Like a Virgin (23 page)

Studies also suggest that Y chromosomes with DNA deleted in particular regions may cause babies to be born with two X chromosomes in some cells of their bodies, but with only one X chromosome in
others. While this only impacts the sex chromosomes – the X and the Y – and does not, it should be said, create the situation seen in baby FD or in Jane from Boston, it
does result in baby girls who have sexual ambiguities or Turner’s syndrome, which creates females without female sexual characteristics. People with Turner’s syndrome are
noted for their short stature, and for a likelihood of other health problems, including difficulties with hearing, sight, thyroid and kidney function, high blood pressure, diabetes, and learning.
Their ovaries also don’t work – so these children are nearly always, like their fathers before them, infertile. (They may also, like post-menopausal women, suffer from osteoporosis
because of their failed ovaries.)

The bottom line is that, when making babies through ICSI, you are often working with screwed-up sperm. The more screwed up the sperm are, the more abnormalities you will see in them, and the
more likely they are to carry damaged DNA. And because the Y chromosome is only ever passed from father to son, if a man is infertile because parts of his Y chromosome are missing, his ICSI son, by
definition, will inherit that corrupted Y chromosome and his infertility too.

On the other hand, IVF and other forms of ART also now make it possible to diagnose genetic abnormalities very early – by the time the embryo is three days old –
something that is not possible in natural pregnancies. As our techniques improve, screening an embryo to identify an abnormality before it is implanted in the mother’s womb could be utilized
to reduce further and further the chances of the diseases that are made more likely by ART.

Today, there are two ways of approaching the process of screening. One, called
pre-implantation genetic diagnosis
, or PGD, looks for specific genetic disorders that a couple is known to
be
carrying, and which therefore they have a high risk of transmitting to their children. PGD takes three to four days, and is primarily used by fertile couples who are
worried about a particular disease that runs in the family. The second is a less targeted technique, known as
pre-implantation genetic screening
, or PGS, which has a turnaround time of
twenty-four hours. PGS looks for mistakes across all of an embryo’s chromosomes, using tests that can detect any abnormalities in an embryo’s chromosomes – for instance, if it
gained extra chromosomes, or lost some of them. This technology is still new and evolving, but it is likely to improve in the next few years. As it does, the genetic weaknesses involved when IVF or
ICSI is necessary will almost certainly become less of a problem. With better PGS, fertility doctors will gain the ability to pick the most normal embryos.

Of course, while genetic problems may be soon within the reach of science to resolve, IVF and ICSI also give birth to complex moral conundrums that would never arise in a world where every
pregnancy happens through sex. When fertilization occurs outside of the womb, and the embryo is then placed there, a woman becomes able to carry a child to term who is not genetically her own. For
a woman who does not have good quality eggs, this is a great advantage, because she can choose to use an egg donated from another woman.

The technology has also become a very efficient way for older women to have successful pregnancies – by freezing a number of eggs or early-stage embryos from which they can select, and
then trying each one out. Some women choose to freeze their eggs at a young age, and use these healthier eggs later in life, when they are ready to have children. But mistakes do happen.

In 2009, Caroline Savage, a forty-year-old American mother of three, returned to the fertility clinic where she had previously received IVF – and got pregnant. The clinic had kept frozen
five of her early-stage embryos, left over from her last cycle of treatments. Unfortunately, there was a mix-up, and the embryo implanted into her womb was not one of her
own; it belonged to a completely different couple, who also had ‘leftover’ embryos stored at the clinic.

Ten days after the procedure, Savage received a call from her doctor, notifying her of the error – news she later described as the worst of her life. The clinic’s directors offered
her a choice: an abortion (free of charge, one presumes) or a surrogate pregnancy (after which she would give the child to its rightful genetic parents). Savage opted for the latter, on religious
grounds, and because she realized that if one of her embryos had been mistakenly inserted into another woman’s body, she would go to the ends of the earth to get back her child. And if that
hypothetical surrogate had chosen the abortion, she would have been helpless to stop it. In the state of Ohio, where Savage lived, surrogacy agreements are open to interpretation, though genetic
parents are considered natural and legal parents of a child that another woman has carried. This was no surrogacy case, however; there was no intention, let alone an agreement, to have someone
else’s baby end up in Savage’s womb. Yet, in this case, Ohio law recognizes the woman whose womb the foetus is in to be the mother of the child, rather than the woman who is genetically
related to it. As mere donors of genetic material used to create that embryo, the other couple have no parental rights or responsibilities with respect to the child being carried to term.

