WEBVTT - The Future of Baby-Making 0:00:04.200 --> 0:00:07.160 On today's show, as we wrap up this season, we're 0:00:07.160 --> 0:00:10.479 doing something a little different. We're going into the future 0:00:11.200 --> 0:00:14.160 to learn about a technology that's in the works but 0:00:14.280 --> 0:00:19.120 not yet available, a technology that even in its development stage, 0:00:19.360 --> 0:00:21.799 has people asking all kinds of questions. 0:00:22.720 --> 0:00:25.200 Imagine it became possible so that you could go to 0:00:25.239 --> 0:00:27.360 a hotel where Brad Pitt had been, you could take 0:00:27.400 --> 0:00:30.320 the dead skin, and you could use that genetic material 0:00:30.360 --> 0:00:33.520 to produce children. Would that be something that was problematic. 0:00:34.120 --> 0:00:37.640 We're talking about a type of reproductive technology called in 0:00:37.760 --> 0:00:42.520 vitro gametogenesis or IVG, that has the potential to open 0:00:42.600 --> 0:00:45.640 up a whole world of options for how humans procreate. 0:00:46.440 --> 0:00:51.680 IVG is essentially a process where cells, including human skin cells, 0:00:51.720 --> 0:00:56.040 could be used to make babies. Glen Cohen knows all 0:00:56.080 --> 0:01:00.240 about IVG. He's a professor of bioethics and law at 0:01:00.240 --> 0:01:01.800 Harvard Law School. 0:01:02.080 --> 0:01:06.399 You could both produce sperm an egg yourself and have 0:01:06.440 --> 0:01:10.120 a child that is your direct genetic descendant, but completely 0:01:10.160 --> 0:01:12.960 taking your genetic material rather than someone else. Now, I 0:01:13.000 --> 0:01:15.920 think for most people this strikes them as extremely strange 0:01:16.560 --> 0:01:19.360 as a desire. Why would you possibly ever want this? 0:01:19.840 --> 0:01:21.640 But just as there are people who want a single pair. 0:01:21.720 --> 0:01:23.880 In terms of rearing a child, there might be people 0:01:23.880 --> 0:01:27.080 who want to not have anybody else's genetic material involved. 0:01:28.280 --> 0:01:32.200 This may sound like science fiction, but scientists and biotech 0:01:32.280 --> 0:01:44.679 startups are already working or making it a reality. I'm 0:01:44.720 --> 0:01:48.120 Laurena Rora Hutchinson. I'm the director of the Ideas Lab 0:01:48.200 --> 0:01:53.240 at the Johns Hopkins Berman Institute of Bioethics. On today's episode, 0:01:53.480 --> 0:01:56.160 there are a lot of ways IVG could be used. 0:01:57.240 --> 0:02:00.520 People who for any reason aren't able to juice eggs 0:02:00.600 --> 0:02:04.520 or sperm could still have biological children, like people who've 0:02:04.520 --> 0:02:08.200 gone through menopause and people whose fertility has been impacted 0:02:08.240 --> 0:02:13.600 by cancer treatment. And people in same sex relationships could 0:02:13.680 --> 0:02:18.200 both be the genetic parent of the same child. But 0:02:18.320 --> 0:02:20.920 given that we could be shaping the future of humanity 0:02:21.160 --> 0:02:24.079 with this new technology, there are a lot of ethical 0:02:24.160 --> 0:02:28.240 questions to unravel. Are there good or bad reasons to 0:02:28.240 --> 0:02:33.760 do IVG? How much should regulators play a role? And 0:02:33.880 --> 0:02:37.280 how long do we have before all this becomes a reality. 0:02:38.320 --> 0:02:42.600 Some researchers predict that it may take decades, while commercial 0:02:42.680 --> 0:02:48.200 startups promise proof of concept trials within one to two years. 0:02:49.520 --> 0:02:53.600 From pushkin Industries and the Johns Hopkins Berman Institute of Bioethics. 0:02:54.040 --> 0:03:05.239 This is playing God. We'll hear more from Glen Cohen 0:03:05.360 --> 0:03:09.040 later on in this episode, but first I wanted to 0:03:09.120 --> 0:03:13.040 understand more about this technology, like how it actually works 0:03:13.160 --> 0:03:17.080 and where the research stands today. So I called up 0:03:17.120 --> 0:03:21.560 Amanda Clark. She's a professor of molecular, cell and Developmental 0:03:21.560 --> 0:03:25.919 biology at the University of California, Los Angeles, and she's 0:03:25.960 --> 0:03:30.680 an internationally renowned researcher and expert on in vitro gamito genesis. 