28Sleep· Journalists Team

From Dusk to Dawn

FictionProbability 60/100

// A story from 2051

Olivia is on top of the world. Today, just as she was beginning to lose faith, the Medically Assisted Procreation (MAP) department at Singapore General Hospital finally called her regarding her in vitro gametogenesis (IVG) request. A few administrative steps later and her appointment is set for the 21st of January, 2051. Her dream of having a child is finally within reach.

The last few years hit her hard. When she was diagnosed with ovarian cancer in 2045 at age 38, she was forced to undergo uterine and ovarian ablation – just as she felt ready to take the plunge and have a child with her partner, Liam. A major blow. In February 2049, she contacted Singapore General Hospital in the hope of getting an appointment for IVG. After almost two years on the waiting list, her wish is finally coming true.

The day before her appointment, Olivia enjoys a night out with friends Levi and Aiden. These guys also went through this process to give birth to their baby girl, Lily. Olivia peppers them with questions about IVG and EUFI (extra-uterine foetal incubation). Although she relishes the chance to finally become a mother, Olivia is not at all reassured about the process.

Aiden eases her mind by explaining that the biopsy doesn't hurt at all. Lily was created from Aiden's skin stem cells that were transformed into eggs by IVG and then fertilised in-vitro by Levi’s frozen sperm. She was then ‘carried to term’ in an artificial womb using EUFI. Levi explains that a midwife does regular follow-ups with the would-be parents at home. Other than that, they don't have to do much else besides alerting the midwife if anything seems wrong. On the day of the birth, the midwife ensures that the birth goes smoothly and records all the baby's data in a Life Pass that will follow the newborn for the rest of its life. Olivia and Liam will return home and start to enjoy their new lives as parents.

19 February 2051. It’s D-Day for Olivia and Liam. A month after the collection of Olivia’s stem cells, the couple is welcomed again at the hospital in a room right next to the lab where the biologists will create the egg cell. An augmented reality projection of what’s happening under the biologist’s microscope is shared on the glass window between the two rooms. The creation of the egg cell goes off without a hitch and it’s placed in a small, fully sterilised rack alongside hundreds of others. It will develop in this giant incubator before being transferred to its own a week later. The biologist explains to the couple that their future child will remain in the lab for two months. During this time, it will be connected to a EUFI incubator, and its development will be highly monitored.

At the beginning of April 2051, the midwife assisting the couple arrives at their home with the incubator. The foetus has developed well and will be able to continue its development outside the hospital. Liam and Olivia are delighted to be reunited with their future child and to be able to stay close to him as he develops. The midwife schedules another appointment with the couple mid-June to monitor the growth of the foetus and adjust EUFI settings.

20 December 2051. Olivia and Liam enjoy a quiet moment with their son in front of their holographic TV. Little Milo is now one month old and thriving. The new parents get a notification from the Life Pass app on their phones to say that an appointment was automatically made with their family doctor for his first TB vaccination. It's 1 pm and the news starts with the headlines: the CO2 level in the air in Beijing has dropped by more than 50% (an all-time record); the remastered film Invictus is released, celebrating sixty years since the end of Apartheid and in which Morgan Freeman is posthumously played by a digital actor. As Milo falls asleep in Liam’s arms, one headline in particular catches the couple's attention. Cornell University's Reproductive Endocrinology Laboratory has just taken reproductive research one step further. The first child with eight parents was born in perfect health – each parent from a different part of the world. With its multiple origins, this child’s facial characteristics may just be the future face of humanity.

// The science behind it

IVG and EUFI: to infinity and beyond

By 2051, virtually anyone with a skin would have the ability to produce eggs or sperm. Procreation has always been a somewhat taboo subject that we don’t like to medicalise. Just take a look at the vitriolic reactions people had to the advent of MAP in 1978. And yet, forty years later, we’ve had more than 8 million births thanks to this new discovery. Since then, research has continued to move forward and improve to allow everyone to procreate – regardless of gender or sexuality. In 2051, if you want to have a child, you can do so naturally but almost half the population will first make an appointment with a MAP hospital service. Research improvements mean that infertility no longer exists. Procreation is now possible for absolutely everyone.

Since 2042, thanks to IVG coupled with EUFI, a same-sex couple can conceive a child without the intervention of a third party and become biological parents. Skin cells from one half of a couple will be transformed into pluripotent stem cells. These cells will then be reprogrammed into male or female gametes (reproductive cells), depending on the missing type of gamete. Women who no longer have ovaries or whose oogenesis (the process of an egg cell becoming an ovum) isn’t functioning properly can also have their stem cells transformed into gametes.

