Designing babies

  • Roger Gosden
W. H. Freeman: 1999. 260pp $24.95
Prodigy synthesis: reproduction taken to its limit. Credit: MORIZ JUNG/CORBIS/AUSTRIAN ARCHIVES

Both the author of this book and readers ought to know my personal biases from the outset. As a chemist, deeply involved and interested in human conception over four decades, I have become so intrigued during the past few years by the cultural and operational effects of assisted reproductive technologies, including IVF techniques such as intracytoplasmic sperm injection, (ICSI), and the separation of sex (under the covers) and fertilization (under the microscope), that I even wrote a novel and a play about the subject. So I opened Gosden's book with a tinge of competitive curiosity, even looking for authorial mis-steps or omissions. But I closed it with unambiguous admiration. “Read this book!” is my warm recommendation, because these topics are covered well.

Gosden surveys in a readable, breezy fashion all the high points of the reproductive revolution that started 21 years ago in Britain with the birth of the first IVF baby, Louise Joy Brown. His prose is straightforward enough not to lose general readers but not so simple as to turn off scientifically sophisticated ones. He is remarkably up-to-date, covering research results until late 1998, as can be seen from an admirable bibliography. And he addresses, perhaps a tad too optimistically, all the contentious issues, from sex predetermination to preimplantation analysis and cloning.

His speculations on how to get men pregnant, however, even by equipping them with uteri, is likely fodder for reproductive Luddites who will simply exclaim “I told you so” and not pay attention to the other issues raised here, 98 per cent of which are truly important. I am not sure whether getting men pregnant and converting them into functioning androgenic mothers is currently a high priority for anybody but a tabloid newspaper. But we do need a vigorous debate on the implications of 100 per cent certain sex predetermination, once effective separation of Y and X sperm has become a routine procedure in humans (a topic thoroughly discussed by Gosden). Or on the fait accompli of using sperm aspirated after death from a man — even after storing it for months or years — to produce a live child via ICSI.

The best written, and in my opinion also most significant, section is the one dealing with the issue of ageing mothers. In the Western and increasingly geriatric world, first-time motherhood is being postponed. A woman is born with her supplies of immature eggs, 90 per cent of which are gone by the time she is 35. As Gosden states succinctly: “Nature has carried out an act of biological sabotage on women” in that the ovary ages faster than any other organ — even though the uterus doesn't. Postmenopausal pregnancies are thus perfectly feasible, provided a source of young, healthy eggs is still available.

The author covers in detail the various options for accomplishing that aim, from surrogate eggs to the preservation of ovarian tissue and its possible subsequent transplantation. But he seems rather dismissive of the already feasible preservation of young mature eggs with concomitant use of IVF. He tends to downplay that approach because of the expense associated with any IVF technology, yet ignores the fact that still-unrealized approaches such as ovarian transplant are likely to be even more costly. He makes a convincing case for why women should be entitled to the choice of later motherhood, even beyond the menopause. The real problem with all of these approaches is, of course, that for a long time to come only the affluent people in the affluent countries will be able to take advantage of such options.

The book is replete with examples of technology being developed for one purpose, but then used by society for very different ones. The direct injection of a single sperm into an egg under the microscope (ICSI), followed by transfer of the two-day-old embryo back into the woman's uterus was developed by Belgian scientists in 1991 to treat male infertility, primarily in men with insufficient sperm. The first baby born of such a technique is now only eight years old, but more than 10,000 such babies have been born since then and by no means all the fathers have been lacking sperm.

In the end, the reproductive optimists will have to accept Gosden's statement, so typical of many practising specialists in reproductive medicine: “I believe the primary goal of reproductive medicine and biology is to help people bear a child with the best possible start in life — physically and psychologically — and to bring diversity to family life.” We all know that life is a terminal disease and that the production of genetically identical offspring is the only indirect way of prolonging it. Gosden makes a good case for how far science, technology and apparently also society are willing to go to satisfy that drive — a subject meriting continuing debate.

Designing Babies may soon require a new edition, given the rapid advances in reproductive medicine, in which case I have two recommendations. The present index is so inadequate that it should be improved or deleted. There are entries for the Nazi party, Shakespeare and Woody Allen, but not for ApoE, BRCA1, PGD or dozens of other highly germane words that are discussed in the text. The glossary is better, but makes no mention of many IVF techniques such as GIFT and SUZI, and makes the error — grating to a chemist — of defining “oestrogen” as “a steroid hormone produced by the ovary”. Oestrogen is a generic classification, but there is no such specific hormone (in contrast to oestradiol, oestriol and the like). While one may forgive the popular press for such a misuse, an expert of Gosden's calibre should not perpetuate it. Nor should the author indulge in one-upmanship with buddy references to “Ian”, “Steve” and “Arnie”. I will offer a good bottle of Californian wine to the first Nature reader who can identify all three of Roger's pals without first having read the book.