0:03:31.200 --> 0:03:33.639 She's been working on developing it for decades. 0:03:35.120 --> 0:03:40.400 I am a basic scientist, and I'm interested in questions 0:03:40.840 --> 0:03:46.000 that are related to fertility and infertility and reproductive health. 0:03:46.920 --> 0:03:49.720 And what I saw as I looked at the scientific 0:03:49.840 --> 0:03:54.160 landscape for what's available to couples who are struggling with infertility, 0:03:54.920 --> 0:03:58.320 is that there seems to be a limit to what 0:03:58.800 --> 0:04:04.440 can currently be achieved with assisted reproductive technologies and medical technologies. 0:04:05.040 --> 0:04:10.120 So for those individuals who, for example, they're ovary or 0:04:10.240 --> 0:04:15.440 testis was destroyed as part of occupational health injury or 0:04:15.640 --> 0:04:20.520 due to chemotherapy or radiation therapy following a cancer diagnosis, 0:04:20.520 --> 0:04:23.839 and now they're cancer survivors. All of these types of 0:04:23.920 --> 0:04:27.960 injuries destroy the cells in the overy in testice that 0:04:28.360 --> 0:04:31.920 enable a person to have a biologically related child. And 0:04:32.040 --> 0:04:36.000 so as a stem cell scientist, I became really interested 0:04:36.040 --> 0:04:38.960 in what could we do as in a scientific community 0:04:39.320 --> 0:04:41.880 to be able to help those individuals and couples who 0:04:41.880 --> 0:04:45.000 want to have a family that don't have the cell 0:04:45.040 --> 0:04:49.479 types necessary for it anymore. So could we regenerate these 0:04:49.520 --> 0:04:52.960 cell types from stem cells? And that's the basis of 0:04:53.040 --> 0:04:54.680 in vitrogemetogenesis. 0:04:55.040 --> 0:04:57.320 Could you give me the broad strokes of what's going 0:04:57.360 --> 0:05:00.520 on with IVG and how it works, So if you're 0:05:00.560 --> 0:05:03.320 just explaining this to someone who had no idea what it. 0:05:03.279 --> 0:05:07.760 Was, So let's begin with the G in IVG. So 0:05:08.680 --> 0:05:14.120 IVG stands for in vitro gametagenesis. So most people understand 0:05:14.120 --> 0:05:18.440 what in vitro is because in vitro fertilization is used 0:05:18.640 --> 0:05:22.920 currently as a medical technology to help an individual or 0:05:22.960 --> 0:05:26.880 a couple to have a baby. The G gametogenesis means 0:05:27.040 --> 0:05:30.440 game meats eggs and sperm. So if we add it together, 0:05:30.760 --> 0:05:35.480 in vitro gamita genesis means making eggs and sperm in 0:05:35.520 --> 0:05:40.680 the lab for the purposes of reproduction. For those people 0:05:40.720 --> 0:05:44.000 that their testes and their ovaries aren't working properly, they 0:05:44.279 --> 0:05:48.360 may not make a functional egg cell or a sperm cell. 0:05:48.400 --> 0:05:50.520 And so if your egg cell or sperm cell's not 0:05:50.560 --> 0:05:54.520 functional or you don't make them in your body, that 0:05:54.600 --> 0:05:57.400 means you can't have a biologically related child. 0:05:58.080 --> 0:06:02.040 And so with IVG eggs or sperm cells made. 0:06:01.880 --> 0:06:05.840 So in future, agamtagenesis means instead of these egg and 0:06:05.880 --> 0:06:10.080 sperm cells being made inside of the body, they are 0:06:10.080 --> 0:06:15.720 made in the lab by researchers, starting with a different 0:06:15.760 --> 0:06:18.279 cell type in the body, for example a skin cell. 0:06:18.520 --> 0:06:22.039 So scientists now know how to take a biopsy of 0:06:22.080 --> 0:06:25.480 the skin or perhaps a biopsy of the blood, and 0:06:25.560 --> 0:06:28.920 to grow those cells in the lab and to use 0:06:29.040 --> 0:06:34.000 molecular biology to convert those cells to a stem cell. 0:06:34.040 --> 0:06:38.320 And this stem cell has the potential to become an 0:06:38.320 --> 0:06:41.520 egg and sperm cell in the lab that could then 0:06:41.600 --> 0:06:45.000 be used for fertilization through in vitro fertilization. 