I think it is highly likely that the reproductive years will look very different in the future.
Let’s start with the egg. In my book I have explained that the egg is the main rate limiting factor to a woman’s chance of reproducing. As we live longer, chances are we will want to delay starting a family even more and we have seen the age of first pregnancy increase every year.
Egg freezing is an option that I described in Chapter 8. But it has problems, such as not being a guarantee of having a baby, the cost, the inconvenience and rules and regulations around its use.
There is work around making eggs and sperm in the laboratory. One of the most exciting is to make eggs from induced pluripotent stem cells (iPS cell). It is possible to take almost any cell and reprogram it to become an iPS cell and these can be used to make other types of cells, including eggs. We could potentially make thousands of eggs for a woman so she would not be limited to the 500 or so that are ovulated in her lifetime or by her fertility decline. This would be a huge game changer in female reproduction.
In other species, there has been some promising research using iPS cells to make mature sperm and eggs and they have produced live offspring. But, at the moment the technique is inefficient and we cannot be totally sure it is safe, even in rodents. So it may be many years before we can do this. But I have no doubt that this procedure will work in the future.
What about womb transplants for women who cannot carry a pregnancy? This field has been very slow to develop because it is not a high priority in the medical world. But a team in Sweden have been incredibly successful. The wombs are usually donated by a relative or from an organ donor. For all womb transplants, the babies are delivered by Caesarean section to prevent stress on the transplanted womb. Theoretically a biological male could have a womb transplant and I am sure it will not be long before it will be done. I think a transwoman may soon request this treatment.
Ectogenesis refers to growing a fetus outside the body in an artificial womb. Full ectogenesis is where an IVF embryo is gestated outside a woman’s body for the whole of its development. Partial ectogenesis is when a late stage fetus is transferred to a ‘biobag’ in order to complete its gestation. There has been some success with partial ectogenesis of lamb fetuses. Complete ectogenesis is likely to be much further away, but this could overcome the need for a womb for those women who have womb issues, for same sex or single men, or for older women. I have no doubt that in the future, we will have an artificial human womb but for now, there are many technical and social issues we have to overcome.
Being pregnant is a major event that women do and men don’t. But whilst women have to carry a pregnancy, we will not have total gender equality because being pregnant affects our lifestyle. There is a possibility that in the future, pregnancy may be taken away from women. We could lose one of the most amazing experiences of our lives. In a recent 2020 survey I conducted, women spoke very highly of their pregnancy experiences
Genetics enters the arena
Genetics has been a passion of mine for the majority of my career.
In genetic testing, we look either at the chromosomes or genes to detect abnormalities.
In Chapter 12 I explain reproductive genetics in detail but here I will just talk about one area that I have worked on for decades.
Preimplantation genetic testing (PGT) was initially developed for patients who were at risk of transmitting a genetic disease to their offspring and I started working on this in 1992.
Gattaca is an American dystopian science fiction film made in 1998; which shows a future where almost everyone reproduces by PGT because this gives people a genetic advantage.
Gattaca is almost here as we are rapidly approach the time when we will be able to fully sequence a human embryo.
If we want to select for the healthiest child with the chosen characteristics, with current PGT methods the chances of finding the perfect embryo are going to be low as most couples only produce a few embryos.
If we could use stem cells to make eggs; we could make 100s or even 1000s of embryos which would vastly increase the potential to select embryos.
This would be a gamechanger for PGT.
I am not sure if our reproductive future will be utopia or dystopia.
I am an optimist and I hope that humans can use our intellects to make the world a better place.
We have the potential to reduce the impact of disease, lead long and healthy lives and to revolutionise the fertile years.