As I watched the progress of my mini-brain through the microscope, it was not the first time I’d seen cells with my genes, alive in a glass dish.
But the ones I’d seen previously weren’t exactly mine. Only 50 per cent of their genes had anything to do with me. The rest came from my partner. They were IVF embryos, divided at around the four-cell stage.
Did I anthropomorphize those embryos, imbuing them with personality, casting them as plucky little characters determined to give it their best shot at becoming a baby? You bet I did.
What were these entities, though? Potential people, some might say, over which I have no right to assert any sort of ownership (except legally). Yet it turned out that they were not potential people. For whatever reason, even those that had looked most promising didn’t have what it takes to become a baby. Perhaps they just didn’t get lucky, but it’s more likely that in some way or another the biology was flawed. As we saw earlier, most human embryos at this stage – just two days after conception – prove to be unviable, whether they are conceived in vitro or in the body. So it’s not at all clear how much scope there is for improving the current success rates for IVF, which stand at typically around 20 to 30 per cent for healthy women under 35.
In vitro fertilization changed the way we can procreate, but it did more than that. It turned our view of ourselves upside down in a way that is rarely acknowledged. It showed us our cellular beginnings, complicating the distinction between the cell and the person. It separated sex from procreation, and it did so at a time – in the late 1960s and the 1970s – when sex, gender and family roles were being subverted and reconfigured as never before. IVF made sex optional, just as the contraceptive pill made procreation optional.1 It transformed our ability to study the human embryo. And it produced a host of questions on which traditional ideas about society, marriage, morality, biology and reproduction offered little guidance. We are still finding our way through this new landscape of techniques for growing humans.
Embryology has revealed the embryo to be an ambiguous and protean thing. In one view, it is a colony of cells “exploiting” the maternal environment to its own benefit. Especially in its earliest stages – as a blastocyst, say – it seems more akin to “human tissue” than to a human. It may exchange cells with the mother. It is certainly not, at any rate, an autonomous, independently viable organism. Its future is contingent, fragile, uncertain, and quite possibly doomed.
All the fractious and furious arguments about the “moral status of the embryo” arise from the incommensurability of cell and person. When, thanks to IVF technology, we became able to see and even intervene in the earliest stages of an individual’s life, we discovered that we no longer had adequate notions of personhood needed to think about the status of that living entity. Some of us may now see images of their early “selves” as clusters of fewer cells than can be counted on the fingers of two hands; as embryos produced in a dish, ready to be introduced to the womb.
So the anguished ethical debates that surround assisted conception are much more than attempts to establish the ground rules of appropriate legislation. They are efforts to grapple with this re-imagining of what it means to be a human being. That cluster of cells was once all we were. At what point did they become us?
* * *
We’ve known for at least several centuries that the physical act of sexual intercourse isn’t essential for reproduction. The first recorded instance of human artificial insemination was performed by the Scottish surgeon John Hunter in the 1770s, who allegedly made a woman pregnant this way with her husband’s sperm. Rather better documented was the procedure in which the American doctor William Pancoast used donor sperm in 1884 to impregnate a woman while she lay unconscious under general anaesthesia with chloroform.2 Having inspected the husband’s sperm under a microscope, Pancoast knew that the man was infertile, and he apparently considered that he was doing the couple a favour. Neither of them knew about the operation at the time. The doctor told the husband later; the wife was never informed.3
The microscope was at that time disclosing the biological moment of conception. The entry of a sperm into a human egg was first observed in 1879 by the Swiss zoologist Hermann Fol. This apparently did not produce an embryo, but growing embryos was one of the first things researchers attempted after Carrel and Burrows refined the art of tissue culturing. In 1912, American anatomists John McWhorter and Allen Whipple found that they could keep three-day-old chick embryos alive in vitro for up to 31 hours. A year later, the Belgian embryologist Albert Brachet showed that he could sustain rabbit embryos at the blastocyst stage in a dish.
Creating a viable embryo from gametes outside the body – genuine in vitro fertilization – was another matter. Rabbit embryos made by IVF were reported by the American biologist Gregory Pincus in the 1930s, and he even claimed in the following decade to have done the same with human eggs and sperm – but these findings were never verified. The first convincing report of IVF as a reproductive procedure for mammals appeared in the 1950s from Pincus’s collaborator, Chinese-American biologist Min Chueh Chang, who described the birth of live rabbits conceived this way. To verify that they had truly been produced by IVF, Chang colour-coded them: he combined the eggs and sperm of black rabbits and transferred the embryos to a white rabbit for gestation. The baby rabbits were black.
Human fertilization is harder. It isn’t just a matter of throwing eggs and sperm together and letting them do their thing. As we saw earlier, it is a complex process that requires some intervention of the female reproductive organs, and for decades no one could find a way to make it happen outside the body. Simply not enough was known about the basic biology of fertilization.
American gynecologist John Rock was determined to obtain a fertilized human egg to examine at the very first stages after conception, and he initiated a programme in the 1930s that today almost beggars belief. With his assistants Arthur Hertig and Miriam Menkin, he searched for fertilized eggs in volunteers scheduled for hysterectomy. The researchers hinted to the women that they might have sexual intercourse just before the operation. That the patients agreed to the procedure testifies to an extraordinary generosity in the cause of furthering an understanding of fertility and its obstacles. That the research was permitted at all shows how little recognition there still was of the need for ethical regulation of medicine.
In 1944, Rock and Menkin claimed to have achieved the first human in vitro fertilization, from eggs collected during surgery.4 The researchers were able to watch the fertilized eggs begin to divide, but that’s as far as they got: they couldn’t claim to see a genuine embryo in the petri dish. Rock went on to make pioneering contributions to the development of the oral contraceptive pill.
There was something of a Wild West ethos in the early years of IVF, when speculative research relied on boldness, persuasion and a certain amount of hubris. While working at the National Institute for Medical Research in north London in the 1960s, physiologist Robert Edwards obtained eggs from any surgeons and gynecologists he could find who were sympathetic to his aims. They were acquired in the course of ovarian surgery, and the “donors” were not asked for consent. Such liberties were the order of the day, but although Edwards was motivated by a strong desire to alleviate the anguish of infertility, it’s hard not to see in this image of the male doctor experimenting on unsuspecting women to initiate “new life” a cultural attitude that had not advanced much since Pancoast’s time. As anthropologist Lynn Morgan has pointed out, the history of embryology is characterized by the anonymity of the women from whom embryos and eggs have come: they are often treated as a passive, faceless source of biological material for study. The wariness or even antipathy of some feminists towards reproductive technologies may stem from a well-founded concern that they retread narratives of male control and dominance.