0:06:45.800 --> 0:06:48.320 So, just to be clear on this, it means someone 0:06:48.520 --> 0:06:52.400 would be able to create an egg or sperm which 0:06:52.480 --> 0:06:55.240 was genetically matched to them because they'd be using their 0:06:55.320 --> 0:06:56.880 own skin cells. 0:06:57.040 --> 0:07:01.240 Yes, that's right. So in future, agametera genesis provides the 0:07:01.360 --> 0:07:07.359 opportunity for having a genetically related child because the skin cell, 0:07:07.520 --> 0:07:12.400 for example, comes from the person who's the intended parent. Wow. 0:07:13.080 --> 0:07:15.480 So where exactly is this technology currently? 0:07:15.920 --> 0:07:21.160 In future, gemtagenesis is being used for research because scientists 0:07:21.240 --> 0:07:24.280 still can't make an egg or sperm cell in the 0:07:24.360 --> 0:07:27.840 lab from human cells. So what scientists are able to 0:07:27.880 --> 0:07:32.560 do is to make very immature egg or sperm cells 0:07:32.560 --> 0:07:35.440 in the lab from human cells. And so this is 0:07:35.440 --> 0:07:38.560 actually very helpful because we don't understand much about how 0:07:38.600 --> 0:07:41.520 egg and sperm cells are made inside the body because 0:07:41.560 --> 0:07:45.920 they're inside an organ and they're relatively rare cell type, 0:07:46.360 --> 0:07:51.720 and so in future, cometagenesis is providing really important molecular 0:07:51.760 --> 0:07:54.960 and genetic information about how gameat forms and that can 0:07:55.000 --> 0:07:59.440 help us to understand the disease of infertility. But it's 0:07:59.480 --> 0:08:01.840 not yet at the point of making a GA meat 0:08:01.840 --> 0:08:05.280 that can be used for reproductive purposes. We are looking 0:08:05.400 --> 0:08:09.320 at decades away from being able to make an egg 0:08:09.400 --> 0:08:12.280 or sperm cell in the lab that could be used 0:08:12.280 --> 0:08:15.440 for reproductive purposes, and that's where the field would like 0:08:15.520 --> 0:08:15.800 to go. 0:08:16.400 --> 0:08:20.320 When we do get to that point, what applications do 0:08:20.320 --> 0:08:23.560 you think would be the best to try first for 0:08:23.640 --> 0:08:24.600 clinical research? 0:08:25.360 --> 0:08:29.640 Well, one of the options is to study in vitrogametogenesis 0:08:29.760 --> 0:08:34.480 in a species that is closely related to humans, for example, 0:08:34.720 --> 0:08:39.360 using non human primates as an alternate model to make 0:08:39.679 --> 0:08:43.520 game meats in the lab, and to use those lab 0:08:43.559 --> 0:08:46.920 made gameats the egg or the sperm cell in order 0:08:47.040 --> 0:08:53.000 to cure a disease model of infertility. And once those 0:08:53.040 --> 0:08:57.599 scientific models have shown that the game meat can successfully 0:08:57.720 --> 0:09:01.719 lead to a healthy pregnancy and a healthy baby, and 0:09:01.760 --> 0:09:06.520 that the resulting animal itself is fertile, only then will 0:09:06.559 --> 0:09:10.319 this technology move into clinical trials inhuman. 0:09:13.720 --> 0:09:18.600 And so, if it is shown to be safe and effective, 0:09:18.800 --> 0:09:23.680 as you've just explained, and it becomes approved as a 0:09:23.720 --> 0:09:27.680 reproductive technology, who do you think would be interested in 0:09:27.840 --> 0:09:28.240 using it? 0:09:28.320 --> 0:09:32.800 And why? I certainly get emails on a regular basis 0:09:32.800 --> 0:09:37.200 from couples that have been going through in viture fertilization 0:09:38.320 --> 0:09:43.160 for five years or more and successive rounds, and none 0:09:43.160 --> 0:09:46.120 of them have been successful, and so this is the 0:09:46.160 --> 0:09:51.320 sort of group who would be very interested in signing 0:09:51.400 --> 0:09:56.040 up for in future commutagenesis. Of course, we had the 0:09:57.360 --> 0:10:03.480 really important breakthrough study that was published using a mouse model, 0:10:03.520 --> 0:10:05.959 which is a model that scientists use in the lab 0:10:07.120 --> 0:10:10.680 where the sex of a gameat can be switched so 0:10:10.800 --> 0:10:14.920 that an egg cell can be made from cells that 0:10:15.040 --> 0:10:20.120 are taken from a man. And so this opens up 0:10:20.120 --> 0:10:24.960 the possibility of same sex reproduction for those that are 0:10:25.000 --> 0:10:28.520 socially infertile. And I think that this is a really 0:10:28.559 --> 0:10:31.920 important aspect of the technology as well. 0:10:31.960 --> 0:10:35.640 And what would it take to make sure that it 0:10:35.679 --> 0:10:37.280 would be a safe process? 