimental Biology in Shrewsbury, Massachusetts. Chang said that if you take an egg out of the body and just leave it alone in a culture dish, as likely as not it will show signs of "dividing"-signs that will inevitably prove misleading, for in fact, the egg will be deteriorating and dying. The events described by Pincus, Rock, and Shettles, Chang more than implied, could just as well have taken place, and therefore the case for fertilization was unconvincing. Furthermore, Chang reminded biologists that the very definition of fertilization had still not been agreed on (this was in the mid-fifties). He advanced the view, which has since been accepted by everyone, that fertilization, rather than being a single event which happens instantaneously (the mythical "moment of conception"), is a process which takes place over several hours. Fertilization, in other words, is not the simple penetration of the sperm into the outermost layer of the egg; rather, it includes a whole series of events and reactions which probably cannot be said to be complete until the division (or cleãvage) of the egg into two cells, each carrying a bad of maternal and paternal chromosomes in its nucleus.
Chang now set out to make a thorough study of the process of fertilization in mammals, with the goal of eventually devising and carrying out an experiment whose meaning no one could dispute. His diligent work during the fifties rescued this sector of embryology from the realm of the exotic. One of Chang's first and most important discoveries while working with rabbits was that the sperm. had to have something happen to it while it was in the female reproductive tract before it would penetrate an egg cell: the sperm had to be "capacitated." The precise mechanism of this physiological change in sperm is even now not completely understood, but exploiting what he had learned, and after extensive investigation in timing and mapping egg development, Chang was finally able, in 1959, to fertilize a mammalian egg outside the body, using "capacitated" sperm recovered from the uterus of a female rabbit killed soon after coitus. Chang's evidence was be-. yond dispute, because he took the egg he had fertilized and implanted it-in the uterus of another rabbit, certified not pregnant, which was segregated from males and in due course gave birth.
In the next few years Chang's experiment was successfully repeated by at least two other research teams. The reports quickened activity in in vitro fertilization in several countries. In 1961 a physiologist at the University of Bologna, Dr. Daniele Petrucci, said that he had fertilized a human egg in vitro, cultured the embryo for twenty-nine days ("a heartbeat was discernible"), and then destroyed it because "it became deformed and enlarged-a monstrosity:" He said-that as a womb substitute he had used a silicone container filled with amniotic fluid (liquid material that separates the 'growing embryo from the innermost membrane of the natural' placenta), which 'he extracted from pregnant- women. Petrucci, who professed himself a good Catholic, told the Italian newspapermen that his aim was just to find a way to culture organs that would resist the 'rejection phenomenon when transplanted. A couple of days after the story was printed, the Vatican's L'Qsservatore Romano ran an editorial which read in part, "God surrounded the act of creation of a human being with the most supreme assistances of love, nature, and conscience. It would' be monstrous to violate these conditions," which suggested to some that certain pressures had been put on Petrucci to stop. Another kind of reaction came in an editorial in Jenmin un Pao, the paper of the Chinese Communist Party:
These are achievements of extreme importance, which have opened up bright perspectives for similar research . . . . Nine months of pregnancy is no light or easy burden and such diseases as poisoning due to pregnancy are detrimental to health. If children can be had without being borne, working mothers need not be affected by childbirth. This is happy news for women.
The Russians were also impressed. Petrucci was invited to Moscow and spent two months at the Institute of Experimental Biology, returning to Bo.lognawith a Soviet medal. Presumably, he gave the Russians the benefit of his expertise, and since then, while he has desisted from further work, there have been rumors from time to time that professors Anoichin and Maiscki in Moscow, have; followed up on Petrucci, "and have got even further than he did."
But rumors only. In another context, writing about "The Ethical Basis of Science," Bentley Glass, professor of biology at the State University of New York and former president of the American Association for the Advancement of Science, said:
A full and true report is the hallmark of the scientist, a report as accurate and faithful as he can make it in every detail. The process of verification depends upon the ability of another scientist, of any other scientist who wishes to, to repeat the .procedure and to confirm the observation.
Dr. Petrucci offered no photographs; he never even published a report in a .scientific journal to describe how he had far surpassed anything that had ever been done before. Because of this, among biologists in the West who understand science roughly as Glass does, Petrucci's "experiment" is said to be "incompletely documented," which seems to be a polite formula for saying, not that there is an honest difference of opinion as there was between Shettles and Chang, but that Petrucci is a fraud.
