Reproductive science: is there something we’re missing?

Thirty
years after the first test-tube baby, Nature
asks various experts for their views on what the next thirty years of
reproductive medicine will bring
.
Some of the more startling predictions are:

  • No more infertility, with both children and 100-year-olds able to have children
  • Embryos created from stem cells, increasing the ease of embryo research and genetic engineering of children
  • … with the resulting greater availability of embryos making it easier to create cloned humans
  • Artificial wombs, enabling babies to develop outside the mother’s body
  • … which, some worry, could become compulsory as an alternative to abortion, or to avoid premature birth or fetal alcohol syndrome
  • ‘Genetic cassettes’ implanted in embryos to counteract the effects of inherited diseases
  • Increase in litigation following evidence that IVF babies may later suffer adverse effects from the environment in which they were grown as embryos

From this
informal survey, it is possible to identify two key factors driving current
reproductive medicine. The first is the
desire to increase the convenience of having children: artificial wombs and widening the ‘window’ of time during which a woman is able to conceive would
enable people to reproduce without facing the dilemma of children vs career, or
children now vs no children at all. The second is the desire to create healthier babies.  Viewed
in terms of promoting, on the one hand, freedom and choice, and on the other
hand, health and well-being, these seem noble ambitions—although,
unsurprisingly and not without some justification, worries about where this
technology might lead us are expressed both in the comments section of the
article and in the related essay
to which the article links.

What is
more surprising is that, of the eight experts
consulted, only one—Régine Sitruk-Ware, of New York’s Population Council—mentioned
developments in contraception. She is
quoted as saying that, of the reproductive science centres funded by the
National Institutes of Health, there are more than twenty on IVF and ‘only a
handful’ on contraceptive research. It
is difficult to believe that the emphasis on IVF research is due to the belief
that giving babies to the infertile and healthy babies to those worried about
passing on a disease to their children are somehow more important than
preventing unwanted preganancies. Since
1971, the number of abortions performed in England
and Wales has risen steadily year by year, with the number of abortions per 1,000 women
similarly increasing (1). In 2006,
201,200 abortions were carried out. A
few years ago, the BBC reported
a survey that claimed that 40% of pregnancies in the UK are unplanned, with almost half
of these occurring despite the use of contraception. Infertility and the risk of passing on an
inheritable disease to one’s children may be important issues—but the emotional
and financial stress of dealing with an unwanted pregnancy, particularly given
that disadvantaged women are more likely than wealthier women to become pregnant unintentionally,
can hardly be dismissed as less deserving of concern.

What, then,
can explain the disproportionate emphasis on research into IVF rather than
contraception? One explanation might be
that the science involved in IVF is more exciting, less depressing—and perhaps,
in an important sense, easier. Looking
for new ways to manipulate genes in embryos and striving to increase the rate
at which implanted embryos result in successful pregnancies are (as the
accounts in Nature’s article
demonstrate) things that the scientists involved find exciting, they can be investigated in the laboratory or clinic, and the scientists’
efforts are no doubt often rewarded with the joyous (and, frequently,
middle-class and articulate) gratitude of the people they have helped to become
parents. On the other hand, reducing the
rate of unwanted pregnancies is a more complicated effort, involving not only
research into contraception effectiveness, but also a cross-disciplinary social
effort to investigate why certain groups of people fail to take full advantage
of the contraceptives already available. Given the prevalence of unwanted pregnancies among the disadvantaged,
such research will also involve dealing with the poverty-stricken and the
uneducated. To an extent, these are
perhaps crude generalisations, but they nevertheless make it easy to see why IVF research may be a
more appealing prospect for reproductive scientists.

Another
explanation for the relative neglect of contraception research could be that
those who would benefit most from it are less well-placed to voice their
concerns than those who benefit most from IVF treatment. The poverty-stricken and the uneducated are not
generally seen as leaders of scientific and social change, particularly when they have
unwanted pregnancies to deal with, or are struggling to bring up children in less than ideal circumstances.  Their
needs are hardly less deserving of scientists’ concern, however. If the picture of the future of reproductive
science painted by Nature is an
accurate one, then we must be very careful not to become dazzled by the exciting leaps that IVF research might render possible, and to focus on the most important
reproductive issues faced by society as a whole.

 

Reference

(1) Office
for National Statistics, ‘
Abortions: residents and non-residents; age
and gestation (residents only), 1976 onwards (England and Wales)
’,
Health Statistics Quarterly 37

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