Fame and glory did not feature high on Edwards’s agenda, however. On the contrary, his efforts courted attacks and ridicule from his peers. His PhD student Martin Johnson summarizes the atmosphere in which his team worked:
If I’m honest, while we were doing our PhDs, and even into our postdoctoral time in the lab, [we] were very unsure about whether what Bob was doing was appropriate, and we didn’t want to get too involved in it. The reasons for that were partly because it was quite unsettling as graduate students and early postdocs to see the sheer level of hostility to the work – when Nobel Laureates and the Fellows of the Royal Society and the emerging bigwigs of the subject … were lambasting into [sic] Bob and saying, you shouldn’t do it … you had to say, well, what’s going on here?
Despite the scepticism, antagonism and ethical disapproval of his peers – eminent biologists such as James Watson and Max Perutz later warned that IVF might produce babies with serious birth defects5 – and the refusal of the UK’s Medical Research Council to fund his work, in 1969 Edwards, working with gynecologist Patrick Steptoe and Edwards’s student Barry Bavister, published in Nature a detailed account of human sperm entering an egg in vitro.6 “Fertilized human eggs,” they wrote, “could be useful in treating some forms of infertility.” The following year Edwards, Steptoe and their clinical assistant Jean Purdy published images of fertilized human embryos grown to the 16-cell stage; by 1971 they had developed embryos in vitro to blastocysts.
The moment of conception? Sperm on the threshold of entering an egg.
Steptoe had the surgical knowhow to re-implant such embryos in the womb, and the researchers knew there would be no shortage of volunteers for this highly uncertain and perhaps even dangerous procedure.
But these photos of human embryos in a dish had a deeper significance. For the first time, we could we see the start of the journey that had been previously tracked back only to something recognizable as a kind of homunculus, a blob of tissue in which a shrimp-like head was already forming.
We have been able to think about ourselves in developmental terms only to the extent that we could see that process. “Embryos as we know them today are a relatively recent invention,” says Lynn Morgan. “A hundred years ago, most Americans probably would not have been able to conjure up a mental image of a human embryo.” Morgan points out how some cultures did not regard the tiny entities sometimes revealed by spontaneous abortion as truly human, and as possessing the same moral status as people.7 Many “pro-life”8 groups now argue their case by mobilizing the imagery of biomedical technology, using the in utero fetus as a stand-in for the embryo to imply the presence and continuity of personhood from conception onwards.
According to historian of science Nick Hopwood, the concept of human development has been actively constructed, not simply uncovered as a “fact of life”. That process, he says, began in earnest with the embryology of the late nineteenth century. Biologists and physicians presented embryogenesis as a complex yet unremarkable biological process, and it was often assumed that the moral questions that it raised could be clarified and even resolved merely by better scientific understanding.
We now know that this is not the case; if anything, the reverse is true. It was hard to know how to make sense of the ontogeny that IVF revealed. By what somersault of the imagination can we link the bawling baby with a little knob of cells resembling nothing much more than a cluster of soap bubbles?
* * *
We tried to make that connection with a phrase that yoked together the archetypal apparatus of the chemical laboratory – the arena of the artificial – with the sacred product of conception and birth. We began to speak of the “test-tube baby”.
Test-tubes were never involved in IVF; their role here is purely symbolic. The phrase “test-tube baby” was first coined in the early twentieth century, when a public understanding of biology was so rudimentary that the de novo creation of life itself from mere chemistry sounded entirely feasible, even imminent. In that circumstance, what we today call IVF – initiating conception and perhaps growth too outside the body – was a feat that looked not so far removed from a god-like creation of life itself.
The child housed in a glass receptacle has long been a part of the imaginarium of human life and death. Babies stillborn, miscarried and deformed have been preserved in jars and bottles for centuries. As Susan Merrill Squier has documented, the image of a being not just stored in a bottle after death but actually created in that vitreous, artificial environment goes back at least to the homunculus that alchemists and mystics in the Middle Ages and Renaissance claimed to be able to make in the laboratory. There are recipes for doing it; Goethe’s Faust describes the genesis of such a creature and illustrates the moral context in which they would be evaluated.9
The in vitro culturing of cells transformed that narrative and gave us the test-tube baby. In his 1924 book Daedalus, or Science & the Future, J. B. S. Haldane described the promise of ectogenesis (in vitro gestation), inspiring his friend Aldous Huxley to pen his famous satire a decade later. In the future society of Brave New World, ectogenic babies are chemically manipulated to create a graded caste system of intelligence.
Haldane saw this (putative) technology as a blessing. It could support both the emancipation of women – which he welcomed in principle – and eugenic social engineering to preserve the vigour of the human race. Haldane and Julian Huxley worried that the widening opportunities for women were making the more educated and intelligent among them less inclined to bear children as they discovered that there could be more to life than domestic drudgery. Lacking such prospects, the “lower classes” went on breeding regardless, with the result (Haldane feared) that the gene pool was degenerating. As Haldane’s narrator in Daedalus explains from his future vantage point in the twenty-first century:
Had it not been for ectogenesis there would be little doubt that civilization would have collapsed within a measurable time owing to the greater fertility10 of the less desirable members of the population.
In this way, making people artificially in the controlled environment of the laboratory played to concerns in the inter-war period about population control and the decline of civilization.
Haldane never imagined that everyone would welcome his vision. “There is no great invention, from fire to flying, which has not been hailed as an insult to some god,” he wrote. “But if every physical and chemical invention is a blasphemy, every biological invention is a perversion.” He knew that some would call ectogenesis and related techniques for manipulating conception in the laboratory “indecent and unnatural”, and he was right. In her overwrought 1938 article for Tit-Bits inspired by the tissue-culture research at Strangeways (see here), Norah Burke spoke of “chemical babies” and asked, “What sort of creatures will these be?” The article’s title guided the reader towards the desired recoiling response: “Could you love a chemical baby?”
But the freighted term “test-tube baby” was itself minted, it seems, by none other than Thomas Strangeways. “It will thus be seen,” he said in his 1926 lecture on tissue culture, “that the idea of the ‘test-tube baby’ is not inherently impossible.” It was a more resonant term than Haldane’s ectogenesis, which sounded like scientific jargon. Here Strangeways conjured up an image anyone could appreciate, at the same time astonishing, exciting and terrifying. It is an icon of modernity itself: of humanity in the age of the scientific control of life.
