29 July 2023

Making babies in vitro: The Economist special

The weekly acknowledges the high failure rate of assisted fertilisation and explains the new techniques -from gametogenesis to mitochondrial replacement- wishing for rapid progress. But it is silent on the risks to children's health. And it does not speak of infertility prevention: a commitment that would damage the enormous business
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The Weekly The Economist dedicates a long special to the topic of assisted reproduction, title Making Babymaking Better (Improving the Making-Children) first of all recognising that Although performance has improved, the number of failures of these techniques is still very high. On average 7-8 out of 10 attempts are unsuccessful, the number of failures growing in parallel with the woman's agemenopause is a process that only occurs in human females and in some whale species. The dossier also points out the increasing number of young women resorting to freezing (or vitrification) of oocytes for use later in life. One in six people today suffers from infertility problems, which -according to the weekly- makes a commitment to research to minimise the risks of these practices and maximise the results. Despite 12 million people were conceived in test tubes -leading the way is Denmark where 9 per cent of births take place in vitro- the mechanisms that initiate new life, in particular how the embryo implants in the uterus, remain to be fully understood.

Very promising studies - particularly in the USA and Japan - on the so-called gametogenesis, or the creation of 'oocytes' from totipotent stem cells derived from skin and blood. At present, gametogenesis has been tested with some small success in mice. The technique would make it possible biological paternity to both men of a same-sex couple without the contribution of female gametes: one would put in the sperm, the other the pseudo-ovocyte made from its stem cells (it would, however, be necessary to use a surrogate mother at least until the artificial womb was developed).

Another field of research is that of the so-called mitochondrial replacement therapy which would allow the 'rejuvenation' of oocytes from an older woman, carrying possible chromosomal abnormalities, with the grafting of mitochondria taken from donor oocytes.

The Economist also gives an account of the economic importance of the sector and the growing interest of investors which push policy in the direction of increasingly liberal legislation on access to these techniques.

The hope is that "just as the sexual revolution in the 1960s and 1970s gave women the option of not having children if they did not want them, emerging technologies could initiate a new revolution by allowing women -and men- to have as many children as they want when they want them'..

The rich dossier of The Economist nevertheless presents two serious omissions: the first lwhere it states that 'test tube babies are as healthy as everyone else'.. Normally, propaganda goes much further, going so far as to make people believe that, thanks in particular to the pre-selection of embryos and possible genetic manipulation, these children are even healthier than others. But even claiming that they are as healthy as others unfortunately does not correspond to reality: are multiplying studies demonstrating that children born of assisted fertilisation -all techniques- are at a 'statistically significant' increased risk of numerous pathologies, including oncological diseasescompared to those born by natural conception.

According to omissis: lo special does not even consider the idea of a policy to prevent increasing infertility, aimed at restoring to young women and men their natural power to reproduce. In fact, the 'right' to have children well beyond childbearing ageright to which the greatest propaganda is being made. Information on the limits of the reproductive age and sexual health, risk disclosure, family welfare, removal of obstacles to work and career, revalorisation of motherhood: this is what would be needed to enable young women to seek their first child within the third decade of life, when fertility is at its highest.

La combating environmental pollution would instead be the main front to preserve male fertility, which has been in free fall for years. Chemical and physical pollution impacts sperm quality; one recent studypublished in preprint in the international journal Science of the Total Environmenteven noted the presence of microplastics -polypropylene (PP), polyethylene (PE), polyethylene terephthalate (PET), polystyrene (PS), polyvinyl chloride (PVC), polycarbonate (PC), polyoxymethylene (POM) and acrylic- in human seminal fluid.

Of course: prevention does not make business.

If efforts were made to prevent infertility, natural reproductive capacity could no longer be sold as an increasingly expensive and sought-after product.

Marina Terragni

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