0:10:37.360 --> 0:10:41.199 Yeah, in vitrogametogenesis would need to be proven safe. That 0:10:41.320 --> 0:10:44.160 game meat would need to be proven to have the 0:10:44.320 --> 0:10:50.640 equivalent quality competency of a gameat an eggorosperm that would 0:10:50.640 --> 0:10:54.560 have been made inside of the body. And so what 0:10:54.600 --> 0:10:58.679 this means is testing the quality of the gameat, the 0:10:58.720 --> 0:11:03.400 competency of the gamat and developing scientific tools that don't 0:11:03.440 --> 0:11:07.160 exist yet. And so a lot of that technology now 0:11:07.240 --> 0:11:09.079 needs to be developed too. 0:11:09.200 --> 0:11:11.640 Do you think that could be potential safety risks two 0:11:11.800 --> 0:11:13.400 children born via IVG. 0:11:15.040 --> 0:11:19.400 Well, human reproduction itself is actually not very successful and 0:11:19.440 --> 0:11:23.640 that is why the use of in future fertilization is 0:11:23.720 --> 0:11:27.800 increasing year over year of a year around the world. 0:11:28.360 --> 0:11:34.319 And one thing we have learned about studying embryos in 0:11:34.440 --> 0:11:38.200 the IVF lab is there's a lot of genetic abnormalities 0:11:38.360 --> 0:11:42.839 during early embryo development in humans, much more so than 0:11:42.880 --> 0:11:45.840 in any other species. And actually we understand very little 0:11:45.920 --> 0:11:49.040 about why there is so much genetic instability in the 0:11:49.080 --> 0:11:52.320 early human embryo. And of course, genetic instability in the 0:11:52.360 --> 0:11:57.280 early human embryo leads to early pregnancy loss. And so 0:11:57.840 --> 0:12:02.559 when we turn now to in vitrogamy genesis, the expectation 0:12:02.880 --> 0:12:07.160 is that the game meat made a research in the 0:12:07.280 --> 0:12:11.280 lab and used in fertilization studies is also going to 0:12:11.320 --> 0:12:13.960 have these same issues that a game meat made in 0:12:13.960 --> 0:12:16.520 the body has. And so the question is how do 0:12:16.600 --> 0:12:20.320 we measure the quality of an embryo made from an 0:12:20.320 --> 0:12:26.280 in vitrogametogenesis gameat eggosperm versus an eggosperm cell that's made 0:12:26.280 --> 0:12:30.439 inside the body. And so that's the beginning of understanding 0:12:30.960 --> 0:12:33.920 how these ga meats would be safe. But in the 0:12:34.040 --> 0:12:38.719 end not even natural conception has always successful, and so 0:12:39.200 --> 0:12:42.400 we know that there are children that are born who 0:12:42.600 --> 0:12:47.080 do suffer from genetic abnormalities, and so it's safeguarding against 0:12:47.160 --> 0:12:50.320 all of those potential eventualities with a game meat made 0:12:50.520 --> 0:12:51.600 inside the lab. 0:12:52.160 --> 0:12:55.640 And are there concerns in the academic research community about 0:12:55.640 --> 0:12:59.160 this technology being used in a way that's risky or problematic. 0:13:00.200 --> 0:13:05.200 So I think it's really important that the academic community 0:13:05.840 --> 0:13:10.360 talks about the promise but also the realistic challenges of 0:13:10.440 --> 0:13:15.600 in viuturogemeta genesis. What makes me very nervous is that 0:13:15.840 --> 0:13:19.000 it's potentially possible to get ahead of the science and 0:13:19.160 --> 0:13:22.960 talk about in viuture gemeta genesis as being a technology 0:13:23.000 --> 0:13:27.400 that's right around the corner for use in reproduction. But 0:13:27.520 --> 0:13:32.360 what we're talking about is a reproductive technology that has 0:13:32.400 --> 0:13:37.120 the potential to be transformative. But there's a lot of 0:13:37.160 --> 0:13:41.440 scientific hurdles that need to be overcome in order for 0:13:41.520 --> 0:13:45.600 this technology to become a reality, and it's really important 