A stock representation of the “test-tube baby”, showing how the recognizably human infant form stands in for the pre-blastocyst embryo, which is in fact what is produced in the in vitro stage.
In short, “test-tube baby” was the right phrase for the right time. That a human could be a product of artifice seemed almost an inevitable conclusion of industrialized mass production, which after all seemed to be generating everything else in people’s lives on an assembly line, standardized, tested and commodified.
It is a short step from Haldane’s ectogenesis to Aldous Huxley’s Central Hatchery, but perhaps even more conforming with Strangeways’s phrase is the idea of the robot as it was first conceived by Czech writer Karel Čapek in his 1921 play R.U.R. The abbreviation is the name of a company, Rossum’s Universal Robots. But whereas Čapek’s robot (the Czech for “labourer”) today conjures up humanoid devices of metal and wires – the Terminator with its synthetic skin stripped away – Rossum’s robots weren’t like that at all. They were made of pliant flesh.
The director-general of R.U.R., Harry Domin, explains that old Rossum, the inventor of the robot, arrived at his discovery via chemical experiments conducted in test-tubes that aimed to create a living substance. Rossum was a marine biologist11 who discovered a new form of “protoplasm” that was considerably simpler in chemical terms than the stuff found inside cells. “Next he had to get this life out of the test-tube,” says Domin.
From this artificial living matter, the company fashions a kind of dough that can be shaped into organs. “There are the vats of liver and brain and so on,” says Domin. “Then there’s the assembly room where all these things are put together.” The process owes a debt to Henry Ford’s factory automation, but it’s obvious that the underlying technology is that of tissue and organ culture pioneered by Carrel and the Strangeways researchers.
The same fears that Čapek mined – of the homogeneous, industrial-scale automation of reproduction – drove David H. Keller’s story “A Biological Experiment” in a 1928 issue of Amazing Stories. It anticipates Brave New World with its dystopian future society in which sex is forbidden and babies are grown in factory vats according to a standardized specification engineered by radiation treatment, to be dispensed to couples who have been granted the requisite government permit.
Dystopias of course always make for better stories than utopias. All the same, it is significant how often these tales of engineered “chemical babies” end with the conquest by the manufactured beings of the rest of humanity. R.U.R. established the template for tales of malevolent robot rebellion and conquest that persist today with Westworld and Skynet in the Terminator series; fiction has little use for a robot that always does what it is told. The unspoken assumption here is that there is something inherently amoral and ruthless about people made by artificial means. In Norah Burke’s exposé, the “chemical babies” are portrayed, for no apparent reason, as “sexless, soulless creatures of chemistry” that may in the end “conquer the true human beings” and lead to an “end to humanity”. But perhaps it is not so hard to understand where, in England in 1938, such fears were really coming from. “How to grow a human” is not and has never been a question for science alone but is deeply and inevitably a sociopolitical affair.
The test-tube baby trope wasn’t confined to Amazing Stories; it was just as apt to appear in the august pages of Nature. Its genesis shows why it is quite wrong to suppose (as too many scientists do) that science just gets on with its sober work while media and popular culture come along and traduce it with sensationalist slogans and images. The truth is that the “professional” and “popular” faces of scientific innovation co-evolve. Honor Fell’s enthusiasm for popularization and dissemination of the research at Strangeways – motivated in large part by a desire to win support and funding for the research – dissipated as she saw the lurid headlines and science-fiction stories that it generated. Alarmed by rumours that the Strangeways lab was aiming to produce test-tube babies, Fell insisted in 1935 that tissue culture should be presented by scientists only as “a valuable technique with peculiar advantages and limitations”. That did not prevent the Daily Express from writing the following year that at Strangeways “living tissues are growing and developing exactly as they would in the complete parts of living animal bodies.” A quote in that article from a suspiciously anonymous scientist “from another Cambridge lab” claimed that the research takes “the first steps to the Brave New World visualized by Aldous Huxley, with babies cultivated in test tubes”. As historian Duncan Wilson points out, while Fell was happy to write and broadcast about the work at Strangeways, being cast as the creator of soulless chemical babies was “clearly not the sort of propaganda that she had in mind”.
One might be tempted to point the responsibility for those distortions and exaggerations back at Fell. But she was surely right to suggest that scientists should talk about what they do, and try to make it relevant to their audience. The point is that they must recognize that they will never keep control of their narratives and metaphors, so they had better think rather carefully about which ones they select. The same tensions are apparent today in discussions of genetics and genomics. The scientists deplore the simplistic genetic determinism that has evolved in the public view of the subject, but it is an easy matter to justify a response that says, “Well, you started it.”
* * *
I met Louise Brown – the first person to have been born by IVF – on her fortieth birthday in 2018, and it brought home to me how recently it is that we found a new way of growing people. Louise is a relative youngster; I was preparing to head off to university when she was born. Her eldest son was just 11 years old on her fortieth anniversary.12
Saying that Louise came from a “new way of growing people” might sound derogating, as if she stepped from the pages of Aldous Huxley. But we were all grown. It’s just that, before 1977, the process had never begun outside the body. I put it this way to remind us that we were each one of us unfolded piece by piece from a fertilized egg in an orchestrated proliferation of flesh. Louise’s conception, and what followed from it, played a big part in making that process explicit and visible, forcing us to grapple with what we could previously wrap in tradition and myth, euphemism and dogma. Science has a way of doing that.
It’s easy to forget how much was invested, before IVF, in a contingency that turned out to be merely a matter of finding the right biochemistry. Back then, there was a common feeling that the act of conventional sexual intercourse – within marriage of course! – not only produced but sanctified the child. “[The] tradition,” wrote Life magazine’s science editor Albert Rosenfeld in its 1969 issue on “science and sex”, “has been to regard a child as the product of the marriage bed – and therefore, in some way, sacred.” It was as if the coy phrase “married love” were some vital ingredient surrounding the gametes like an aura and ensuring the normalcy and propriety of the child. But, Rosenfeld warned:
the force of love may henceforth have little to do with the process. The crucial fragments of the world may simply be taken out of cold storage on demand … love in the old sense would no longer be a part of the procreative process.
The sentiment here is much the same as that which led Pope Pius XII to condemn artificial insemination in the 1940s on the grounds that it would “reduce … the act of married love to a mere organic activity for transmitting semen”, turning “the sanctuary of the family into a biological laboratory”. Rosenfeld’s “force of love” here indeed becomes almost an active biological agent, directing the outcome of cellular union like a spiritual transcription factor. Barely 50 per cent of the Americans polled by Life in 1969 imagined they “could feel love towards a baby” conceived by IVF from their gametes; only a few per cent more imagined that a child so conceived would love its parents. In the test-tube, it seemed, love evaporated.
