The Ethics of In Vitro Gametogenesis

Françoise Baylis comments on the ethics of using gametes derived from human induced pluripotent stem cells for future human reproduction.

__________________________________________

A recent New York Times article, provocatively titled “Babies from Skin Cells? Prospect is Unsettling to Some Experts,” has once again drawn attention to controversial research by scientists at Kyushu University in Japan who succeeded in making fertile mouse pups using eggs created through in vitro gametogenesis (IVG). This is a reproductive technology that involves creating functional gametes (sperm and eggs) from induced pluripotent stem cells. Induced pluripotent stem cells are cells derived from adult body cells (such as skin cells) that have the ability to become other body cells including reproductive cells (sperm and eggs).

Supporters of this reproductive technology eagerly anticipate similar research in humans. Indeed, enthusiasts are quick to trumpet the potential benefits of in vitro gametogenesis. These benefits fall into three general categories.

First, we are told that research to derive human gametes from induced pluripotent stem cells is important for basic science. It will advance our understanding of gamete formation, human development, and genetic disease. In turn, this increased understanding will create new options for regenerative medicine.

Second, we are told that this research will allow clinicians to improve fertility services. For example, with in vitro fertilization (IVF), women typically have to undergo hormonal stimulation and egg retrieval. This can be onerous in terms of the time required for interviews, counseling, and medical procedures. It can also be harmful. Potential psychological harms include significant stress and its sequelae. Potential physical harms range from the pain and discomfort of the daily hormone injections to the resulting cramping, abdominal pain, nausea, vomiting, bloating, mood changes, rapid weight gain and respiratory difficulties, damage to organs in close proximity to the ovaries, and life-threatening ovarian hyperstimulation syndrome. If human eggs were made in a laboratory from skin cells, then women could avoid the burdens and harms associated with hormonal stimulation and egg retrieval.

Third, we are told that this research will increase reproductive choice. For example, cancer survivors who become infertile or subfertile because of their cancer treatments could still have genetically-related children. Also, older women with age-related infertility or subfertility who want genetically-related children could use in vitro gametogenesis. In addition, same-sex couples could have children who are genetically-related to both partners by having one partner create gametes of the opposite sex. As well, a single person with no partner and no interest in using donated or purchased gametes from another person could choose to use their own gametes in conjunction with gametes of the opposite sex created using in vitro gametogenesis.

In the abstract, I can support the first and second research objectives which aim to improve regenerative and reproductive medicine. I have serious reservations, however, about the third objective where in vitro gametogenesis does not obviously respond to a medical need. Rather, it aims to satisfy a personal interest on the part of prospective parents – namely, a want for genetically-related children. I reject the view that genetic ties are critically important to family-making. Indeed, I believe that we should be wary of overvaluing genetic-relatedness especially when this undermines the legitimacy of social parenting through adoption, blended families, other-mothering and so on.

More generally, any and all practices that reinforce social biases toward genetic parentage are deeply problematic. They contribute to discrimination by reinforcing racism and also contribute to stigmatization by suggesting that some genes are better than others. These facts behoove us to recognize the ways in which in vitro gametogenesis, like other reproductive technologies, promotes a modern type of eugenics.

As the acclaimed legal scholar, Dorothy Roberts reminds us, “[t]he desire to have genetically related children is not entirely natural, but is determined by our political and cultural context.” As such, we must be mindful of embracing practices that contribute to reification of the gene.

__________________________________________

Françoise Baylis is a Professor and Canada Research Chair in Bioethics and Philosophy at Dalhousie University @FrancoiseBaylis