0:13:45.640 --> 0:13:49.600 that as scientists we communicate that effectively so that we're 0:13:49.600 --> 0:13:52.839 not giving false hope to people who think this technology 0:13:53.280 --> 0:13:55.720 is going to be right around the corner and could 0:13:55.720 --> 0:13:59.160 help them within the next five to ten years, when 0:13:59.360 --> 0:14:02.360 the technology is just not there yet, and the most 0:14:02.400 --> 0:14:06.960 important thing will be ensuring the safety of the technology, 0:14:07.240 --> 0:14:10.400 and that in the end comes down to the quality 0:14:10.440 --> 0:14:12.800 of the erg or sperm cell made in the lab 0:14:13.040 --> 0:14:17.600 and ensuring that that quality is equivalent to the quality 0:14:17.640 --> 0:14:19.360 of an erg or sperm cell that would have been 0:14:19.360 --> 0:14:20.120 made in the body. 0:14:21.200 --> 0:14:24.040 Thank you, Amando. It's been amazing to hear about this 0:14:24.120 --> 0:14:26.600 new technology and all the important work that you're doing. 0:14:27.520 --> 0:14:30.000 So happy for the opportunity to talk about the science. 0:14:31.800 --> 0:14:34.200 After the break, we'll go back to Glen Cohen. The 0:14:34.240 --> 0:14:37.640 ethicis we heard from earlier. We'll find out how he 0:14:37.680 --> 0:14:51.600 thinks as a society we should approach IBG. Let's go 0:14:51.720 --> 0:14:54.960 back to Glen Cohen. Glenn is a professor and deputy 0:14:55.000 --> 0:14:59.120 dean at Harvard Law School. There, he's also the director 0:14:59.440 --> 0:15:03.920 of the Peak Flom Center for Health Law, Policy, Biotechnology, 0:15:04.000 --> 0:15:09.760 and Bioethics. Glenn thinks reproductive technologies like IVG have the 0:15:09.800 --> 0:15:16.600 potential to really change our society and spark new ethical challenges. So, Glenn, 0:15:16.600 --> 0:15:18.800 could you tell us about some of the ethical issues 0:15:18.840 --> 0:15:19.840 surrounding IVG. 0:15:20.520 --> 0:15:23.000 So when talking about IVG, I think it's really important 0:15:23.040 --> 0:15:26.160 to distinguish different use cases, because different use cases raise 0:15:26.200 --> 0:15:29.840 different ethical questions. Start with the easiest use case, I think, 0:15:29.880 --> 0:15:33.640 ethically speaking, which is the use of IVG to help 0:15:33.680 --> 0:15:36.920 individuals who cannot produce scam meat, So, for example, people 0:15:36.920 --> 0:15:42.080 who cannot produce eggs during their regular, normal, healthy fertility period. 0:15:42.480 --> 0:15:45.360 For that group, some of the issues are, what do 0:15:45.400 --> 0:15:48.040 we have to do to perfect this technology? Does it 0:15:48.080 --> 0:15:50.640 involve a lot of embryo destruction along the way and 0:15:50.760 --> 0:15:53.360 is that a problem? How do we know when this 0:15:53.480 --> 0:15:56.000 is safe and effective and ready for human use? And 0:15:56.040 --> 0:15:58.880 when do we move to first in human How will 0:15:58.920 --> 0:16:01.760 we know what the inter generational effects might be and 0:16:01.800 --> 0:16:04.400 how do we track that? And can we actually demand 0:16:05.000 --> 0:16:09.280 to have data from successive generations people who never consented, 0:16:09.360 --> 0:16:11.800 for example, to this because they were born this way. 0:16:12.120 --> 0:16:13.920 And then I think we have some kind of interesting 0:16:14.000 --> 0:16:18.400 questions about policing inappropriate use, So whether, for example, we're 0:16:18.440 --> 0:16:22.440 worried that people might derive eggs from adult cells from 0:16:22.520 --> 0:16:26.480 someone who didn't consent, so taking leftover skin cells for example. 0:16:26.840 --> 0:16:29.720 And then maybe finally is just a broader question about 0:16:29.720 --> 0:16:33.360 whether this is a worthwhile goal for humanity, especially when 0:16:33.360 --> 0:16:36.360 we have so many people with other kinds of medical needs. 0:16:36.800 --> 0:16:39.000 Is this really where we should be spending our time, 0:16:39.080 --> 0:16:42.000 spending our money, and spending our research effort. 