All this created a sense of cognitive dissonance around Louise’s birth in 1978 – an event so familiar, so ordinary, that reporters did not quite know how to merge it with their science-fictional fantasies. Witness how Newsweek announced her arrival into the world by caesarian section at Oldham General Hospital in northern England: “She was born at around 11.47 pm with a lusty yell, and it was a cry round the brave new world.” Or this from the Daily Express: “She’s beautiful – that’s the test-tube baby.” Pretty much uniquely among people conceived by IVF, Louise is still “the test-tube baby”. She seems to have resigned herself to it with grace. Meeting her in person shows at once how absurd and misguided all those preconceptions were. The ordinariness of her family life in Bristol – Louise is, I believe, happy and even eager that it be seen as such – contrasts starkly with the strange kind of celebrity status that her then-unique mode of conception “in a test-tube” has given her.
The lexicon of IVF warrants further interrogation. For the newspapers insisted that Louise Brown was something else too: a “miracle baby”. And aren’t miracles supernatural events?
Yes indeed, and we know who the original miracle baby was, born of a virgin in Bethlehem two millennia ago.
To be enabled to have a child when you didn’t think it possible, like Louise’s mother Lesley Brown (who had blocked fallopian tubes), certainly seems marvellous and wonderful. But the insistence with which IVF children are even now denoted “miracle babies” speaks of other factors at play. It implies that this is no mere medical intervention in a biological process but has instantiated God’s work: an achievement both astonishing and hubristic. Faustian, you might say.
Anthropologist Sarah Franklin sees a quasi-religious connotation to the way IVF is portrayed as a “technology of hope”. Hoping for a child was once deferred to the grace of God, who alone decided whether or not to bring it into existence. In the absence of that hope and grace, what you have are souls in anguish: the “desperate” couples so essential to the media narratives of assisted reproductive technologies. That desperation, and its dependence on divine will, have the imprimatur of holy scripture:
Now when Rachel saw that she bore Jacob no children, Rachel envied her sister, and said to Jacob, “Give me children, or else I die!” And Jacob’s anger was aroused against Rachel, and he said, “Am I in the place of God, who has withheld from you the fruit of the womb?”
Infertility was once regarded as a sign of divine displeasure, and it still carries a moral stigma – in secular culture, often transmuted to the idea that women who cannot get pregnant are too uptight, while those who will not are selfish. As biologist Clara Pinto-Correia has said, “There is still not one social group, not one culture anywhere on earth, that doesn’t abhor infertility.”
But sexual intercourse and procreation was always a complex transaction in the Christian West. What mattered so dearly, so perversely, to the miraculous birth of Christ was that no sin was involved. Which is to say, no sex.13 Likewise, so much of the suspicion, prurience and religious condemnation that has surrounded IVF comes from the fact that it can produce a child without copulation. That creates a contradictory mélange of responses: is this a kind of special purity, or is it unnatural? Such uncertainty accounted for much theological unease about the medieval homunculus: not born of Adam, the being might be free of original sin. Before Louise Brown, the most famous person to have been made without sex in the usual sense was Frankenstein’s monster, who said to his maker, “Remember that I am thy creature; I ought to be thy Adam, but I am rather the fallen angel.”
Deep anxiety about procreation has always led us to corral and constrain sex itself (and has then tempted us to test and flirt with those boundaries). That, I suspect, is the fate of a creature facing Darwinian selection with a brain far larger than is strictly needed for the job: sex will always be more of a problem for us than for our animal cousins. But IVF brought new problems to weigh on the mind and the conscience. Among the many unsettling notions it invoked was that sex is now optional. Was that bad? Was it bad because sex is meant to be bad, except when (even when?) marriage made it obligatory? It was all very confusing.
* * *
The invention of in vitro fertilization was the pivotal moment in changing attitudes about the nature and uses of human cells. By creating more fertilized eggs than are generally re-implanted in the uterus, IVF produces “spare embryos” that may be used, with consent, for scientific research. It has made possible the entire field of human embryo research, while the availability of human embryonic stem cells in these embryos has opened up a new arena of biomedical study. At the same time, IVF permits intervention in human growth at its earliest stages, motivating new possibilities for overcoming disease but also fears of how biomedical technologies might be used to alter our natures.
On the one hand, somewhere currently in the region of 6 to 8 million IVF births14 have normalized the technique to the point where there is no longer any stigma or sense of unnaturalness attached to it. The Catholic church still officially bans it, but – as its authorities surely know – many Catholics take no notice. In some countries, IVF now accounts for around 6 per cent of the annual births.
On the other hand, I don’t believe we have yet culturally processed the shift that IVF has occasioned in our ideas about how humans come into being. Rather, we have constructed normative stories just as energetically as we made the idea of IVF alien and strange before it became a regular part of the reproductive landscape. Yet these narratives don’t eliminate our prejudices and preconceptions about how humans are (and should be) made. Those judgements simply seek a new object, which is found every time some new technology arrives to push back further the technological boundaries of conception. In place of the “test-tube baby” we now have the “designer baby”, the “three-parent baby”, the “saviour sibling” and more.
It’s a common mistake to imagine new technologies as being solutions to easily stated problems. If we were to assert that the automobile arose from a desire to travel faster, or the computer from a desire to perform complex calculations quickly, hindsight reveals the inadequacy of such formulations. Not only do technologies acquire a life of their own and take off in unanticipated directions, but they – especially the most transformative of them – come to represent something more than themselves, and far more than their inventors ever envisaged. They create new possibilities, but the possibilities are never neutral, ethically, morally, socially or politically. They are shaped and selected by hopes, dreams, fears, by cultural decisions and judgements. Technologies enter the language (“change gear”, “foot on the gas”, “I’m online”, “email me”), they provide alluring new metaphors (neither the genome nor the brain is like a computer, but you’d be forgiven for thinking otherwise from popular discourse), they reveal themselves in icon-laden visual shorthand.
That all this applies to IVF is no surprise, speaking as it did to such culturally resonant issues as procreation and infertility. In retrospect, there was not the slightest prospect that IVF would remain a medical procedure for addressing cases of infertility between married couples, which is what Robert Edwards and Patrick Steptoe intended. Not least, once it became a private and lucrative industry, other forces came into play besides the laudable goal of reducing the pain of infertility within marriage.
