Bioethics Forum Essay

Today’s Politics Threatens Tomorrow’s Reproductive Technologies

In mice, startling new ways to conceive are already real. 

In a landmark achievement in 2012, Japanese scientists turned cells from a mouse’s tail into viable eggs. These eggs were joined with donor sperm and implanted in a surrogate mouse, which birthed healthy pups. Some of these pups were able to reproduce normally. Those researchers have continued this research and, last year, they reported in Nature that this new method, called in vitro gametogenesis (IVG), produced an egg from a male mouse, leading to two male mice having offspring.

“IVG could be a game changer for women and men dealing with infertility, women of advanced maternal age, and same-sex couples, allowing them to have genetically related children they could not otherwise,” states a report on IVG recently released by The National Academies of Science, Engineering, and Medicine.

While scientists have not yet solved how to develop human eggs and sperm from skin cells, the research is progressing step by step. From a technical perspective, it’s plausible that within a decade, any two people may walk into a fertility clinic, have their cheeks swabbed, and leave as prospective parents. In a lab, their cells would be converted first into stem cells and then into sperm or eggs. These would be combined in a petri dish to form embryos, some of which the prospective parents would later choose to transfer for implantation. This could transform the lives of many couples who are not able to have genetic children because one of them does not have viable sperm or eggs, like those who struggle with infertility or gay and lesbian couples.

But science can’t change lives if people aren’t allowed to use it. As optimistic as some experts may be about the revolutionary potential of IVG, it’s hard to ignore the dissonance between our rapidly advancing science and our backsliding politics. The Alabama Supreme Court’s decision that frozen embryos are “children” in the context of wrongful death laws might lead to even more interference with parents who want to have real children. Eleven other states have similar fetal personhood laws that might also be used to prevent desperately wanted pregnancies.

Beyond repressing women’s rights, the personhood movements, emboldened by the overturning of Roe and the Alabama decision, threaten to stifle medical progress that could, for the first time in history, liberate future families from some biological constraints. Although legislative changes just signed by the Alabama governor now protect IVF providers from criminal prosecution, the state’s court decision illuminates an underlying hostility to women’s rights–and to the future of reproductive science. 

The Alabama case should be an alarm bell for those seeking new forms of assisted reproduction, methods like IVG, that would eliminate multiple burdens for women seeking help from science to conceive. Egg retrieval cycles would no longer be necessary, with their uncomfortable, costly, and risky hormone injections to hyperstimulate ovaries. IVG would also free women from the pressures of having children before age 35, the dreaded and arbitrary threshold for being deemed a “geriatric” mother whose supply of viable eggs is dwindling. If no biological clock were ticking, the choice of career versus motherhood would become less fraught. “Having it all” might become possible.

To be sure, IVG carries ethical considerations of its own. With the ability to create multiple embryos from easily obtained cell samples, the use of preimplantation genetic testing would become routine. This is already starting to happen. Two months ago, San Francisco company Orchid announced that it would offer whole genome sequencing of embryos ahead of IVF–a first in the U.S. fertility market.

While the company’s clinical validation was published as a preprint that has not yet been peer reviewed, a couple can pay $2,500 to get a readout of their embryos’ medical risks for genetic diseases. So far, Orchid and the other U.S. company that offers polygenic screening for embryos, Genomic Prediction, provide information on health risks only, but parents could access the data and seek out analyses of their embryos’ genetic predispositions for nonmedical traits as well, the thornier ones like intelligence and looks.

This trend represents the opposite of today’s political movement toward control of women’s bodies. Whole genome sequencing of embryos for IVF, and possibly someday for IVG, veers toward the other extreme of an unprecedented degree of information, choice, and freedom over reproductive outcomes. How much oversight or leeway parents should have in deciding about the characteristics of their future children remains uncharted territory.

Cultural norms can change in a generation. The first “test tube” baby was conceived in secrecy in 1978 by scientists who feared their work would be taboo–and who eventually won a Nobel Prize. Today, nearly 100,000 babies per year in the U.S. owe their lives to IVF. What we view as ethical in the realm of reproduction is sometimes a matter of what seems commonplace.

What will it be a generation from now: science-assisted births for parents of all ages and genders? Or forced births for women who don’t want children and prevented births for those who do? 

We can’t have that both ways.

Henry T. Greely, JD, is Professor of Law, professor by courtesy of Genetics, and Director of the Stanford Center for Law and the Biosciences at Stanford University, and author of The End of Sex and the Future of Human Reproduction. @HankGreelyLSJU

Kira Peikoff holds a graduate degree in bioethics from Columbia University and is the author of Baby X, a new thriller about IVG. @kirapeikoff