Until recently, the only way to make eggs or sperm was the old-fashioned way: in the ovaries and testes. In the not-too-distant future, it may be possible to use cells from almost any part of the body to create these germ cells, also known as gametes.
This process, called in vitro gametogenesis (IVG), raises the possibility that babies could be made using muscle or liver or blood cells. While not yet ready for prospective human parents — so far it has only been accomplished successfully in mice — it raises major ethical and legal questions that we should start thinking and talking about now.
IVG works like this: Cells from almost any tissue or organ are reverse engineered into becoming induced pluripotent stem cells. These cells, which can develop into any kind of human cell, are then nudged to become egg or sperm cells.
Why would anyone want to do this? Infertility due to cell failure or cancer treatment could cease to be the emotionally shattering issue it is for many families and individuals. It could also be a solution for women who experience premature menopause.
IVG could lead to a dizzying array of reproductive possibilities. In a female-female couple, for example, skin cells from one partner could be turned into sperm cells used to fertilize the other partner’s eggs. No man would be needed in the creation of such a baby.
We are already in an age of disruptive reproductive technologies. Babies have been born using mitochondrial replacement techniques, often known as three-parent babies. News of mice born to same-sex parents went viral last year. The eventuality of IVG is obvious to many of us watching the field.
Literacy about emerging issues in the reproductive sciences is increasing, which is a good thing. But it still isn’t getting the attention it deserves. Writing in the journal Trends in Molecular Medicine, one of us (I.G.C.), along with a complement of leading IVG experts, strongly suggest that now is the time for increased public engagement — surveys, focus groups, expert reports, op-ed debates, and the like — on this technology before embryos created by it make their way from the lab to the nursery. The group also argues that the public and regulators need to think about the ethical and legal challenges that this technology will present and get ahead of them.
As with other assisted-reproduction technologies, IVG is likely to spark heated legal and ethical questions. But some of them will be different than those arising from earlier technologies, which begin with sperm and eggs made by individuals’ testes and ovaries. This new process creates germ cells and, by that process, embryos from anyone’s existing cells.
The likelihood of prospective parents creating a large number of embryos this way and implanting only a select few may agitate many people. Should regulations limit the number of embryos a person could create using his or her own stem cells? Should embryos created through IVG be treated the same as those derived through existing fertility technologies or the old-fashioned way of making babies?
The issue becomes even more fraught with confusion when IVG is combined with preimplantation genetic screening. Couples, or even individuals, could in principle create hundreds of embryos and use genetic tools to select the “best” one. Some might see such embryo farming as a modern-day form of eugenics that puts a higher value on some lives than on others. Some bioethicists worry that such eventuality appeals to our worst instincts, which the authors of the Trends article characterize as “an untoward desire for mastery and human perfectionism in which reproduction becomes manufacture.” And what happens to all these excess embryos? We could see a commodification of embryos that resembles the current practice of selling sperm and eggs.
IVG also raises the specter of unwitting nonconsensual parenthood, also known as the celebrity scenario, in which gametes are created from cells secretly taken from an unsuspecting individual. Would such “donors” be treated as parents by the law? Whether the state can protect against the unauthorized imposition of parenthood is an open question.
The ethical, social, and legal conundrums surrounding stem-cell derived human gametes are vast and require close and careful consideration, not only by experts and scholars but by the public as well. We are all stakeholders in the future of reproduction, and should begin talking about this new technology and its implications now.
Glenn Cohen, J.D., is professor of law and faculty director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. Alex Pearlman is a bioethicist, communications manager, and research associate at the Petrie-Flom Center and editor-in-chief of its Bill of Health blog.