Making Babies

Five predictions about the future of reproduction

By Alexis C. Madrigal

Forty years ago, there was exactly one way for humans to reproduce. A man’s sperm would combine with a woman’s egg, inside of her body. Together they would form a zygote, which would become an embryo, and then a fetus. With any luck, the woman would carry the fetus to term, and a baby would be born. The process had not changed since long before anyone could call us human. Until one day, after years of trial and error, Dr. Patrick Steptoe and Dr. Robert Edwards combined an egg from Lesley Brown with sperm from her husband, John, in a petri dish and implanted the resulting embryo in her uterus. On July 25, 1978, Louise Brown came squalling into the world, heralding a revolution not just in the mechanics of reproduction but in the surrounding culture.

At the time, James Watson, a co-discoverer of DNA’s double-helix structure, warned that if in vitro fertilization were allowed to proceed on a broader scale, “all hell will break loose, politically and morally, all over the world.” Since then, not only has reproductive technology gone ahead, it has headed in previously unthinkable directions, and with little public scrutiny. For example, over the past 20 years, a new procedure called intracytoplasmic sperm injection has allowed fertility clinicians to select an individual sperm and insert it into an egg. It is the only reliable option for men with very low sperm counts or low-quality sperm, and for the hundreds of thousands of men it’s enabled to have children, it’s been life-changing. Happily, the procedure appears to cause only a relatively minor increase in the risk of birth defects.

Future reproductive innovations are likely to develop in similar ways—led by practitioners, with little U.S.-government oversight. Few people, it seems, want to stand in the way of someone who desires a biological family. And so far, almost no one has. But some of the reproductive technologies on the horizon could test our flexibility. Here, drawn from interviews with scholars, doctors, and entrepreneurs, are a handful of guesses about how the future may change what’s involved in making a person—from the ease of getting pregnant, to the mechanics of procreation, to our very definition of family.

1. It Will Take a Village to Make a Child

Sperm and egg donation and surrogacy have already enabled unusual parental configurations. In some cases—say, a father contracting with an egg donor and a separate surrogate mother—a new baby could be said to have three biological parents. But this is only the beginning of what science may make possible in the near future. One new IVF procedure would combine the nucleus of a patient’s egg with mitochondrial DNA from a donor’s egg. The FDA is mulling approving the technique, which could prevent diseases that originate in mitochondrial DNA; it’s already been successfully tested in monkeys.

Or take uterus transplants, in which one woman’s healthy uterus is implanted in someone else’s abdomen. Since 2012, nine Swedish women have received a uterus donation from a relative—in most cases their own mother. They’re now undergoing IVF treatment, to see whether they can conceive and carry a baby. If successful, they’ll be the first women to bear a child with another person’s womb. Not only that: their children will in effect be sleeping in the same “room” that they once did. The implications are fascinating. As Charis Thompson, a sociologist at the London School of Economics who has written a book about IVF, observes, “Parenthood is multiplying.”

2. Your Biological Clock Will Be Personalized …

One of the key problems in fertility research is how to help women who wish to start families later in life. Many women in their late 30s and beyond turn to IVF, usually with little sense of whether the physically demanding and expensive treatments are likely to work. Services like Univfy are trying to help women understand their own fertility better. One of Univfy’s co-founders, the ob‑gyn and fertility researcher Mylene Yao, says that women are entitled to a better read on their chances of conceiving through IVF than the rough age-based estimates that most fertility clinics provide. “There is no such thing as an average 38-year-old woman,” Yao told me. Her company draws on detailed data from a five-year study of IVF patients and other predictive models to provide personalized information about an individual’s likelihood of conception. She compares the effort to those of Netflix and Amazon: “We’re all, as consumers, getting better predictive information with online shopping than with health care.”

3. … And Procreation Will Be Precisely Timed

Max Levchin is a co-founder of Glow, a fertility-tracking app that helps users time sex for the greatest chance of conception. This isn’t so revolutionary—solid knowledge of the menstrual cycle, a thermometer, a pen, and paper will let you do much the same thing—but by allowing users to pool data anonymously, it could lead to a better understanding of population-wide fertility patterns. There have been surprisingly few large-scale studies of couples’ efforts to conceive; Levchin hopes that data from Glow can help change that.

The problem is, the data that people record are not very reliable. For example, slight temperature variations are key to predicting ovulation, and deviations in exactly when a woman takes her temperature can add noise to a data set. Down the road, Levchin sees simple sensors having a big effect on a couple’s odds of conception and, ultimately, on our understanding of fertility patterns. He envisions a sticker-like thermometer that could “sit in some place, like the small of the back,” he says. “You’ll have a continuous feed of someone’s temperature.”

Such monitoring could be even more important for expectant mothers. Already, Taiwanese designers are working on an app called Fetus Care, which they say will use data from a sensor to detect worrisome uterine contractions or an abnormal fetal heart rate. Perhaps one day implantable sensors will track the interior state of the womb. After all, the FDA has approved ingestible data-logging sensors for use in other parts of the body.

4. Synthetic Sperm Will Save the Nuclear Family

As long as we’re entertaining far-out but technically feasible scenarios, the most radical revision in reproduction could be the creation of artificial gametes, a k a sperm and egg cells. Researchers may ultimately be able to take a cell from an adult man or woman, turn it into a stem cell, then change that stem cell into a sperm or an egg. Doctors have already succeeded in breeding same-sex laboratory animals in this way.

Timothy Murphy is a philosophy professor at the University of Illinois College of Medicine at Chicago whose work focuses on the bioethical implications of reproductive technologies for gay, lesbian, and transgender people. He points out that creating artificial sperm and eggs could, rather than leading to radical social change, actually preserve a normative family structure. “For gay and lesbian couples, the synthetic gametes would eliminate the need for a third party,” Murphy notes. This kind of assisted reproductive technology—“unnatural” as it might be—would allow same-sex couples to keep reproduction solely within the family.

5. Genotyping Will Breed Conformity

Here’s a final paradox: even as reproductive freedom increases, enabling more types of parents to have children, these parents may choose children who fit a narrower and narrower notion of normal. Charis Thompson, the sociologist, told me about a conversation she recently had with a British infertility doctor, who gave a disturbing preview of where we might be headed.

“You start out offering these prenatal screenings for certain conditions that everybody agrees are very severe. It is not particularly eugenic, but about alleviating the suffering of the child and the parents. But there is slippage,” she said. “The more you can test for and screen out, the more people do. And the example this person gave was the high number of people who will abort a fetus that is found to have an extra digit.”

A mere 11 years after the completion of the Human Genome Project, it is technically possible to scan an embryo’s entire genome during the IVF process. If parents are already aborting pregnancies to avoid extra fingers, how many will resist the temptation to implant only the embryo with the “best” genome?

Which is to say, the future of reproduction might be increasingly diverse families making increasingly similar babies.


A Brief Chronicle of Assisted Reproduction

History

1677: Antonie van Leeuwenhoek observes sperm under a microscope.

1784: First successful artificial insemination of a dog

1934: The German physician Herman Rohleder publishes Test Tube Babies, a book about assisted reproduction.

1978: Louise Brown, the first IVF baby, is born.

Predictions

2029: If current trends continue, the twin birth rate hits 4.3 percent, up from 1.9 percent in 1980.

2050: Age barriers to childbearing could be effectively eliminated through egg freezing, IVF, and artificial-womb technologies.

This article available online at:

http://www.theatlantic.com/magazine/archive/2014/06/making-babies/361630/