Meanwhile, more serious men, many quite young, were initiating projects whose findings appeared in the Journal of Embryology and Experimental Morphology, Science, the International Journal of Fertility, and other sober and reputable publications. Their work would converge, toward the end of the sixties, in successful in vitro fertilization and growth of the human egg. Three of the most important projects were run by Americans:
Joseph C. Daniel, Jr., professor of biology at the University of Colorado, used rabbits, ferrets, and mink to investigate the development of the embryo just before it implants in the uterus. He found that certain proteins and other compounds are crucial at this phase. Professor Daniel was supported by grants from the National Institutes of Health and the Atomic Energy Commission.
Ralph Brinster, professor of veterinary medicine at the University of Pennsylvania, perfected a combination of nutritive substances (the "medium") in which eggs can be cultured best. He also described the changing biochemistry of the embryo during the time from fertilization to implantation, and devised an efficient incubator and culturing chamber for in vitro work, hooked up to CO. gas and maintained at 37° centigrade. Professor Brinster's work was also sponsored by the NIH.
Dr. Wesley Whitten of the Jackson Laboratory at Bar Harbor and Dr. John Biggers of Johns Hopkins cultured mice eggs from fertilization to just before implantation. For the first time, they observed the whole development of the embryo in this crucial stage when it is "free," not yet attached to the mother, and can be manipulated in vitro and reimplanted without apparent harm to the offspring. The work of Whitten and Biggers was supported by the National Institute for Child Health (in addition, Biggers' work was supported by the Population Council).
With the knowledge and experience gained from these and other experiments available to him, Dr. Robert G. Edwards of Cambridge University was ready in 1969 to try to achieve convincing in vitro fertilization, of the human egg. He had been making various preparations for this for ten years. Among other things, he and his group had plotted out the stages a human egg must go through on its own between the time it leaves the ovarian follicle and the time it is ready to be fertilized. Edwards would not have been able to do this preliminary research, let alone achieve fertilization, had he not exploited a new method of obtaining large numbers of usable human eggs.
Women volunteers were injected with a hormone, gonadotrophin, which caused them to "superovulate" many eggs (usually only one egg matures per menstrual cycle). Thirty hours after the injection, the volunteer would undergo an operation called "laparoscopy" (Greek, lapara, "flank" or "abdomen"), performed by a surgeon in Edwards' group, Patrick Steptoe. Two small punctures were made in the woman's side, into the ovary. Through one of these openings Dr. Steptoe introduced a slender hollow suction tube, and through the other an ingenious miniature optical device with a tiny flashlight which allowed him to look into the ovary. While he held the optical image steady in his left hand, with his right he maneuvered the suction probe from follicle to follicle, sucking out the eggs. In this way the Edwards group has been able to collect the basic, unsubstitutable, natural material they needed, which no other investigators had ever had in such quantity and quality.
In 1969, the eggs were incubated and washed, and three hours after collection, each one in its separate dish was put in the presence of sperm, which the volunteer woman's husband had contributed. The ratio of nutrients in the dish, the regulation of temperature, gas, and acidity followed closely the work of the Americans on mice, rabbits, and hamsters; Edwards counted, as it turned out only partly correctly, on the uniformity in timing and chemistry among eggs, sperm, and embryos of all mammals. As for "capacitation" of the sperm, Edwards was relieved to find that it would not be necessary to ask the volunteers to have intercourse, and then to operate to recover sperm from the uterus; the masturbated sperm could be capacitated simply by adding to the medium of the culturing dish some serum from the blood of a lamb fetus.
Having put eggs and sperm together, Edwards and his colleagues watched through microscopes to see what would happen. "Suddenly," Edwards was later to recall, "to our unbounded delight, the sperm started penetrating the eggs." In a minority of the dishes, there was to be definite proof of the first stage in fertilization, defined by. the formation of "pronuclei" and the expulsion from the center of the egg of something called the "second polar body." Edwards was entitled to his emotion, for this was a considerable success, but there was still no evidence that he had been able to push the process of fertilization to its acknowledged completion: the cleavage of the egg into two cells each having its own nucleus and full number of chromosomes. Possible reasons. for this failure suggested themselves, and the Edwards group prepared another series of experiments under somewhat different conditions. It was decided to take the eggs from the volunteers before they were ovulated, and to mature them in vitro, so that the timing in placing them with sperm could be exact.
