Like many people, I still remember clearly my mother’s two-for-the-price-of-one account of sex and procreation, told to me when I was five or six years old: “When a man and a woman truly love each other, they decide to make a baby together.” The story made no mention of homosexuality, of transgender or intersex people, of infertility, condoms, or the plastic clam in the bathroom with its pink and green pills and the little wheel with the days of the week printed on it. Over the past 20 years, the triad of love, sex, and reproduction—never as stable as its proponents have claimed—has broken apart spectacularly. Even with glitches in the system—from scammers on Tinder and blackmailers on OKCupid to rumors of Chinese government officials accessing Grindr’s user data—the outlines of what sociologists call “differentiation” are clear: many want their sex and reproduction served à la carte, putting love off until it’s convenient and children until they’ve passed certain personal and professional milestones.
Unfortunately for them, technology is lagging behind culture. The average age of first-time parents in the developed world has climbed precipitously in recent decades, and age-related infertility, coupled with falling sperm counts, is leading ever more people to turn to in vitro fertilization (IVF). But IVF is far from a panacea: for women under 35, the live birth rate is 31 percent, but for those past 40, it drops to less than 10 percent. IVF depends on invasive egg harvesting and often produces faulty embryos. Moreover, the science behind evaluating laboratory-produced embryos remains flawed. Comparing the struggles the industry faces with the enormous quantities of money it moves—15 billion dollars in 2017—it is hard not to recall the old advertising jingle: “There’s got to be a better way.”
This is precisely what Stanford law professor Henry Greely proposes in his recent book The End of Sex and the Future of Human Reproduction. Greely believes that sometime in the next 20 to 40 years, sexual reproduction as well as IVF in its current iteration will likely be supplanted by what he calls Easy PGD—a combination of pre-implantation genetic diagnosis and the creation of embryos via eggs and sperm derived from parents’ stem cells. The benefits are obvious: advances in genetic testing will allow the screening of thousands of medical conditions and—depending on the law—will permit parents to select their child’s height, hair color, physical strength, and disposition. The use of stem cells will make biological children an option not only for those struggling with traditional pregnancy, but also for gay couples or intersex individuals reluctant to adopt or use donor sperm or eggs.
With recent tech flops ranging from Elon Musk’s “incredibly profound” Hawthorne Test Tunnel, which moved a single car through a one-mile tunnel at an average speed of 30 mph, to the revelation that numerous AI-based virtual assistants are actually just people responding to text messages, skepticism is healthy when it comes to headline-grabbing futuristic breakthroughs or books titled “the end of” something. But Greely shows the science necessary to make Easy PGD a reality has been advancing at a remarkable clip. The Human Genome Project ran from 1990 to 2003, with a budget running into the billions; this past November, a Massachusetts company, Veritas Genetics, offered whole genome sequencing and interpretation for two hundred dollars. Veritas estimates the cost will drop to less than a hundred dollars in the next five years; this could allow the affordable screening of dozens of embryos, selecting for health, optimal implantability, and even cosmetic traits.
As to where the stem cells will come from, there are currently two techniques under investigation: somatic cell nuclear transfer, responsible for Dolly the sheep (and Damian the frog, the fifth Beatle of animal cloning), and induced pluripotent stem cells. As the first requires donor material and involves the destruction of embryos, Greely sees the second approach as the likelier of the two. At present, the difficulties are enormous: Mitinori Saitou, one of the leading researchers in the field, has successfully derived sperm and egg cells from mouse stem cells, but the process is inefficient, and offspring have been prone to disease. Much of the problem relates to our ignorance of how embryos themselves develop, and while a team of Dutch scientists has managed to make “model embryos” from mouse stem cells to study this very issue, the likelihood of producing human model embryos in this way still appears remote.
If Easy PGD is the future, the legal and moral issues it raises are far-reaching. Most would likely celebrate the elimination of devastating hereditary illnesses like Lesch-Nyhan syndrome or Tay-Sachs disease, but where do we draw the line between an affliction and simple human diversity? The Deaf Culture movement views deafness as a social and linguistic identity and rejects the disability label—so should deaf parents be entitled to choose sperm or egg cells likely to give them a deaf child? The U.K. banned so-called “designer disabilities” in 2008, but in the U.S. no central policy regulates genetic testing, and a survey of American facilities found that three percent of clients had gone looking for embryos with a specific disease or disability. On the other end of the spectrum, it is easy to imagine Tiger parents conspiring with their doctors in an arms race to engineer perfect children.
PGD could be a blessing for non-traditional families wanting to have their own biological children, but, Greely asks, how non-traditional are we willing to go? He imagines the offspring of two siblings, of the very old, of the legally dead, of the unsuspecting—once stem cells can be used to make gametes, all these doors are open. The most chilling possibility may be uniparenting, with sperm and egg cells derived from a single individual. Greely seems skeptical that such a thing would catch on—but in our selfie-ish age of social media, perhaps it can.
The jury is still out on the science behind Easy PGD—Greely thinks it is just decades away, while others view it as little more than science fiction—but this isn’t an all-or-nothing proposition. IVF technologies will improve; our understanding of human genetics will improve; and the robustness of genetic testing will improve. The consequences of large-scale intervention in human reproduction are mind-boggling, and Greely is right that we should debate them now, before the future catches us off-guard.
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