Should we try to take this transformative potential into account when we develop new technologies? It’s not obvious how that might be done. Even the most perspicacious of inventors and discoverers can’t be expected to foresee the psychic and cultural currents that their innovations will tap into. No one knew, before the advent of mobile phones, how much we craved the cocoon of a private mental space in public places, nor how thoroughly we could imagine ourselves insulated within it. We hadn’t guessed that we were so anxious to escape our surroundings into a place where we could curate our lives.
But we can learn from experience, and it would surely be no bad thing if the acknowledgement that technologies are much more than solutions to problems was recognized beyond, say, the small band of folks who, typically under the academicized banner of “science and technology studies”, make these considerations their business.
In the case of IVF, there should have been ample warning that a “cure” for infertility would activate powerful social forces – for there has never been a time in recorded history when we have not fantasized about the possibility of “making life”, and especially making people. Contentious issues ranging from abortion to genetic engineering, feminism to transhumanism are all channelled through that ex vivo union of sperm and egg. All are conditioned in one way or another by ideas about our own “essence”.
Philosopher Rom Harré caught the crux of the matter when he proposed that “our social identities, the kinds of persons we take ourselves and others to be, are closely bound up with the kinds of bodies we believe we have.” Because IVF has changed our beliefs about our bodies, it has changed our concepts of identity.
“Conception in vitro is now a normal fact of life,” writes Sarah Franklin, “yet having passed through the looking glass of IVF, neither human reproduction nor reproductive biology look quite the same.” IVF, she says,
confirms the viability of a new technological ground state, or norm, of human existence and renewal … The meaning of being after IVF … describes an ambivalent position that is constantly being reworked, rewritten, and recomposed.
Franklin argues that unease about the “artificiality” of the moment of in vitro fertilization and conception has in fact motivated social conformity in the presentation and practice of IVF. While her assertion that it “is designed to precisely replicate each of the steps in the journey to parenthood” seems a little hard to swallow for anyone who has actually gone through it, the imagery typical of IVF clinics has an assertively heteronormal, fairy-tale quality. And that is not simply a veneer that society and the marketplace has chosen to lay over a “neutral” science. Patrick Steptoe’s opposition to IVF for single or lesbian women on the grounds that it was unnatural and morally wrong obviously reflects the mores of his time (from which scientists have never in general been exempt); yet still this reminds us that the architects of new technologies do not work in a sociopolitical vacuum.
As Franklin points out, IVF clinics are keen to reassure clients that the technology is simply giving nature a “helping hand”. Sure, there is a bit of stuff that happens in the lab – but soon enough the resulting embryo is back in the uterus where it belongs, and everything goes ahead as normal, positively disguising the more radical implications. You’ll rarely see a media article about assisted conception without the obligatory image of an egg cell or few-cell embryo under the microscope. Chances are, it will show the IVF variant called intracytoplasmic sperm injection (ICSI), in which a lack of good sperm mobility – a common cause of fertility problems – is addressed by injecting a sperm directly into the egg using a tiny needle. The message here is complex and coded. With its luminous backlighting and the presence of technical equipment – the needle, and the larger pipette on which the egg cell is held – we are left in no doubt that this is a technological procedure. But the needle penetrates the soft, yielding egg in a cell-scale recapitulation of intercourse, whispering to us the reassurance that this is after all just a familiar sexual union, with the glassware there just to give nature that “helping hand”. The message is: Sure, this is a technology – but it looks a lot like real sex, right? In such ways, a wholly technique-driven procedure for making humans is naturalized and can be smoothly accommodated into our culturally approved methods of procreation. The “love force” triumphs after all.
An assertion of traditional gender roles is another of the subtexts of these constructed narratives – and of course, everyone in the adverts is better looking (and probably younger) than the average consumer. One can, I suppose, hardly blame IVF clinics for displaying a parade of gorgeous babies – those after all are the product. But the stock advertising tropes are revealing in themselves: of course these business ventures will emphasize their “superiority” (here measured by the pregnancy success rate) against rival brands. Any company in the parenthood sector does the same. What is odd about this market, however, is that there can be no guarantee that you will get the product you’re paying for.
Love–sex–baby: the reassuringly “normal” visual narrative of procreation offered by IVF clinics.
It’s often pointed out that the IVF narrative sidelines those for whom it doesn’t work, as well as the arduous nature of the process. It remains difficult, uncomfortable and uncertain. The success rate drops rather rapidly with the woman’s age. Egg collection for producing embryos is painfully invasive and doesn’t guarantee their quality.
The official narrative, not only in the media but also in much academic discourse, also makes little or no mention of the role of the male (whether or not he is to be a care-giving parent), reinforcing a perception that this is a female affair – albeit one originally developed largely by men15 and often conducted on women by male doctors and technicians. By tacit collusion, a picture emerges in which not just fertility but also infertility is solely the woman’s responsibility.
Should women welcome assisted reproductive technologies (ARTs)? Influential feminist writers such as Donna Haraway and Shulamith Firestone think so. Firestone, author of the groundbreaking feminist text The Dialectic of Sex (1970), agreed with J. B. S. Haldane that these techniques could be an emancipating force, albeit only if accompanied by a radical re-definition of gender, sex, parenthood and family. ARTs have the potential to dislodge stereotypes; feminist writer José van Dyck is right on the money when she says that one reason they face such opposition
is not that they are defying nature, but that they are defying culture. They profoundly challenge our preconceptions of a society that seems “naturally” divided along axes of gender, race, class, age and physical or psychological condition. They also challenge traditional social structures, such as the nuclear family, identifiable races or ethnic groups.
As Franklin has said, “There is a revolutionary purpose to be achieved through tools, machines, instruments, and biology, and indeed through their union.” That, of course, is precisely what worries social and religious conservatives about ARTs.
But while the possibility of freezing eggs or embryos is mooted today to delay childbearing so that young women can first build successful careers, one might question whether women should have to accept the status quo that imposes that difficult decision in the first place. Some feminist groups have greeted ARTs with scepticism, dismay and even outrage. They have been portrayed as a male conspiracy, orchestrated by “techodocs”, to oppress women or even to eliminate them from the procreative act.16 In the 1980s, the German militant feminist group Rote Zora bombed IVF clinics. Without condoning that kind of extremism, I think feminists are right to raise concerns: ARTs could challenge stereotypes, but they also have the potential to reinforce them.