In 1970, the laparoscopies were repeated, the eggs and sperm placed together under new conditions, and by thirty-eight hours after this in vitro insemination, many eggs had undergone a cleavage into two cells; by forty-six hours some had divided again into four cells; by sixty-two hours, some had divided again into eight cells; by eighty-five hours a few had divided again into sixteen cells. According to the report of the Edwards group published in the English journal Nature, none of the embryos matured past sixteen cells. When no cleavages had been seen to occur for two days, the embryos were removed from their dishes.
The photographs published in Nature show clear, jellylike mass, not much like a soccer more like a bunch of grapes.
These photographs and other data are substantial evidence that true fertilization and development took place in vitro. The evidence is not, however, indisputable. A determinedly skeptical embryologist might still insist, even in the face of the symmetry and regularity of the cleavages, that there is a chance the eggs were simply deteriorating all the time; he would not be convinced unless, as in Chang's experiment with rabbits, an egg was put back into the uterus of one of the volunteer women, she was then segregated from her husband, and eight and three quarters months later she gave birth. It should be noted that no embryologist has expressed such doubts formally; Edwards' colleagues in the field seem to be convinced by the evidence available. Yet this is not the end of it.
One or more embryos [Edwards wrote in Nature} have been produced from twenty-nine of the forty-nine patients under treatment in this work. The normality of embryonic development and the efficiency of embryo transfer cannot yet be assessed, although conditions for implantation in the treated patients should be favorable.
Edwards thus indicates that when it is taken, the next step for his group will in effect duplicate Chang's absolute test with rabbits. The question is, When will that step be attempted?
Indeed, the question may be asked, Why have Edwards and his group been at their work with human eggs, sperm, and embryos at all? Has it been just for the satisfaction of research and discovery? Edwards' answer is a definite "no." His answer, in interviews and statements, is that he wishes to relieve the suffering of the women who come to his laboratory as volunteers. These women are sterile; they have tried, and failed, to have babies. Their husbands have adequate sperm, but there has been no conception. They and their husbands are very unhappy to be childless, and much preferring to follow any hope of conceiving their own child rather than adopt one, they have been referred by obstetricians and gynecologists to the lab in Cambridge. Edwards says, "We tell these women, 'Your only hope is to help us.'" Because of their motives, his success in fertilizing and culturing eggs cannot be the end of it; rather, it is a first step, which makes them eager for the obvious next one.
It is known that roughly a fourth of sterile women fail to conceive because their oviducts are either blocked or nonexistent, thus preventing sperm from reaching the egg. In the technique used by Chang, and by now routine in lower mammals, the egg is fertilized in vitro; it completes in vitro the divisions it would normally undergo in the oviduct; then, the embryo is implanted in the uterus, where its presence provokes the growth of a placenta, within which it matures into a fetus that is eventually born and is normal. The infertility that most of Edwards' Volunteers are suffering from is attributable to blocked or absent oviducts; They come to Edwards for one reason only, to be cured of their barrenness. And the money which pays for Edwards' work (American money, Ford Foundation) is specifically awarded for research in fertility. This is why the next step is obvious.
And yet the decision to take it is not easy. What makes him hesitate, Edwards says; is that much testing remains to be done on the in vitro embryos to make sure that the manipulation of eggs and sperm does not damage the chromosomes, which would show up in more or less serious birth defects. "The last thing we want is abnormal babies." In order to do this minute checking up on the genetic material in the nuclei of the cells, a procedure called "karyotyping" (Greek, karyo, "nucleus"), the embryo has to be removed from its dish, which endangers its survival.
According to the published reports, 'all the genetic work has been done on embryos which spontaneously stopped growing. In fact, officially, the problem of deciding to take the next step is postponed and somewhat eased by the report that none of the embryos has survived in vitro past the sixteen-cell stage, while only an embryo developed well past that stage can successfully implant itself or be implanted into the uterus. However, when the Edwards group does succeed in culturing embryos to the implantation stage, the decision to implant a given embryo will have to be based on statistical evidence, and on hope-it will not be possible to karyotype the embryo itself. As Edwards' colleague, Dr. Steptoe, says, it will call for a "brave decision."