0:16:42.240 --> 0:16:45.280 Yeah, a lot of different ethical issues there. So you've 0:16:45.320 --> 0:16:50.160 begun with talking about keeping it within a person's period 0:16:50.240 --> 0:16:53.560 of life where they would, in theory be able to 0:16:53.640 --> 0:16:57.080 produce eggs. Could you talk about some of the ethical 0:16:57.120 --> 0:17:02.720 issues around using IVG for a person who's gone through menopause, 0:17:02.760 --> 0:17:03.400 for example. 0:17:04.000 --> 0:17:06.640 So I often like to distinguish what I call mimicking 0:17:06.760 --> 0:17:11.440 uses versus extending uses of new reproductive technologies. Mimicking is 0:17:11.480 --> 0:17:15.440 attempting to give people who by virtue of medical issues 0:17:15.640 --> 0:17:18.879 would ordinarily be able to do the kind of reproduction 0:17:18.960 --> 0:17:21.879 that everybody else does, enabling them to do that. So 0:17:21.920 --> 0:17:23.639 a way of thinking about this is there's a person 0:17:23.680 --> 0:17:26.840 with a disability and we're trying to correct for that disability. 0:17:27.359 --> 0:17:30.920 Extension uses are attempts to extend and give people fertility 0:17:30.920 --> 0:17:35.880 options that would not be available to other people similarly situated. 0:17:36.160 --> 0:17:38.679 And the post meant apausal example is a good example 0:17:38.680 --> 0:17:42.199 of an extension use. Women have as a species a 0:17:42.359 --> 0:17:46.159 set reproductive period where they are producing eggs that comes 0:17:46.160 --> 0:17:48.840 to an end, and the question is should we extend 0:17:48.960 --> 0:17:52.520 beyond that end. So, in terms of the ethical issues 0:17:52.560 --> 0:17:55.399 that are raised here, one set of issues has to 0:17:55.440 --> 0:17:58.840 do with whether enabling reproduction later in life is a 0:17:58.840 --> 0:18:02.119 worthwhile goal. There are some individuals who are worried that 0:18:02.200 --> 0:18:05.600 when you produce children whose parents are quite old, that's 0:18:05.640 --> 0:18:08.880 an unfortunate circumstance for the child. And that's a relevant 0:18:08.880 --> 0:18:12.040 thing to think about. So that's one issue. Another is 0:18:12.040 --> 0:18:14.480 that there are some individuals who just think the human 0:18:14.520 --> 0:18:17.760 species is a particular kind of thing and living a 0:18:17.880 --> 0:18:21.600 uniquely good human life is to be a particular kind 0:18:21.600 --> 0:18:23.800 of entity. And that's an entity that has a period 0:18:23.840 --> 0:18:26.359 for everything, right, a time for all things in life, 0:18:26.680 --> 0:18:28.760 and it's just wrong to go beyond that. 0:18:29.359 --> 0:18:29.560 Yeah. 0:18:29.560 --> 0:18:33.880 So it's really interesting hearing your distinction of extension versus mimicking. 0:18:34.280 --> 0:18:36.480 And I'm just really curious when people are in the 0:18:36.520 --> 0:18:40.320 same sex relationship and they want to reproduce genetically, would 0:18:40.320 --> 0:18:42.440 you also put them in the extension category. 0:18:43.640 --> 0:18:46.000 Yeah, so I think this is a really interesting question, 0:18:46.200 --> 0:18:48.880 especially if we're talking, for example, about two women. Right, 0:18:48.920 --> 0:18:51.840 you may have two women who are actually completely healthy 0:18:51.840 --> 0:18:54.040 in terms of their reproductive life. Right, if we were 0:18:54.119 --> 0:18:57.320 to provide sperm, each of them would be able to reproduce. 0:18:57.880 --> 0:19:00.119 And yet they're making an ask to say that's it's 0:19:00.119 --> 0:19:02.960 not what we want. We want to both be genetic parents, 0:19:03.600 --> 0:19:06.320 And they're saying It's not that I want to kind 0:19:06.320 --> 0:19:10.800 of have parody with somebody who's healthy when I'm unhealthy. Instead, 0:19:10.800 --> 0:19:13.280 they're saying, I want to have parity with everybody else 0:19:13.400 --> 0:19:16.960 who's heterosexual, infertile, who's able to basically use sperm and 0:19:17.000 --> 0:19:19.800 egg from both parts of their couple. I do think 0:19:19.840 --> 0:19:22.080 that this is an extension use. Now calling it an 0:19:22.080 --> 0:19:25.760 extension use does not