Reproductive Choices: The Promising Landscape of Assisted Reproductive Technology
In early June 2005, upon opening my postbox for my Frascati, Italy apartment, a glossy, elegantly-designed brochure fell to the floor, revealing pink pictures of mothers and babies and sterile pictures of test-tubes. The brochure was a suspiciously-crafted campaign piece from the Committee of Science and Life, urging me not to vote in the upcoming Italian Referendum on Law 40, which was passed in 2004. Absent, however, were the voting dates and a clear explanation of the issues, upon which to vote. This was not an ordinary analog-spam that fell out of my postbox. Instead, what I held in my hands, was a graphic example of a collusion of the largest religious, philosophical and social structures in human historyâ€”church, politics, and cultureâ€”that surround humans’ increasing power over nature.
In 2004 as a ‘gift’ to the Vatican, Berlusconi’s coalition in the Parliament passed a series of assisted reproductive technology (ART) laws that are widely considered to be the most restrictive in the western countries. The law restricts assisted reproductive technologies to heterosexual couples who live together and are of childbearing ageâ€”therefore excluding single womenâ€”and bans the use of donated sperm or eggs, prohibits prenatal screening for abnormalities and prohibits doctors from freezing embryos or using them for scientific research. These laws passed quietly, too quietly, and, in an angry backlash, a group of people gathered the necessary half-million signatures in order to petition for a Referendum to overturn these laws. Such a petition must be approved by a constitutional court. The court rejected the petition â€œin wholeâ€, but instead accepted a Referendum â€œin partâ€ to overturn the most controversial parts of the ART laws. The Referendum then became a series of questions:
Do you vote Yes (to overturn) or No (to keep) the following laws:
- Rights given to a human embryo under the law;
- The limits the law places on research involving human embryos;
- The limit to three embryos during each IVF procedure that the law allows, as well as the requirement for the woman to have all three embryos implanted; and
- The ban on IVF use by couples who use outside donors.
The four laws were voted upon by the Italian citizens on June 12-13, 2005. In a shockingly low 25% turnout, and because the turnout didn’t reach the necessary 50% voting-population minimum to be valid, the Referendum was extinguished. In the mother and family-oriented Italian culture, how could a set of draconian laws that marginalizes women and family choices, and was delivered by an extremely unpopular prime minister, be extinguished so easily? Simple, enter non-democratic governmental politics urging the citizens not to vote, and the richest per-capita country in the world, which funded the Committee of Science and Life, that is, the Vatican. Upon watching the talk-show discussions on Italian television afterwards, I came to the conclusion that the Vatican played with some very old human fears: the fear of technology, the fear of losing our human-ness, and the fear of the future.
Katherine Hayles, in her article: ‘Wrestling with Transhumanism’,1 astutely encapsulates these fears to focus her criticism on the area of reproduction, which she further refines as: reproduction of individuals through children, reproduction of the species through technology as well as biology, and reproduction of psychological, philosophical, social and economic institutions that facilitate and/or threaten the continued existence of humans as a species. However, as a literary scholar, she chose the context in which to criticize transhumanist reproductive views to be science fiction and speculative fiction, jointly signified by SF. Isn’t such a SF timeline too distant and too speculative to be relevant to our daily lives? Indeed, transhumanist reproductive ideas are relevant now, as graphically illustrated by my glossy, pink brochure, that I held in my hands on that day in early June 2005. Moreover, transhumanists grapple with these issues in the socioeconomic climate of today, suggesting courageous solutions to what might normally be considered as insurmountable human limitations. Let’s start with a look at the biological features of half of our human species.
A Woman’s Reproductive Lifetime
An unborn human baby girl has already produced all of the oocytes, or unmature egg cells, that she will produce in her lifetime.2 Her ovaries, at the time between 16 and 20 weeks of her mother’s pregnancy, contain 6 to 7 million ooctyes, but, by the time she is born, one-sixth of those will remain. Up to puberty, more oocytes will waste away, so that, in about 12 years, she will have ~300,000 oocytes. However only a small percentage, about 400, will mature into eggs to be viable for reproduction in her entire lifetime. Until an egg is released, it remains dormant in its follicle-suspended state in the middle of cell division, and is thus one of the longest-lived cells in the human body. A dormant egg cannot perform the usual cellular repair processes, however, so damage increases as a woman ages. A chromosomal or genetic abnormality is thus more likely when a woman conceives a baby later in life.Â With a human girl’s likely biology, her best time for reproduction is the twenty years between later puberty (say age 15) and age 35. Many women’s reproductive years decline starting in their late-20s.