Toward the other end of the process of childbearing, or gestation (Latin, gestare, "to bear," "to carry"), other researchers, quite independent of the sort of in vitro embryological work being done by Edwards, have been devising ways to save babies when a woman's natural machinery fails and the fetus is born too soon. This new branch of medicine is called "fetology." The fetus, its umbilical cord to the natural placenta haying been cut, is placed in an incubator which supplies heat and oxygen. There it is fed intravenously, and its breathing is forcibly assisted by an iron lung. By such means, doctors are now able to save most seven-month-old premature babies (average weight two pounds), some six- and-a-quarter- to seven-month-old "premies," and a very few under six and a quarter months. Incubators, which have been in use for a long time, substitute for many of the functions of the womb or placenta in order to permit the premature baby to gain size and weight. However, the baby is indeed a baby, and not a fetus anymore, because the umbilicus has been cut and the lungs are working. Some fetuses are expelled from the mother's body even earlier in gestation, and they die in an incubator.
The challenge is to build an environment that duplicates the ordinary environment of a fetus, in which it will not have to do things for which its body is unready. Fetologists are trying various approaches. Dr. Robert Goodlin at Stanford has put fetuses born less than six months after conception into a thick steel chamber where a saline solution saturated with oxygen is kept under a pressure of 200 pounds per square; inch, roughly the same experienced by a deep-sea diver at a depth of 450 feet. This immense pressure drives the oxygen through the skin of the fetus, sparing its lungs the need to work. But Goodlin has not solved the problem of buildup of carbon dioxide and other poisonous wastes, and no fetus has lasted more than forty-eight hours. Dr. Geoffrey Chamberlain, a British scientist then in Washington, D.C., on a year's research. scholarship, has kept alive some much younger fetuses, weighing only 300 to 980 grams, which were obtained during Cesarean section for therapeutic abortions.
Chamberlain's method is to save the umbilical cord and connect it to a combination heart-lung-kidney machine. In a report in the Ob-Gyn Observer on his most successful experiment, Dr. Chamberlain wrote, "A brisk spontaneous flow [of blood] was noted 22 minutes postpartum; the fetus was kept on the circuit for 5 hours and 8 minutes. Only when a cannula slipped out by accident and could not be reintroduced was the experiment halted." Earlier during gestation (when the organism is still actually an embryo), Dr. D. A. T. New of the Strangeways Laboratory in England has cut out from their mothers mice only 2 millimeters in length and cultured them on drops of blood plasma. and nutrient solution. The embryos have rudimentary hearts and nervous systems. During the time they continue to grow in Dr. News experiment, they quadruple in length, their hearts begin to beat, their brain, spinal cord, eyes, ears, guts, and kidneys develop, and their limbs begin to bud. However, as in Goodlin's experiments with human fetuses, the lack of a placenta or placenta-substitute to draw off poisonous wastes has been fatal to the mice within forty-eight hours.
Perhaps the most promising of all the approaches so far is that of Drs. Warren Zapol and Theodor Kolobow at the National Heart Institute, Bethesda, Maryland. Zapol and Kolobow separate a lamb fetus from its mother at a gestation age of 125 days. The complete gestation cycle in sheep is 147 days, so the equivalent human fetus would be seven and a half months, an age at which the ordinary incubator is pretty adequate. However, instead of incubating the premature lamb, causing its lungs to function, Zapol and Kolobow keep it alive by what they call "extracorporeal perfusion." This involves placing the fetus in an unpressurized bath of solution resembling amniotic fluid (the same stuff used by the Italian Petrucci in his "experiment"). The lamb's umbilical cord is attached by a catheter (segmented polyurethane Lycra, Du Pont Corporation) to a circuit of machinery including a pump, a bag of adult-sheep blood, a silicone membrane lung (Medical Division, Dow Corning Corporation), and a bottle of antibiotics and nutrients. As the fetus is removed from its mother, the system is attached and the lung and pump are put to work to take over.
The significant thing about this method is that it seems to achieve both nutrition and carrying-off of waste products. The levels of various chemicals in the lamb's body seem to stay fairly constant: in technical language, ". . . the fetus remains in a metabolically stable state lasting several days." Nor is death, after several days, caused by poisoning: "During perfusion, the fetus rested quietly in the artificial amniotic bath. About once each hour it moved its head...or legs spontaneously. It exhibited a strong sucking reflex as well as a withdrawal reflex when pinched. After 55 hours of perfusion, the fetus abruptly underwent cardiac arrest." Apparently Zapol and Kolobow have problems remaining to contend with. But perhaps these are not insuperable.