Wracked with this knowledge, Savage and her husband asked a lawyer to reach out to the genetic parents, and three months later the couples met. The pregnancy was a difficult one for Savage, and
she was scheduled for a Caesarean section. She cannot now risk another pregnancy herself, but still wants to grant a chance of life to her remaining embryos. To do so,
she
will have to hire another woman to carry the embryos to term. Savage would never have given birth to someone else’s genetic child in a world without IVF, but nor would another woman have been
able to give birth to hers.

Infertility is a complex problem with many causes, and its solutions present just as many ethical conundrums. A century ago, European doctors tried to allay the public’s
fears by claiming that there was nothing truly ‘artificial’ about this new method of insemination. After all, the babies produced would be very real, the equal of any who had been
naturally conceived. The field of reproductive medicine was simply a way of assisting nature.

Today, around one out of every fifty babies born in the UK, and one in a hundred babies in the US, starts life in a lab. What is more, starting life in vitro is no longer seen to be unnatural.
In Europe, around one in four young men now have a sperm count that would render them subfertile or infertile; they will likely need to use ICSI if and when they decide to reproduce. An estimated
sixty thousand women in Britain seek IVF every year. By the current medical definition of infertility – the failure to achieve a pregnancy within one year of regular, unprotected intercourse
– some nine million people in the UK fall into this category.

There are many women with abnormally shaped wombs, unhealthy eggs, or no eggs; many men whose sperm are just not up to scratch; and men and women who have had, for example, treatments for cancer
that have killed off their reproductive material before they have had a chance to become a parent. Some couples can’t have children because one of them is
infertile,
but if a couple cannot have a child because they are two men or two women, then technically, they are infertile too.

Bringing egg and sperm together cannot, by itself, resolve all of the issues that people may face when they want to have a child but cannot. So it makes sense that, one day, possibly soon, we
will expand our means of reproduction to be far broader than our current repertoire. To get a glimpse at the future of reproduction, simply think about the problems that ART has not yet resolved.
Who are the Lesley and John Brown of the next phase of human history?

Thirty years after the first test-tube baby, science is poised to add many new weapons to its armoury in the battle against infertility, including using your own stem cells to generate fresh
sperm or eggs or both, when you don’t have any or have run out. There may perhaps be gene therapy to prevent miscarriages from corrupt chromosomes. There is even a body of research to prepare
us for reproduction in space, where sperm seem to move faster (a fertility plus) but some hormones may not be activated (a developmental negative).

Since humans first evolved, men and women have needed each other to make babies. But the nature of human reproduction is about to change radically. Children born this year will be able to make
babies in ways their parents could barely dream of – when, that is, they decide to have children, at a time
entirely
of their own choosing.

The Mosuo people live high in the Himalayas, in the Yunnan and Sichuan provinces, near the Tibetan border, in China. They live a primarily agrarian life, raising yak, water
buffalo, sheep, and poultry. They are also one of the few peoples whose language appears to have no word for ‘father’ – perhaps the most exotic facet of their way of life, to an
outsider.

The Mosuo are a matrilineal culture: it is the women who determine the family line and inherit the family property. Such practices have existed in Tibetan and northern Indian societies from
Neolithic times, presumably motivated by a desire to keep wealth and resources within the kin group. These customs started to decline – or at least, to be hidden – after missionaries
and colonists began to malign them in the nineteenth century. Among the Mosuo, however, maintaining a matrilineal culture grew into something of a necessity as more and more Mosuo men started to
leave their villages to become monks or trade along the Silk Road.

With their men absent or unavailable, the Mosuo women took over the day-to-day administration of the community. They chose not to marry, opting instead to look after their
own households, some populated with four generations of Mosuo women. At puberty, a girl would be given a private bedroom, in an otherwise open-plan home, and like a society debutante she would
attend dances, looking for a suitable partner for courting. If a young man caught her fancy, the girl would be free to choose him as her lover – and not just as a lover, but as a father to
one or more of her children. But their relationship was temporary; the man might be allowed to stay the night, but in the morning he would go back to his own dwelling, to live with his own
mother’s line. There was no requirement – no expectation – that the father would stick around.

These so-called walking marriages involve none of the messy elements of a long-term partnership. There is no divorce, no joint-property disputes, no custody battles. In this way, new generations
would be born and the missing men would be replenished, with the village remaining peaceful under the watchful eyes of the mothers.