IVG opens up a multitude of possibilities and allows everyone to fulfil their desire for parenthood. This has been taken a step further since the end of 2049 when people expressed the wish to procreate on their own. IVG allows them to create both male and female gametes from their skin.

This hasn’t been approved by the international bioethics committee, as the very limited genetic mixing could be risky for the child. However, IVG has paved the way for so-called multiplex parents. Last year, in early 2050, four polyamorous people were able to give birth to the first four-parent child. The four parents-to-be – in this case, two men and two women – were separated into two pairs whose gametes were harvested to form two embryos through in vitro fertilisation. One embryo was then reprogrammed into a male gamete, the other into a female gamete. IVF of the egg by the sperm, both artificial, allowed the creation of the final egg cell. The development of the foetus and the birth of the child went well, but its growth is still monitored to prevent all possible problems.

Creating gametes and egg cells to grow an embryo has been made possible. But how can we ensure the development of this embryo without an intra-uterine environment? Quite simply – by creating an artificial environment. This has taken decades of research, as the placenta is an extremely complex organ to re-create, and amniotic fluid has to respect extremely specific conditions in terms of composition and temperature.

But with the number of very premature babies increasing every year, researchers around the world have been looking into the matter. In 2038, after numerous tests, the first very premature baby of 19 weeks was able to grow to term. Thanks to a state-of-the-art incubator that identically reproduces the intra-uterine environment, this replicates the exchanges between the foetus and the body of the mother through the placenta: the EUFI. Since the child had no side effects and all its vital signs had stabilised once in the incubator, this process was taken a step further. At the end of 2040, the first child developed entirely with EUFI was born, opening a whole new field of possibilities. However, this technology remained exclusively for medical purposes until 2046. EUFIs are now available to everyone – subject to approval and a certain waiting period.

The availability of EUFI is a new milestone in access to reproduction, whether for same-sex couples, for women who don’t or no longer have a uterus, or for women who wish to have a child without having to carry it. This marked the end of the seemingly unbreakable link between sex and procreation. It has also brought great societal upheaval since reproduction no longer relies mainly on women.

The lab: the future of procreation

And why not? Since 1978, IVF has proved its worth. In addition to the millions of babies born through this method, women as old as 70 have been able to give birth. In some countries, same-sex couples can also become mothers with the help of a donor. In 2016, IVF opened the door to multi-parenting with the birth of the first three-parent child, which enabled a woman with the hereditary Leigh syndrome to give birth to a healthy child.

IVG is a science to take seriously. In Japan, a group of researchers in agriculture, medical and embryo science conducted a promising experiment on a mouse in 2016. Its eggs were artificially created from skin cells. As a result, she gave birth to 26 pups.

On a human level, research is still in its infancy. Japanese researchers tried to create an egg cell from blood cells. Unfortunately, the gamete was too immature to be fertilised, but scientists still managed to create the egg. We’re not at the stage where we can start thinking about multiplex parents yet, but the beginnings are promising. We know the process works, but it will take a few more years of research to be applied to humans.

As far as ectogenesis is concerned – i.e., the development of an embryo or foetus in an artificial womb – opinions are divided. Magdalena Zernicka-Goetz and her colleagues at the University of Cambridge have succeeded in developing an embryo in-vitro for 14 days. On the other hand, maternity wards are able to take care of very premature babies at the 22nd week of pregnancy (i.e. five and a half months).

The question is: will we be able to close this 5-month gap and ensure artificial foetus development for a whole nine months? Scientists are hard at work to make this happen. Yoshinori Kuwabara, professor at Juntendo University in Tokyo, has developed a technique called EUFI. Using EUFI, he can ensure the proper development of goat foetuses for three weeks using catheters connected to the umbilical cord and incubators containing artificial amniotic fluid.

Science is progressing fast, and it looks as if IVG and artificial gestation may arrive sooner than we think. It’s going to open a hornet’s nest of legal questions and ethical dilemmas that we should start thinking about already. How many parents should we allow to be involved? Is it going to be accessible to everyone without any stipulations? Should IVG be a choice for all, or an absolute last resort? And how will IVG influence the development of future generations – halting adoptions, creating so-called ‘designer babies’ and causing a further population explosion?

It’s one vision of the future which could mean immense joy for some, and massive conundrums for rule-makers around the world.

// Sources & further reading