The editorialist of the New Scientist has said, ". . . the development of the 'perfect' artificial placenta can only be a matter of time."
Early in 1970, the National Academy of Sciences published the results of a study undertaken by a panel of distinguished scientists, at the request of the federal government, on "The Consequences of Technology." The scientists were asked to estimate when various technological developments could be expected to take place. One of these developments was described as the "capability of fertilizing a human ovum in vitro and implanting it in a surrogate mother." (Surrogate motherhood will mean either a kind of space-age wet-nursing, or prenatal adoption, the principle in both cases being that an embryo from the egg of one woman may be implanted in the uterus of another woman at the right moment of her menstrual cycle.) At the time this panel of experts was asked for its estimate, the Edwards group bad already succeeded in getting the first stages of ii vitro fertilization, and was on the verge of getting cleavage to sixteen cells and perhaps beyond. Yet the average estimate of the panel for the date of achievement of this technology was 1995.
It was not the first time that those who are relied on for advice and prediction have failed to see bow, imminent the future is. The reasons for this failure not clear, but perhaps the general bewildering multiplicity of events and reports has something to do with it. Also, a panel entrusted with technological forecasting may be under strains of advocacy and opposition that are eased by pushing the future safely into the next century or to the very end of this century. However, in a democracy it is not only the experts who prepare the way for the future. Two familiar phenomena of democratic societies are the respected opinion-maker and the public opinion poll. Anyone who is interested in the social setting of embryological research should consult the evidence from respected opinion and public opinion; while the amount of it is not substantial yet, it does invite some working conclusions to be drawn. The New York Times, under the headline, "Test Tube Babies Ahead?" published an editorial about the Edwards experiments praising the hope they hold out for childless couples. Then the Times said:
Ultimately the prospect looms of human babies engendered by fertilization and development completely outside any woman's body-test tube babies, in the most literal sense. . . Abuses are easy to envisage, but it is encouraging that so far at least there is no evidence of such abuses in the use of artificial insemination to help women conceive. The real question even now is whether-and how-people can develop the sense of social responsibility that will be required if, by the year 2000 or earlier, women are able to have children without any of the morning sickness, special diets and other discomforts and dangers pregnancy now entails.
The Times mentions artificial insemination. At least 20,000 babies are conceived by mechanical means in the United States each year, and there may be a million Americans now alive who were so conceived. This indicates a widespread acceptance of the technique, though a recent Harris poll on "New Methods of Reproduction" had only 5 percent of the sample knowing what artificial insemination is. However, once it was explained to them, 49 percent of men and 62 percent of women approved insemination with the husband's sperm in cases of infertility; 24 percent of men and 28 percent of women approved insemination with anonymous donor sperm. The poll-takers also explained other 'techniques still not in existence, and got opinions on these. Thirty-two percent of men, 39 percent of women would approve of' embryo implants of the sort planned by Edwards-37 percent of men, 48 percent of women said they "would feel love" for a baby of their own conceived in this way. The poll-takers then asked about "test-tube babies," babies who at, no time 'would be inside the mother's body. Thirty percent of men, 35 percent of women were of the opinion that "this would be justified if wife might die or be crippled from childbirth." However, if "a woman just wanted to skip pregnancy and have a baby too," more than 90 percent of men and women would disapprove. Forty-seven percent of men, 53 percent of women said they "would feel love" toward such a "test-tube baby" of their own (for some reason, the percentage here, for both men and women, was higher than in the case of the embryo implant). Fifty-five percent of men, 61 percent of women said they believed a "test-tube baby would feel love for [its] family." A striking aspect of the results of this poll is that women invariably display a greater readiness to consider "new methods of reproduction" than men. This readiness is enhanced when the responses are broken down by age group: for example, of the women under thirty, fully 57 percent approved embryo implants. And yet, there was confusion too. Many of the men and women who approved of the new methods, including "test-tube babies," said they saw in them a way to bolster the ideal of monogamous marriage by ensuring that no couple need be childless; yet it was admitted that the new methods might have exactly the opposite effect-that is, of undermining further the ideal of the family.
