Harsha Chawda, India’s first test-tube baby was born in 1986. In vitro fertilization (IVF), the technique used then, has since gone on to prove a blessing for several infertile couples. However, at the time of inception, this technique faced much criticism. The objections ranged from the ethical—disrupting natural life processes—to concerns about the fate of unwanted or unused embryos generated during the process, and possible social stratification due to the then excessive financial costs of the procedure. Yet, time has broadly validated the technique, reduced costs, and made it safer and more reliable.
In vitro gametogenesis (IVG), a newer form of assisted reproductive technology, is now poised for the same hot seat that IVF occupied for several years. Still in an experimental phase, the technology promises genetically linked offspring to not only infertile couples but post-menopausal women, gay couples, single people and even groups of more than two individuals (whether male, female, or a mix of the two) to have their own children. As the name suggests, this technology involves the artificial construction of gametes, i.e. the male/female reproductive cells. Any well-differentiated adult cell (e.g. skin cells, hair cells, etc.) of the human body can be used to do this, surpassing the need for gamete donation, leading to an endless supply. The production of gametes, along with their fusion, occurs in the laboratory, leading to the creation of embryos, thereby providing an alternative to the hassle of assembling embryos within human bodies.
This can lead to an inexhaustible supply of embryos, thereby offering parents the chance to select an “ideal” future child. But in addition to its ability to create new embryos from any normal cell, a contribution quite path-breaking by itself, IVG attains full potential when combined with other technological advances that are simultaneously evolving. Genetically modified human creation can be turned into reality much faster by combining IVG and targeted gene-editing technologies. Such designer babies will no longer be a hypothetical concern, once the Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/Cas9 system, a targeted gene-editing technology, starts finding full expression. This will not only help parents select the best embryo but also facilitate alteration of a certain set of genes, thus creating their version of a “perfect child” with “vanity” traits such as height, enhanced muscular strength, fair skin tone or eye colour and even increased intelligence.
The jury is still out on the merits or otherwise of having “such designer babies” in the midst of normal human beings. It is one thing to be entertained by X-Men and quite another to live alongside people with enhanced capabilities, thanks to artificial procedures applied at the time of conception. Such interventions raise some serious concerns such as off-target mutations and mosaicism. In the former situation, CRISPR could miss the target gene and attach to another similar sequence, thereby creating properties far different from the intended outcomes. The latter scenario arises when the attaching is spot on but the edited gene fails to alter the DNA sequence of all cells. This leaves the embryo vulnerable to genetic diseases, leaving future generations to suffer from the error.
Another challenge is that it requires policy deliberation with respect to unauthorized IVG, which involves making babies out of human cellular debris without the explicit consent of the donor. Courts that have till now dealt with non-consensual parenthood, rising from stolen sperm or forced pregnancies, will face new challenges with respect to unauthorized IVG. This will pose worrying legal questions regarding the definition of parenthood and penalties for unauthorized cell access. Such cases can get more complicated when a single embryo has more than two genetic parents. Will the law support multiplex parenting or give more rights to—or saddle with more responsibilities—the larger contributor of genetic material?
In a society like India where prenatal sex determination is banned because of strong cultural preferences for the male child, this era of IVG and designer babies could lead to a further deterioration of the sex ratio. Instead of having to determine gender once the embryo is conceived, parents could choose to engineer the same prior to conception and evade the law. While these solutions may only work with further advancements and exponential cost-reduction, it is good to weigh their impact early on.
IVG’s promises, therefore, come with huge responsibilities in terms of developing rigorous, internationally accepted scientific protocols as well as clear ethical norms and practices. There is a strong need for global conversations around this issue, with India and her stakeholders—ranging across government, the scientific establishment, and the LGBT community—being active participants. The Asilomar conference in 1974 placed self-regulations on scientific research on the then new technique of recombinant DNA. James Watson, the co-discoverer of the DNA double helix structure, famously reflected later: “If we don’t play God, who will?” Though technology has advanced considerably in the last four decades or so, developments such as IVG compel us to ask roughly similar ethical queries. Who knows how far is far enough—except in hindsight.