itself determine whether it's right or wrong, 0:19:25.800 --> 0:19:28.439 good or bad, But I think it does acknowledge that 0:19:28.480 --> 0:19:31.439 the ask here is a little bit different, and that 0:19:31.480 --> 0:19:33.760 the political theory and the questions we're going to ask 0:19:33.760 --> 0:19:36.080 about whether this is the kind of ask that's appropriate 0:19:36.359 --> 0:19:39.200 or one society should support, are a little bit different 0:19:39.240 --> 0:19:42.679 than the case of somebody who's facing medical infertility. Some 0:19:42.760 --> 0:19:47.240 of my colleagues, they prefer the term disfertility for this situation. 0:19:47.400 --> 0:19:51.320 Single individuals, same sex individuals. So it's not that they are, 0:19:52.280 --> 0:19:55.119 in terms of their healthcare or their medical state, infertile. 0:19:55.440 --> 0:19:58.080 It's that there's a social reason why they can't reproduce, 0:19:58.320 --> 0:20:00.320 and they are making an ask of society to help 0:20:00.320 --> 0:20:02.040 them overcome this social reason. 0:20:03.119 --> 0:20:06.200 Yeah, so interesting the different ways that things become framed, 0:20:06.280 --> 0:20:09.480 even in the development of the science has big impacts 0:20:09.560 --> 0:20:12.240 on how it's then perceived by wider society. 0:20:12.720 --> 0:20:15.560 And that's exactly right. And it's worth emphasizing that one 0:20:15.600 --> 0:20:20.040 of the leading IVG commercial players, there's not that many 0:20:20.040 --> 0:20:22.320 on the scene, but have been public about it in 0:20:22.400 --> 0:20:24.560 the press about them and the New Yorker story that 0:20:24.640 --> 0:20:26.760 was done about them, there's a lot of emphasis that 0:20:26.800 --> 0:20:29.840 the leading kind of scientists and the leading kind of 0:20:29.920 --> 0:20:32.639 business person in it are gay men, right, and this 0:20:32.720 --> 0:20:35.000 idea of kind of personalizing it. So a big part 0:20:35.040 --> 0:20:38.400 of their story and their pitch is that as gay men, 0:20:38.560 --> 0:20:41.640 we wanted to have children with our partners that are 0:20:41.680 --> 0:20:44.880 also genetically both of ours. All of this puts pressure 0:20:44.920 --> 0:20:47.920 on the question about whether genetic parentage is the end 0:20:47.960 --> 0:20:50.760 all and be all right, because you might say, there's 0:20:50.800 --> 0:20:53.400 a way in which all of this discussion of IVG 0:20:53.960 --> 0:20:58.040 might strike adoptive parents, for example, as quite untoward. Is 0:20:58.080 --> 0:21:01.040 to say, it's so important that I know adopt that 0:21:01.160 --> 0:21:03.920 actually that I want to invent this entire new technology 0:21:03.960 --> 0:21:06.440 and do this. So there's a way in which how 0:21:06.520 --> 0:21:09.720 you frame this is also how you frame questions about 0:21:09.720 --> 0:21:12.879 the value of genetic connection versus other kinds of connections, 0:21:13.320 --> 0:21:15.919 and I think it's worthwhile for us to have that conversation. 0:21:16.080 --> 0:21:19.000 That conversation requires us to take a hard look at 0:21:19.000 --> 0:21:23.080 ourselves and say, why is genetic parentage so important for us? 0:21:23.080 --> 0:21:24.720 Why is it so important that both of us be 0:21:24.920 --> 0:21:28.840 genetic parents? And it's true, fertile heterosexual individuals are able 0:21:28.840 --> 0:21:31.679 to do this, no problem. But you know, is this 0:21:31.720 --> 0:21:33.320 the kind of thing that we think it's a really 0:21:33.359 --> 0:21:37.959 strong moral imperative to have technology to solve, or instead 0:21:37.960 --> 0:21:41.640 should our goal be to try to de emphasize genetic parentage. 