The Times editorial and the Harris poll seem to show that there is important "public" enthusiasm for the goals, both official and possible, of the embryological research now under way, even if this enthusiasm is qualified by some doubts and fears. Indeed, it may be debatable how long the vociferous reaction in the case of a deformed baby from embryo-implant would persist, stifling grants and research. And if exquisite care is taken choosing the first embryo for implant, and the baby is born apparently sound, the excitement and, enthusiasm will probably overwhelm doubts, and criticism. The whole idea of "new methods" will be given a boost, and methods which had seemed fit only for science fiction will undergo a strange metamorphosis: "test-tube babies," for example.
Leaving aside for the moment the question whether such a method is desirable-is it feasible? The answer would have to do with technology, with whether ways could be devised to transfer the embryo fertilized in vitro to an artificial placenta which would duplicate for eight and a half months the environment of the natural placenta. The complexity of this invention of nature has already been 'hinted at. It has taken scientists five years just to get to understand the physiological process involved in the diffusion of oxygen and carbon dioxide across the placental membrane of the pig. How other substances-amino acids, vitamins, sugars, proteins-are passed is still a mystery. In addition, it is known that just a bit too much of a substance, or too little, too late or too early, can cause peculiar things to happen to embryos, whether they are mammalian and placental, or lower down on the phylogenetic scale. For example, if lithium chloride or magnesium chloride is added to fish eggs, the fish that are hatched will be Cyclopean. So it would be, at the least, a delicate, painstaking, and drawn-out task of plotting the career of a human embryo and fetus in the placenta from minute to minute, and then fabricating the machinery to duplicate the
placenta and a computer to monitor and direct it and oversee the piping-in of nutrients and carrying-off of wastes. The technological problems here are formidable, as fetologists working on the margins already know; but are they more formidable than those involved in, say, Apollo 11? Probably not, and using Apollo as a hackneyed but serviceable example, it might be said that for the United States, there is no technological project that is not assured of success provided the decision is made to invest whatever talent and money are necessary; provided also that there is a strong enough sense of national priority so that any misfortune (such as the death by flr of three astronauts on the pad at Cape Kennedy) does not endanger the life of the project itself. It would be too much to expect an artificial womb to "work" the first time, and people would have to be ready to accept the death of a fetus, even though, in contrast with Gus Grissom, the fetus never volunteered.
What reason would there be to make the development of an artificial womb a national priority? Once they are compiled, the specific and predictable benefits of an efficient artificial womb make an impressive list:
1. Fetal medicine would be much improved. By being able to monitor growth and development continuously, fetologists would be able to catch, and perhaps treat, sickness that occurs in the natural womb but does not show up until after birth.
2. Likewise, fetologists would be able to immunize a child for the diseases it would be likely to contract in the world, but while it is still in the sterile safety of the womb.
3. Tissue samples could be taken from the fetus, cultured, and frozen for storage, which would resist the rejection phenomenon should the human born ever require organ transplants.
4. An efficient artificial womb, far from increasing the incidence of birth defects, would reduce them by keeping the fetus in an absolutely safe and regular environment; safe, for example, from infection by German measles or drugs taken by the mother. There are now thousands of babies born in the United States each year with defects, ranging from relatively minor ones like harelip, to deformed limbs and congenital diseases of the nervous system. Whatever the magnitude of the defect, it is disastrous: doctors say that the immediate and overwhelming response of the parents is not love or pity, but anger; they are angry at the doctor, and angry at their deformed child for choosing them as its parents. This behavior is evident on the part of both parents alike: there is no special redemptive mother-love. Some parents will reject the child, or, after a guilty reaction, some will gird themselves for the job of lifelong sacrifice, of being "noble."
5. The same new conditions that would allow fetologists to prevent birth defects would allow geneticists eventually to be able to program a fetus' development for some superior trait on which society could agree: larger brain capacity, for example. This would seem to be the direction that is being taken anyway now, with genetic counseling. The artificial womb would lift such work out of the realm of the haphazard.
6. An artificial womb would make "sexing" (choosing the sex of the embryo) a simple matter.
7. That part of the population which would use the artificial womb would not have to worry about illegitimacy or doubtful paternity. For the first time it will be possible to prove beyond a shadow of a doubt that a man is the father of his children.