ARTs and the science and technology that have stemmed from them – stem cells, genome editing, and advanced tissue culture – challenge deeply held preconceptions not just about procreation, sex and gender but about identity, self, life and death. It’s right that we should be unsettled by them, but this does not mean we should fear them. We can begin by bringing these challenges into the open, where we can talk about them honestly and frankly. The value of looking ahead to where such technologies might lead is not to predict, pre-empt and potentially forestall them, but to interrogate their implications for our ideas, values and morals here and now. To put it another way, Franklin argues that IVF is, for anthropologists (and, I think, for society generally), “good to think with”.
* * *
On the fortieth anniversary of Louise Brown’s birth, much of the media discussion was about those 6 million plus babies who came after. But as Franklin has said,
Even the somewhat surprising scale of human IVF’s expansion worldwide over the past thirty-five years may pale in the wake of its future significance – which will not only be measured by IVF’s expansion into genetic disease prevention but must also take into account a watershed point in the very meaning of the adjective “biological” as it becomes increasingly synonymous with technology.
Synonymous is perhaps going too far, but what Franklin is driving at here is the fact that biology is no longer distinct from technology. As we saw, IVF embryos provided access for the first time to a supply of human embryonic stem cells. These in turn led to the discovery of our cells’ unguessed plasticity.
Such studies on human embryos and their cells might help to improve IVF itself, as well as revealing new understanding of the process of “natural” conception and development: for example, illuminating the causes of early miscarriage and growth defects. “Research on human embryos has changed our fundamental understanding of the genetics of cell biology,” says Alison Murdoch, professor of reproductive medicine at Newcastle University. “As well as helping us understand why fertility of the human species is so uniquely bad, the research has extended applications of human embryology beyond the clinical treatment of infertility into prevention of other medical problems.”
Yet as we’ve seen already, research on human embryos is controversial. The idea of experimenting on “spare embryos” that might have the potential to become a human being (though many do not) is morally repugnant to some people. Others accept that excess embryos are inevitable if IVF is ever going to achieve good success rates, and feel it is better to use them to benefit science and medicine rather than just discarding them.
Where you stand in these issues depends in large part on what ethical status you feel the human embryo should have. That is of course a question with wider ramifications, especially for regulation on abortion. Does the embryo deserve the full rights and protections of a human person? Or is it – at least before reaching the fetal stage in which the central nervous system begins to develop – just a ball of cells, more tissue than person? The scientific picture makes the process of human development from zygote to newborn baby a continuous one, with no stage to which we can uniquely point as the threshold of personhood. Even fertilization itself is not a well-defined event – it takes several hours after a sperm enters an egg for the chromosomes to become united into the genome of the individual. Even then the zygote may yet divide into identical twins. Science can inform the ethical debate, but it can’t offer a definitive resolution.
Once IVF became a reality, the British government recognized that regulation was needed to navigate and police these problematic boundaries. In 1982, it convened a committee chaired by moral philosopher Mary Warnock to draw up recommendations. The Warnock committee fudged the matter of the embryo’s ethical status, calling it a “potential human being” without explaining if or how this “potential” made it less or equally a moral object compared with a human being delivered into the bright light of the world. The report argued that the human embryo should be accorded “special respect” and not be treated as mere material for experimentation. But what did that mean? That experiments be conducted with a suitably sober countenance? The Warnock report resolved none of these issues – and did not pretend otherwise. Any answers, it said, would be “complex amalgams of factual and moral judgements” – and should be set to one side in favour of a more practical resolution about “how it is right to treat the embryo”.
That avoidance of definitive judgements might sound like a failing, but it was rather an inevitability that was put to good use. The report recommended that research on human embryos be limited only to embryos less than 14 days old. The argument was that at this stage the human embryo develops the feature called the “primitive streak”, the first intimations of a spinal column (see here). Once it has a primitive streak, an embryo can no longer split into identical twins. So in some crude fashion, this point can be considered the threshold of unique personhood.
But it isn’t really. For one thing, a primitive streak doesn’t always appear on a human embryo precisely at 14 days. And it is just one of a series of developmental landmarks towards the infant. Certainly, it doesn’t signify that the embryo can thereafter experience sensations such as pain. The question of why a “potential human” can be material for experimentation before 14 days but not thereafter was unresolved.
Yet the 14-day rule, which became law in the UK in 1990, established a clear and pragmatic boundary for legally enforcable regulation that allowed embryo research to proceed. Warnock had no illusions about the arbitrary nature of her ruling; the point was that it enabled a framework for research, so that researchers knew where they stood. And besides, at that time – and thenceforth, until very recently – the 14-day rule was in no danger of being breached anyway, because no one could keep a human embryo alive in vitro for more than five or six days.
But advances in embryology are now pushing at that boundary, raising questions about whether 14 days is still an appropriate cut-off. In 2016, developmental biologist Magdalena Zernicka-Goetz at the University of Cambridge and her co-workers reported that they had found a way to let human embryos develop all the way up to 13 days in vitro. At that point, the researchers had to end the experiment to conform to the law; otherwise, who knew how long the embryo might have persisted?
The trick here was to find some way of mimicking implantation into the uterus, which human embryos undergo around seven days after fertilization. Recall that at this stage the embryo is a blastocyst, consisting of a hollow sphere with the inner cell mass – the stem cells that will form the future fetus – clustered in one part. The outer layer of the blastocyst’s cells comprise the trophectoderm, which will make the placenta, while the inner cell mass is made up of the epiblast – the nascent fetal tissue – covered with a layer of “primitive endoderm” that will become the yolk sac. Around day 9, the epiblast develops an inner void called the amniotic cavity. Then the beginnings of the body plan appear during the process of gastrulation around day 14, which is when the primitive streak is formed.
To keep the embryo alive beyond the implantation stage, Zernicka-Goetz’s team needed nothing especially fancy beyond the right environment. They found that simply sticking to the surface of the plastic slide holding the embryo is enough to keep it growing, so long as the culture medium is conducive (the researchers used amniotic fluid taken from cows). The entity that results doesn’t look exactly like an embryo implanted in the uterus – for one thing, it is flatter. But it shows the formation of a yolk-sac-like cavity surrounded by trophectoderm cells, as well as a structure that looks like an epiblast, complete with its own amniotic cavity. All the normal stuff, then.
These in vitro-attached embryos offer a laboratory model for studying the early post-implantation stages of development. But many important events also happen after the gastrulation stage, between day 14 and day 28. Because of the impossibility of probing embryo growth in humans during this crucial time, it’s still something of a black box – which might contain valuable insights into human health, disease and malformation. Much of what we know about these stages at present comes only from studies of mice, but there are some important differences between mice and men.