0:21:41.760 --> 0:21:45.240 And there's a certain irony here because chosen family and 0:21:45.400 --> 0:21:47.679 I'm gay, so I can say this chosen family is 0:21:47.720 --> 0:21:50.960 a big adage within the gay community. And yet it 0:21:51.000 --> 0:21:52.240 seems to be there's a way in which this is 0:21:52.280 --> 0:21:54.639 a chosen family, but also a way in which this 0:21:54.680 --> 0:21:57.760 is a very genetically related family that in some ways 0:21:58.080 --> 0:22:02.800 reproduces very typical, very heterosexual conceptions of what family is. 0:22:03.240 --> 0:22:05.840 I think that some of the questions that are raising here, 0:22:06.520 --> 0:22:08.399 we really have to think about this as we are 0:22:08.480 --> 0:22:12.800 moving into this new unknown territory and the directions we're 0:22:12.800 --> 0:22:16.880 going in, the implications that can have so would IVG 0:22:17.119 --> 0:22:21.600 resolve any of the ethical concerns around existing alternatives to 0:22:21.680 --> 0:22:26.480 biological procreation, so for example, using an egg donor surrogacy 0:22:26.560 --> 0:22:27.040 or adoption. 0:22:28.160 --> 0:22:31.080 So one thing that's nice about IVG that helps kind 0:22:31.119 --> 0:22:34.480 of resolve some of the ethical considerations about other technologies 0:22:34.520 --> 0:22:37.040 is for egg retrieval. There's many people who say egg 0:22:37.040 --> 0:22:40.600 retrieval imposes risks on women, and in particular, if you 0:22:40.600 --> 0:22:43.200 think about egg freezing, where we're talking about young women 0:22:43.440 --> 0:22:46.840 who are kind of proactively trying to retrieve eggs and 0:22:46.880 --> 0:22:49.680 freeze them for a potential future use, there's a way 0:22:49.720 --> 0:22:53.199 in which they are imposing hardship on themselves, costs upon themselves, 0:22:53.480 --> 0:22:56.720 and also the potential low risk levels but potential for 0:22:56.800 --> 0:23:00.720 things like ovarian hyperstimulation syndrome for a potential future use. 0:23:00.720 --> 0:23:02.520 And if you could tell people, if you ever find 0:23:02.520 --> 0:23:05.520 yourself in that situation, we'll have a solution then and 0:23:05.560 --> 0:23:08.240 there you don't have to proactively do that, that might 0:23:08.280 --> 0:23:10.480 be quite attractive. So that's one thing that might be 0:23:10.560 --> 0:23:13.760 ethically good about this or solve another ethical problem. The 0:23:13.800 --> 0:23:16.720 other is the question of markets for eggs more generally 0:23:17.080 --> 0:23:18.920 and sperm to a lesser extent. But there are some 0:23:18.960 --> 0:23:23.760 people who find it objectionable that we have widespread markets 0:23:23.800 --> 0:23:26.440 in the United States where people buy and sell eggs. 0:23:26.800 --> 0:23:29.600 If you think those kinds of markets are problematic, there's 0:23:29.600 --> 0:23:32.840 a way in which IVG solves the problem because you 0:23:32.920 --> 0:23:35.600 now are able to do it to yourself. So it 0:23:35.720 --> 0:23:39.240 ends a certain market that at least some people find problematic. 0:23:39.560 --> 0:23:43.200 Those are two kind of advantageous parts about IVG. One 0:23:43.240 --> 0:23:45.720 disadvantage is, at least in the case of gay men 0:23:45.880 --> 0:23:49.639 or single men or women who have a medical issue 0:23:49.640 --> 0:23:52.720 that stops them from carrying to term, it might increase 0:23:52.800 --> 0:23:55.920 the use of surrogacy. And for people who think markets 0:23:55.920 --> 0:23:59.199 and surrogacy or surrogacy as a whole is problematic, it 0:23:59.240 --> 0:24:03.440 may be that by stimulating surrogacy use in the United 0:24:03.480 --> 0:24:06.560 States or across the world is a problem. 0:24:06.880 --> 0:24:08.719 So how will we know when it's ready to do 0:24:08.760 --> 0:24:10.560 a trial with human participants? 0:24:11.200 --> 0:24:14.399 So this is a very very complicated process. You know, 0:24:14.440 --> 0:24:16.800 we have an agency FDA, which is very good at 0:24:16.840 --> 0:24:19.320 looking at drugs, for example, to say we're ready to 0:24:19.320 --> 0:24:22.520 do a clinical trial in human beings. It does not 0:24:22.760 --> 0:24:26.240 have particular experience with reproductive technologies. And in the US 0:24:26.280 --> 0:24:29.720 at least that's partially a political reality that it doesn't. 0:24:30.000 --> 0:24:31.919 But I think that essentially what you're going to do 0:24:31.960 --> 0:24:35.639 is you're going to get increasingly close to human kinds 0:24:35.640 --> 0:24:38.720