8. Women who are prone to miscarry, or who because of body structure or constitution run a danger of injury in childbirth, would be spared the unhappiness, disappointment, and danger. Other women would be spared the discomfort.
9. Women who decided to have children by the artificial womb might choose to undergo the operation in which the fallopian tubes are tied. This would not affect fertility, but it would be an instant, guaranteed, and permanent barrier to conception from sexual intercourse. No other "birth control" would have to be exercised, and the Pill, together with its harmful and unknown side effects, could be dispensed with. Of course, these women would never have to have abortions, either.
It would seem that from the development and use of an artificial womb, all of society would benefit, but women would stand to gain the most. The artificial womb would set about breaking to pieces the stubborn remnant of biological fact and cultural myth that makes all women pay. The invidious question whether women are different from men in some ultimate and irreducible metaphysical way, whether as a result they should be set and should set for themselves, different goals and different styles of life, would be removed from the context of biological difference, which has so far complicated its resolution with gratuitous 'factors, and would be set in a context of biological equity. Culturally, if the artificial womb "catches on," it will mean that the awefulness 'associated with pregnancy and childbirth will have nothing to feed on, and motherhood, if it continues to excite any awe at all, will not do so more than fatherhood. This will have its inevitable effect on the relation of women to men, women to their children, and the society or state to children. Once a woman has no more difficult or lengthy role in reproduction than a man (or not much more difficult or lengthy: she will still have to undergo laparoscopy once, when several dozen eggs will be collected and put into cold storage), she will find that society does not expect her to have a special relation to her offspring that takes up years of her life, and also she will not expect it of herself. Too, a society that can grow fetuses in a laboratory will be more disposed to have meaningful day- and night-care centers and communal nurseries on a large scale, for the state, being a third parent, will wish to provide for the maintenance and upbringing of its children. Natural pregnancy may become an anachronism. The two tiny laparoscopy scars, exposed by a bikini on the beach, will be as ordinary as our smallpox vaccination, but women will no longer have lost their figures in childbearing. The uterus will become appendix-like, though the ovaries will be as crucial as before. At the age of twenty, each girl will be able to choose to be superovulated and her eggs collected and frozen, as it is known that babies conceived by young women are less likely to suffer from mongolism and other birth defects. If there are advances in prenatal care, it may not be necessary to prohibit natural childbearing in the interest of public health and eugenics. In that case, the women who wish to put up with the old style and all that it implies will be free to do so. But it will be a throwback and increasingly rare as the manifest advantages of the artificial womb make it likely to win the competition.
Most, if not all, of its disadvantages might be more apparent to us than real to the next generations. We bear it in mind that a man-made mutation like this, finishing what the Pill started, unprecedented in evolution perhaps since sea creatures grew lungs and came out on land or apes developed the ability to touch thumb to forefinger, must have its effect on the body and mind of everyone in society, men not much less than women. Might not everyone, and particularly women, also suffer from the artificial womb? The myth of the beatific Madonna has, after all, among its various sources the fact that some women do experience unusual wellbeing when they have a baby. A more recent myth is that women on the Pill for a long time, who have much sex but never a baby, suffer the opposite of the bodily and psychic happiness of the Madonna. Does this mean the body has its own wisdom and that for, women to be given access to an artificial womb would be to go against the deepest instincts provided by nature?
Again, the question may be invidious. In the first place, as a matter of fact, for every beatific mother in our society there is at least another with "postpartum blues." To propose a "fundamental nature" for women (or men) to which it is immoral or unwise to offer an alternative may be to support a fallacy which is really old-fashioned. The well-being of the Madonna, her rosy complexion, may have as simple an explanation as that during pregnancy and lactation, her body's production of estrogen has shot up: maybe a woman having a baby by the artificial womb might take estrogen orally.
But won't women be "alienated," as we say, from their children, causing further distance to be put between all of us from the crucial beginning, which is not what we need? Again, perhaps an invidious question. In the 1840s, opponents of Dr. Simpson asked whether (actually they claimed that) anesthesia during labor would make children "strangers" to their mothers. Has this proven true? Maternal love does not seem to be connected with the pain of childbirth, or even with childbirth; we know that some women beat the children they have borne, while others love the children they have adopted.
