First coined by the French philosopher Antoine Cournot, ‘the end of history’ is a phrase that was later popularised in the 1990s by the American political scientist Francis Fukuyama.
But might the 2020s see ‘the end of sex’? It's not an altogether frivolous question. Bernard M Dickens, for example, cited Henry T Greely's book The End of Sex and the Future of Human Reproduction, which ‘looks two to four decades ahead in the development and popularization of genetic biotechnology to predict and justify widespread abandoning of sexual intercourse for the purpose of reproduction’ (Dickens, 2017: 165). It could be argued that book promotions thrive on outrageous claims, but Greely's are derived from scientific advances published in peer-reviewed journals.
Take, for example, the concept of artificial gametes. Smajdor et al (2018) note that initial steps towards laboratory-created sperm and egg cells were taken in 2003 and 2004 by scientists working with embryonic stem cells. Subsequent work revealed that substituting embryonic stem cells with ordinary adult skin cells allowed so-called ‘induced pluripotent stem cells’ (iPSCs) to be produced. These iPSCs could in turn be manipulated into specialised cells such as gametes, and research is ongoing.
For patients who are infertile through an inability to produce eggs or sperm, artificial gametes represent a possible means to parenthood, an option that many would be keen to take. For example, in a survey of more than 900 couples in whom the male had non-obstructive azoospermia, Hendriks et al (2016) found that 89% of couples would choose artificial gametes as a favoured treatment option.
Artificial gametes would ensure biological relatedness, and patient autonomy invites the inference that we have a right to use our gametes in whatever way we choose. For ecample, there need not be any obstacle to a post-menopausal woman recruiting one of her skin cells so that an egg might be created.
On the other hand—and acknowledging at the outset that it is not ‘natural’ to have a heart transplant, or a hip replacement, but it is widely accepted—it seems legitimate to suggest that artificial gamete technology represents a wholesale subversion of a natural process. The prospect of unforeseen consequences of this technology is raised by Regalado (2017: 35), who notes that it may be feasible ‘to make eggs from a man's skin cell and sperm from a woman's skin cell, though the latter would be more difficult because women lack Y chromosomes.’ Such ‘sex reversal’, he suggests, would make it theoretically possible for reproduction between a same-sex couple.
Quite apart from what damage such laboratory cellular manipulation might inflict on an artificial gamete's DNA, the nucleic acid could be further exposed to already well-established gene-editing technology, enabling the removal and/or insertion of sequences that could herald the era of so-called ‘designer babies’. As Regalado (2017: 39) observes, because gene-editing technology is not error-free, ‘embryos might be imperfectly edited, creating unknown and intolerable risks for any child.’
A further cause for concern is identified by Smajdor and Cutas (2014: 748) in their study, ‘Artificial gametes and the ethics of unwitting parenthood’. They issue a simple yet stark reminder that we are continually shedding—while I am writing, and you are reading this, for example—a diversity of non-reproductive cells. Given the future possibility that artificial gametes could be produced from these innocently shed cells, ‘anyone could in theory collect them, take them to a laboratory, convert them to gametes and use them to conceive a child.’ Thus, the authors speculate, even the Pope (to use an extreme example) could become the genetic father of a child without having met the child's mother. Given this possibility, they reflect on the extent to which parental responsibility might reasonably be ascribed, based on a positive genetic test.
The scenarios evoked by possible applications (or misapplications) of artificial gametes technology may seem unlikely today, but for those embarking on their midwifery careers, it is entirely possible that they may need to be prepared to address some fraught ethical dilemmas that could arise from such emerging technologies in the not-too-distant future.