A Woman’s Choices
What are her choices for her future given those twenty years? Between age 15 and 35, she must build her career to a professional level, manage her time so that she can devote some of that to a social life, meet some interesting people, develop a partnership with one (or some), and hope that life smiles in such a way and that she gains enough wisdom so that not too many of her mistakes delay any of these pathways. Then, by the time she is in her early to middle 30s, she can be starting her family.
How many women do you know, who have established their professional careers by their early 30s? Educated women, like educated men, need time for that. In some fields, it is possible to be at a professional level by one’s early 30s, however, if she chooses a career in a technical or scientific field, then she will have a much poorer chance to meet these goals, as those career endeavors, if one is to be successful, leave less time for a social life. So immediately there is a pressure to veer away from those time-consuming careers in the technological and scientific fields, towards more family-friendly environments.
Given that science and technology are the vehicles of human progress, and given that half of the human species is a significant number, our western societies have a pressing issue in the reproductive sciences, if our species is to advance with our full human resources. Presently for a woman to modify her biological reproductive capabilities, she has the following choices:
- contraceptives andÂ birth control methods such as condoms, birth control pills, I.U.D.â€™s
- In-vitro fertilization (IVF)
- egg freezing
Birth Control Pills were a major societal breakthrough, allowing women to free themselves from their monthly biological imperative and begin to choose a life to include a career. After more than half a century from its introduction into western societies, it’s considered for women a respectable modification of her biological reproductive functions.
IVF technology provides a remarkable method to conceive a human life outside of the womb. In use for more than twenty years, it was the first effective infertility treatment and gives women and couples a means to reproduce outside of societal norms and women’s reproductive ages. Well over 3 million children worldwide have been conceived by IVF since 1978. Moreover, pre-implantation genetic diagnosis is boosting the genetic lottery for genetic defects.3 What is less known, however, are that the methods are expensive and painful, the side effects are 1) the large uncertainty and lack of science associated with what is a viable embryo for implantation, 2) a propensity in the US to transfer too many embryos which leads to multiple pregnancies with the associated risks and major family life changes, 3) a lack of discussion by the fertility doctors to tell the patient of the health risks involved (see ovarian hyperstimulation, for example), and a glut of hundreds of thousands of embryos in cryopreservation due to the US government’s ban on embryo research, and due to the uncertainty and moral confusion by their owners for how to dispense with them.4, 5 Â There are some hopeful signs for mitigating these risks, however. With the incoming US presidency, the ban on embryo research may be soon lifted6 , therefore clearing the way to more embryonic scientific research and finding realistic uses for the embryos that are currently in cryopreservation and providing better science for determining the most likely embryos for implantation.
Egg freezing is a viable technology since 2002,7 however the societal progress for acceptance is extremely slow. Even though the egg extraction portion of egg freezing has been in practice in IVF for decades, egg freezing is considered by the American Society for Reproductive Medicine, as late as late-2007, to still be an experimental procedure,8 despite the fact that vitrification, the process in which water is drawn out and anti-freeze chemicals added, is improving success rates to the same level as normal IVF treatment. Many doctors will freeze eggs for cancer patients, but will not offer the option to young, fertile women. Their perspective is that it is unethical to normalize a woman’s waiting to bear children, and that the only interests served for such a service are unforgiving work cultures9 or aging mothers who’ve consciously chosen to have children later in life, with or without a partner. The doctors, therefore, don’t view it as one of an array of choices that women and their partners would like to have in viewing their long-term lives. Costs for a young woman undergoing such a procedure is also prohibitive (USD ~10 000) at that early point in her career life.
However, out of the three reproductive technologies listed here, egg freezing technology provides the most courageous and comprehensive assistance to women and has the potential to change society the most. Consider these points:
- With this technology, the woman has twenty more years of buffer time in which she can build her career to something supportive for herself plus her family. In our society, there is an abundance of smart, fit, capable women in their fifties who are strong and energetic enough to run after a toddler-on-the-loose. If they had frozen their eggs at age 20, they, at a much older age, would have a reasonably high chance of bearing a healthy child. Not only that, but their careers would have the same kind of longevity and safety and support to provide a good living for both of them.