So there’s much interest and excitement about the prospect, raised by the results of Zernicka-Goetz and her colleagues, of investigating the post-14-day embryo. But that would be made possible only by changing the existing law.17 Warnock has advised against rushing to do so, but others think the scientific benefits could warrant reconsideration. Besides, as we will see later, the Warnock Committee’s pragmatic compromise may not be adequate to deal with some of the newest ways of growing a human being, where the conventional trajectory of embryo development might be bypassed altogether, along with its agreed moral milestones. There’s no consensus on what to do about it. The question of when cells become people isn’t going to go away; on the contrary, it becomes ever more pressing as biological science advances.
* * *
One of the common causes of female infertility is a decline in egg quality with age. A woman who wishes to conceive later in life can currently elect for her eggs to be collected at a younger age and frozen for later use. There’s no sign that the procedure carries health risks for a child conceived that way, although in truth it’s too early to know if problems might appear when the child reaches adulthood.
But what if you didn’t plan ahead, and now in your late thirties you are finding it hard to conceive? What if you have no eggs at all, perhaps because of surgery for ovarian cancer? You could use donor eggs, but these are in short supply, given how gruelling the procedure is for collecting them. And in any case, you might want a child that is genetically related to you.
There may still be hope of that – not yet, but with luck in a decade or two. It might become possible to make eggs “artificially” from induced pluripotent stem cells generated, as mine were, from a scrap of skin. In the embryo, some pluripotent stem cells will become the germ cells that give rise to gametes: eggs and sperm. We saw earlier that this is a specialized process, different from the formation of somatic cells in that the gametes have only one set of chromosomes and are generated in a bespoke mode of cell division called meiosis. All the same, there is no obvious reason why that should be beyond the capacity of induced pluripotent stem cells.
In fact, both “artificial” eggs and sperm might be created this way in the petri dish. And there’s an urgent need for both. At least half of infertility problems arise because of poor sperm quality in the man, and it’s getting worse: sperm counts in men fell by a staggering 50 to 60 per cent between 1973 and 2011. That doesn’t imply a comparable drop in birth rates – couples in which the man has poor-quality sperm may simply have to try for longer before conceiving, or may elect to use donor sperm. But the issue with poor sperm isn’t just about conception. Low sperm counts are often an indication of other health problems, actual or incipient, including testicular cancer, heart disease and obesity. Alarmingly, no one really knows what is causing the decline, although it seems likely that a mixture of environmental factors is to blame: poor diet, smoking, pollutants and chemicals that disrupt the development of the male reproductive system. At any rate, the decline in sperm count may be signalling a wider malaise in men’s health.
Artificial sperm would not solve that broader problem, but it could alleviate infertility arising from low sperm numbers or quality. Already, IVF can work for men with low sperm count, because the sperm can be collected, concentrated and brought into contact with the egg. It can even work for sperm that can’t “swim” – a common problem in low-quality sperm – using the ICSI technique to inject a sperm directly into an egg. But some men produce no sperm at all. In such cases, making sperm artificially by reprogramming stem cells could one day allow couples to have a biologically related child.
“When I think about it, it is quite astonishing,” says Azim Surani, a developmental biologist at Cambridge who is one of the leading researchers in the production of artificial eggs and sperm. “Each cell in your body is a potential gamete. This is a profound change in the way we think about cells.”
The notion of children “grown” from a piece of arm might sound bizarre, repugnant and even impious to some. There is of course a biblical resonance to this too, giving it the frisson of a god-like power:
And the Lord God caused a deep sleep to fall upon Adam, and he slept: and he took one of his ribs, and closed up the flesh instead thereof;
And the rib, which the Lord God had taken from man, made he a woman, and brought her unto the man.
But making gametes from stem cells is not as easy as making neurons. It requires a kind of recapitulation of the way natural gametes develop from embryonic stem cells. Some of those cells become selected for a germ-cell fate a few weeks after fertilization. First they form so-called primordial germ cells (PGCs), which move through the embryo until they reach the region developing into the gonads: the testes or ovaries.18 It’s only then that the gonads start to take on the features of one or other sex. If the embryo is male, some cells in the nascent sex organs produce a transcription factor from a gene on the Y chromosome denoted SRY (see here), which directs gonadal development towards testes. Otherwise they become ovaries by default.
Once in the gonads, the germ cells receive signals from the surrounding tissues that prompt them to mature into gametes. Meiotic cell division to form sperm happens constantly in males after puberty, but in females the diploid cells (with doubled chromosomes) called oocytes, from which haploid eggs are produced, begin meiosis in the fetus but then stay arrested halfway through that cycle for years, until the girl reaches puberty. They complete the cycle while lodged on follicles in the ovaries, before detaching to enter the fallopian tubes during ovulation. During meiosis, the epigenetic modifications that the chromosomes of PGCs have acquired are stripped away, resetting the genes to their pristine, pluripotent state.
So there’s a lot to recapitulate in vitro: to turn stem cells into PGCs, then let them mature and undergo meiosis to form gametes. But it can be done – at least in mice. In 2011, biologists Mitinori Saitou of Kyoto University, Katsuhiko Hayashi of Kyushu University, and their colleagues created “artificial” sperm from the skin cells of adult mice after reprogramming them to iPSCs. They transformed the iPSCs into PGCs by injecting a single transcription factor, called BMP4.19 They then transplanted these artificially induced PGCs into the testes of live mice, where the cells received the signals needed to complete their growth into sperm. The researchers used some of this sperm to fertilize mouse eggs, which developed into embryos and then into apparently healthy mice pups. In 2016, a Chinese team claimed to have made artificial mouse sperm wholly in vitro and to have used it to fertilize eggs, transferring them into female mice for gestation. But some other scientists working in the field remain sceptical of those claims, which have not been repeated.
The analogous procedure can be used mutatis mutandis to make female gametes. Saitou’s team has transplanted primordial germ cells, made in the same way from iPSCs or embryonic stem cells, into mouse ovaries, where the cells completed their development into eggs. The researchers have also developed a method for conducting the process entirely in vitro, using a kind of “artificial ovary” to provide the signals needed for complete maturation of the eggs, made from cultured mouse ovarian cells.
In one provocative experiment, Saitou’s group took mouse eggs through an entire generational cycle without the intervention of adult mice at all. They made mouse eggs from pluripotent stem cells in vitro, then fertilized them by IVF using sperm from adult mice. They grew the resulting embryos to the blastocyst stage in a dish, at which point they could harvest new embryonic stem cells for the next round of gamete formation.