However, by "creating life" won't we be raising ultimate questions that we are not prepared to answer, such as "What is a human being?" The effect may well be to raise such questions. As for "creating life," that is to misunderstand what the artificial womb will do. It will not "create" life, for the materials which contain all the factors for differentiation, growth, and genetic coding—the egg and sperm will not be created or fabricated: they will only be given another environment in which to work out their process. Sexual reproduction will be preserved; only intercourse and reproduction will be separated, once and for all.
The "ultimate" questions will be harder to ignore, perhaps. But this has been predicted. Jean Rostand, the French biologist and Nobel Prize winner, has considered what life will be like and what questions people will have to face up to when the artificial womb and other "inevitable" technologies become a reality:
People will live for two hundred years, or even more. There will be no more failure, no more fear, no more tragedy. Life will be safer, easier, longer. But will it still be worth living? . . How shall we contrive to exercise the formidable powers allotted to us . . . ? How . . . shall we avoid finding ourselves on the perilous slope and yielding to the abuses of a Promethean intoxication?
Well, Rostand says, "our task will be to improvise the solution, taking account of the collective mentality, of the social and moral situation [and remembering Bacon's warning], 'Knowledge, if it be taken without the true corrective [charity] hath in it some nature of venom or malignity.'"
Rostand assumes the artificial womb and other such innovations are "inevitable": that seems a peculiar idea. He also predicts that when the womb arrives it must have a universal effect. Here he is evidently right. If there is a single prototype artificial womb made and successfully tested, it is unlikely that it will turn out—as the Apollo missions might—an exorbitant stunt without consequence for "the man in the street." Because it will literally be down to earth, an artificial womb will have the potential to change the life of every person. But is the artificial womb "inevitable," as Rostand says? "Inevitable" seems to imply that something will come to pass without our doing anything or despite our intervention, which in the case of an artificial womb is nonsense. And yet there is a meaning of "inevitable" which, in this context, is not ridiculous. This is the meaning which in effect asks to what extent human beings exercise free will, and to what extent they are determined by forces forever beyond them. A very ancient question. Yet is it conceivable that if Dr. Simpson, in 1842, had not decided to give anesthesia to a woman in labor, anesthesia would not be routinely used in labor today? It is not conceivable. If he had not done it, some other doctor would, driven by the combination of curiosity, sympathy, and ambition which many men, not just a single indispensable man, are endowed with. The picture of the solitary scientist breaking ground may be excessively romantic. Without denying the medical scientist in particular his glory, his Nobel Prize, and the gratitude of the people whose suffering he has eased, it may be said that the scientist is far from being on his own, that he is, as we all are, an agent of something, determined by a force, a momentum which blurs distinctions between "it has become possible to do it," "it should be done," "it must be done," and is resolved in the inevitable: "it will be done."
Looked at in this light, it would not seem to make much difference (except, obviously, to the volunteer childless couples at Cambridge) whether Dr. Edwards decides to implant an embryo: the operation is going to take place pretty soon whatever he decides or does. Likewise the question whether what is about to be done in embryology, and what is about to be done in fetology, will ever come together in its logical consummation. If it becomes a national priority, it will be achieved sooner; if unlimited money and support are not forthcoming, it will be achieved later. But it is hard to imagine it not being achieved at all.
Certainly it would take more exertion, over the long run, to prevent it than to achieve it, and why prevent it? Who is to say that Monsignor Vallainc, the Vatican press officer who branded the Edwards experiments "immoral acts and absolutely illicit," is not the hapless spokesman of cruelty and stupidity, our contemporary version of the ministers who damned Simpson? In any case, it is not the thirteenth century anymore, and the centers of research happen not to be in Russia or in Roman Catholic theocracies. There is no forbidding most things and no arresting Dr. Edwards and charging him with murder. More than this: the research is conducted quietly, indoors; it does not require the vast hardware of an Apollo project, and there are no thunderous blasts and clouds of smoke. The expunging of perhaps our foremost Myth, with its ancient, numberless effects of inspiration and practice, habit and suffering, may be accomplished both inevitably and quietly—which leads to the ironic part, that whether anyone, or any movement, comes out for the artificial womb, or not, will make little difference in the end. The only difference it might make—and perhaps this is no small thing for the race—is that at least we will be able to say that our liberation did not catch us by surprise.
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