- The workforce will become deeper and broader. Women workers, who cover a wider spectrum of ages and experiences, will fill more market niches.
- Young couples who postponed starting a family now have more money and more time to devote to their careers.
- Single women who find themselves mateless during their usual prime years, will now have time to build a better life to support themselves and their children (later, and with or without partners). Today, in the United States, one in three women in their thirties are single and childless, compared to one in ten in the 1970s. The number of unmarried mothers is also at an all-time high: in 2004, 36% of all births were to single mothers.10
This leads to the idea of what support for a child and the family unit means. The coupling-for-family-support idea becomes more optional, if the woman does not depend on her partner’s support for raising their child; she can better support herself/themselves. The couple might still do it because they want to, but they now both have more choices.
- There will be companies catering to frozen egg donors and this could start a thriving industry. Already women are helping women find their way out of their conundrum. The company Extend Fertility (http://www.extendfertility.com) recruits women interested in egg freezing and connects them to a network of cooperating egg freezing clinics. They are beginning to see the idea accepted by close to the right audience: women in their mid-thirties. As of late 2006, 2000 women had inquired, and of those, 200 had frozen their eggs.11
- Businesses will now have to accommodate older, more established, employees in their 40s as they begin their new families. These same companies will find that their younger employees are now more educated than they were before.
- Governments could pass new laws to try to increase their revenue from the new markets that arise.
- Women wanting the more traditional roles will create a backlash against those who want to freeze their eggs.
The best approach to inject this technology into existing societies would likely involve situations where young women work in hazardous occupations that might adversely affect her reproductive abilities, for example, jobs in the chemical industry or work in the military. Under such conditions, the employer has the responsibility to provide insurance for her, giving a natural reason for applying the egg freezing technology. Once the technology is practiced in a few industries, its acceptance (and market demand) will push it to others.
The large potential of this egg freezing technology to change our lives for the better, fits perfectly well with the agenda and ideas of today’s transhumanist. In this reproductive arena, transhumanist ideas are meeting head-on and can provide viable solutions for, the reproduction of individuals through children, the reproduction of the species through technology as well as biology, and reproduction of psychological, philosophical, social and economic institutions that facilitate and/or threaten the continued existence of humans as a species. No far future timelines and little speculation are needed.
Support for these ideas is growing from quarters other than the transhumanists, as well.Â Carl Djerassi, one of the inventors of The Pill, believes that advances in egg freezing techniques would be greatly beneficial to the human race:
There are so many unwanted children in the world. This would be a way of helping to reduce the number of unwanted children. Every child born to a woman who has taken a conscious decision to have a child at that time would be wanted and loved and properly cared for. Is there not something to be said for wisdom, affection and maturity? Why shouldn’t a woman have a child when she is older if the science is there to help her? Nowadays it is not thought peculiar if a man in his 50s or 60s has a child. So should it be different for a woman?12
1 Hayles, K. â€œWrestling with Transhumanism,â€ Global Spiral 9, June 2008.Â Available:Â http://www.metanexus.net/Magazine/tabid/68/id/10543/Default
2 The Merck Manual of Medical Information, Second Home Edition, Internal Genital Organs
3 Jo Whelan. Reproduction revolution: Sex for fun, IVF for children, New Scientist, 20 October 2006.
4 Mundy, Liza. Everything Conceivable, Anchor Books, 2008, pg. 288-306.
5 Springen, Karen. “Agonizing Dilemma”, Newsweek Web Exclusive, Dec 4, 2008.
6 Science Under Obama: Next Administration Would Chart a Dramatic New Course
7 BBC World News, “Frozen egg birth brings IVF hope”, 11 October, 2002.
8 Maher, Brendan.Â “Little consensus on egg freezing”, NatureÂ 449, 958 (2007), doi:10.1038/449958a
9 Mundy, Liza _Everything Conceivable_, Anchor Books, 2008, pg. 328-329.
10 ______ pg. 345.
11 _____ _ pg. 328.
12 Children without sex is what the future holds, claims inventor of the Pill.Â 01 June 2007, The Daily Mail, Associated Northcliffe Digital.