This experiment was a combination of procedures developed previously, yet in a sense it changes the whole nature of sex and reproduction. It means that one can grow a succession of mouse generations in a few days (the usual gestation period of a mouse is about 20 days) without ever making a single adult organism – indeed, without really making a “mouse” at all. Given a supply of sperm (which too can be made artificially if you wish), one can progress indefinitely from stem cell to egg to embryo to stem cell. The cells are, you might say, having sex and generating a genealogy without any need of the “organism” as such.
We don’t really have words for what this procedure consists of. Biology, of course, doesn’t care a whit about that.
This would all be dandy if there were any need to treat murine infertility (it’s quite the opposite in my domestic experience). But what about making human gametes? We’re some distance away from that. So far, researchers have coaxed human pluripotent stem cells to the stage of primordial germ cells, but getting them to mature further is tricky because again it requires the right signals from the gonadal cells. It turns out, though, that these signals aren’t terribly species-specific. Mouse gonads can do the job – or at least part of it – for human germ cells too. In 2018, Saitou and colleagues reported that they had cajoled human PGCs onto the next stage of development towards eggs, called oogonia cells, in vitro by culturing them alongside mouse ovarian cells. Saitou admits that he thought it would be too much to expect the mouse tissue to have this effect on human PGCs, but he decided to try the experiment anyway. No, mice are not (wo)men – but as far as their cells are concerned, in this case they are close enough. It now remains to advance the oogonia on to become oocytes, and then to negotiate the challenge of meiosis that would make them into viable egg cells.
It seems likely that the analogous approach would work for advancing human PGCs towards sperm in vitro, by culturing them among mouse testicular cells. Again, whether fully mature sperm could be produced this way isn’t clear, but it might not be necessary anyway: even somewhat immature sperm, lacking the swimming “tail”, might be capable of fertilizing an egg if injected directly into it.
* * *
These are early days. We don’t know for sure how closely the primordial germ cells or oogonia made artificially resemble those in human embryos or full-grown humans. We don’t yet know how thorough their epigenetic resetting is: if the cells “remember” even a trace of their original lineage (as skin cells, say), they may fail to develop properly when fertilized. (The human oogonia-like cells made by Saitou’s group do, however, seem to have been largely stripped of their epigenetic marks.) Some of the mouse eggs made from artificially induced PGCs look a little odd and misshaped, and they don’t fertilize with the same success rate as “natural” eggs. In any event, no responsible researcher would countenance trying to use such cells for human reproduction without checking out safety questions like this in great detail.
All the same, artificial mouse gametes have yielded apparently healthy mice. And bioethicist Hank Greely of Stanford University says that he sees no obvious “show stopper” that might prevent what is feasible in mice ultimately from working in humans. Stem-cell biologist Werner Neuhausser of Harvard University says that “regeneration of human gametes from somatic cells in the lab is probably just a question of time and effort.” The clinical need for such a technology, he adds, is tremendous.
Don’t hold your breath, though. “I get lots of emails from people saying, ‘my husband is fertile, he’s desperate to have kids,’” says Surani. “Well, nothing is impossible, but this is very complex if you’re going to think about clinical applications.” To establish the feasibility and safety for human reproduction, he says there would first need to be work on non-human primates, which is slow, expensive and regulated almost beyond reach in some countries.
“Even with safeguards in place we would have to accept some residual risk,” Neuhausser warns. “Ultimately, some patients would have to take a leap of faith if this technology enters clinical trials.” Surani doubts that will happen within ten years, while Saitou’s collaborator Katsuhiko Hayashi tends to warn people who contact him, eager to volunteer for IVF with artificial gametes, that using these methods for human conception could be as much as five decades off.
* * *
Reports of falling sperm counts fuel fears explored in dystopian fictions such as P. D. James’s The Children of Men and Margaret Atwood’s The Handmaid’s Tale, in which human reproduction becomes almost vanishingly rare. Right now, there’s no reason to imagine that such a scenario could come to pass. But it does seem that some aspects of modernity – whether it’s changing diets and lifestyles or environmental pollution – could make fertility problems more widespread. And Richard Sharpe of Edinburgh University in Scotland, an expert on reproductive health, says that if the decline continues and the current lack of knowledge and research about causes and cures doesn’t improve, it may one day become easier to use in vitro-generated male germ cells than naturally produced sperm to achieve conception. We might hope that we’ll never need that option, but it’s good to have an emergency plan. As bioethicist Ronald Green has put it, “If the human race as a whole were seriously endangered, and if our reproductive abilities were seriously compromised, we might have to manufacture human beings.”
Yet beyond the rhetoric that artificial gametes will “end infertility” and “democratize reproduction”, there are questions about how to think about fertility in the first place. Philosopher Anna Smajdor provocatively suggests that advances like these “could blow away the biological barriers of reproduction” – for example, making it possible for post-menopausal (even positively elderly) women and prepubescent children – indeed, as we saw above, even for embryos. Greely confesses that, despite having studied this field for many years, he has more than once been brought up short by suggestions of how these technologies might be used. One possibility is the “uniparent”, whereby a person (either male or female) has both eggs and sperm made from their somatic cells and used to create a child (a “unibaby”) – who would, because of the recombination of chromosomes during conception, not then be a clone in the strict sense.20 Another is “multiplex parenting”, where three or more people mix their genes to have a baby. In effect, says Greely, this could mean “two people want their child to mate with someone else, without the wait and bother of actually having a child and raising him or her to puberty.”
The ability to make gametes from any bodily residue we leave lying around, like cells you leave on beer bottles and wine glasses, opens up other alarming scenarios. You can imagine the celebrity paternity suits already.
Such ideas, Greely concludes, are “evidence of just how wide-ranging and non-intuitive the implications of new biological technologies may be for human reproduction.” Even the imagination of experts is boggled by the possibilities.
I imagine most people will find some of these scenarios grotesque. But, safety issues aside, the ethical questions aren’t as straightforward as you might think, not least because no philosopher has yet resolved the rights and wrongs of bringing someone into existence versus their not existing at all. (How are a person’s rights respected by denying them existence?) One thing seems clear: attempts to reach absolute judgements about rights and wrongs are likely just to hamper serious debate, while being outstripped anyway by the latest scientific advances. The guiding principle should surely not be “what?” but “why?” – with the “why” being directed towards the welfare of a child born this way. Smajdor’s point is not that we should rush to embrace all options that arise or are imaginable. Rather, we are going to have to grapple with some hard questions about what we truly mean by fertility, reproduction and sex, and how we feel these things are – and should be – related.