The Future of Fertility

CHRISTIANE AMANPOUR, CHIEF INTERNATIONAL ANCHOR: Now, from rewriting cultural assumptions about love to the cutting-edge science of new life. Questions about having children to the writer to Emily Witt, to the limits of reproductive research. In her latest piece for “The New Yorker,” “The Future of Fertility,” which reveals her discovery. And she explains to Michel Martin how a few biotech start-ups could be about to change the game.

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MICHEL MARTIN, CONTRIBUTOR: Thanks, Christiane. Emily Witt, thanks so much for talking with us today.

EMILY WITT, STAFF WRITER, THE NEW YORKER: It’s great to be here.

MARTIN: You are — before we get into your article, “The Future of Fertility,” I wanted to ask you about your book from a 2016, “Future Sex,” critically acclaimed, certainly, you know, made a lot of waves. You explore sex and desire in the age of the internet. Is there a through line between that work and this latest report on fertility?

WITT: I think there really is, because that book was about examining three major changes. One of which was people getting married much later, or not at all. Waiting longer to kind of settle down in the traditional sense, if they ever did. And it was about changes in technology and also, changes in our idea of what a family is and what a relationship is in a broader spectrum of identities and practices and exploring all of that. And I think this does fit in, because it’s very tied to the new timeline that many of us live under. And also, I don’t know, new ideas the family, especially, I think.

MARTIN: It’s my understanding that it really kind of stemmed from your own personal questions, you know, about some of these issues. What were some of those questions? Do you still have them?

WITT: Yes. So, I started writing that book when I turned 30. And this kind of the — you know, my parents have been married for more than 40 years and the relationship that they had and the traditional family that I grew up in just seemed very elusive to me. And I wasn’t sure if it was some kind of personal failing or some kind of structural change, but I noticed many other people around me in a similar situation and demographic changes that also reflected that many people were going through this at the same time. And in the end, I spent most of my 30s in relationships. But now, I’m 42 and I am single again. And you know, I think the book was, in many ways, about trying to figure out what was going on in my own life.

MARTIN: So, in “The Future of Fertility,” this is the piece we want to talk about that published in “The New Yorker.” You profile new biotech start-up firms working on producing reproductive cells but without human ovaries. Would you just tell us a little bit about the two companies that you focus on? You know, what exactly are they doing? If you could explain this so that, you know, all of us can get it? And how does their research overlap?

WITT: Yes. So, in the past 10 or 15 years, there’s been major advancements in stem cell technology, which means that you can use a cell in your own body, a skin cell or a blood cell, turn that back into a cell that has the potential to become any other kind of cell in the body. And that’s been used to study cardiac problems, pancreatic problems, all kinds of things. But one kind of cell that they might make is an egg cell or a sperm cell that might help people with fertility issues. So, I focused on two companies. One is trying to make an egg cell from a stem cell and the other one is trying to create, basically, the ovarian egg environment in which an egg cell matures. So that an immature egg cell could be taken from the human body and then, put in this environment with – – which would — kind of make the process of IVF but hopefully, be a little less invasive and time consuming.

MARTIN: And there were major breakthroughs, I think before your piece was published. Can you just tell us what they were and why they’re important?

WITT: Yes. So, they’ve achieved this in mice but they haven’t achieved it with humans yet. And right before I went to press, one company, Conception, managed to bring the human egg cell to the follicular phase, which — it’s formed what’s called a primary follicle, which means it’s kind of ready to progress into a mature egg cell. So, that was a big advancement that shows the technology has a lot of promise. And then, similarly, this other company, Gameto, which is creating this kind of like lab made ovarian environment using lab made cells had a similar breakthrough creating that environment and published a paper about that.

MARTIN: There’s so many dimensions to this. There’s the question of what this could potentially achieve for people. So, let’s just talk about that first. You know, why is this something that is appealing to people, not just the sort of scientists as kind of a thought exercise, can we do this, but how this has the potential to benefit humanity, for want of a better way to put it?

WITT: Yes. I think in a few ways, I mean, first, it would be really useful to couples suffering from infertility that want to have a genetically related child. Especially, egg cells in particular are kind of scarce and they can be difficult to mature and grow and extract from the human body. So, that’s one — you know, just couples suffering from traditional fertility issues. But one area that I was especially interested is in female reproductive longevity. As we all know, women have a shorter reproductive lifespan than men do. They are bored with all the eggs they ever half and usually, by the time they are in their early to mid-40s, those eggs are no longer viable for reproduction. And, you know, we live in a time where we are living longer, we start relationships later, and that’s caused a lot of — that’s a big burden for a lot of women to try to fit, you know, their career, their relationships, their childbearing, all, you know, before the end of their 30s. So, I think there’s a real desire to prolong that timeline a little bit, which can have really massive repercussions. And then, the third demographic that this might affect, our same sex couples that would like to have a genetic child. So, Conception, the company that’s working on making the human egg cell was — two of its cofounders are gay men. And using that technology, it’s possible that a sell taken from a male donor, using this technology, could be turned into an egg cell with two X chromosomes. So, that’s part of the promise too.

MARTIN: So, let’s talk about some of the concerns that have been raised about this kind of work. Should we — let’s just start with the safety questions. Are there any?

WITT: Yes. There’s huge safety questions. I mean, this is human life. It’s not — you know, it’s even testing a pharmaceutical, it’s human life. So, yes, they would have to prove — you know, assuming they accomplish this, which they haven’t yet, they would first have to do animal studies across multiple generations to ensure that, you know, the genetic imprinting has happened kind of intact, that there is no inherited diseases that could only manifest a couple of generations down the line. And then, there would need to be clinical trials with humans too. And of course, like, nobody would be confident about doing this unless it really felt safe, as big as the desperation is on the part of people suffering from infertility.

MARTIN: But then, there’s the broader sort of social concerns. You know, one is that — one of the things I was really glad that you raised in your piece is that, you know, the research into women’s, you know, fertility overall or women’s health overall, can we just say it, has not been a priority of the scientific establishment ever? Ever? And so, you know, one of the scientists whom you interviewed just said, hey, how about could we figure out like, you know, just some of the things that affect women’s health? Could that be a higher priority?

WITT: Yes. I mean, so, you know, there’s very little understanding of the causes of infertility beyond this biological timeline. But scientists don’t even really understand, first of all, why menopause happens, what, you know, triggers the timeline of it, when it starts, why there’s such a large window, it can — you know, it can happen to a woman in her mid-30s or it can happen to you when your 50, and nobody really understands why or the effect of ovarian aging on aging and the rest of your body. Nobody really — one thing I learned in this article that was really interesting to me is that humans are pretty unique among mammals in that their ovaries age basically more than twice as fast as the other organs in the body. Including chimpanzees, our closest relatives, they can reproduce almost to the end of their lives. So, there’s just — it’s just this kind of black box that science doesn’t quite understand, and the argument is that, yes, if you could better understand that process, there might be a less kind of high intervention way of treating infertility, or at least prolonging reproductive longevity.

MARTIN: And then, there’s the tension you described in your piece between, you know, how these biotech start-ups share their information with the world versus kind of traditional academic scientific research. Could you talk a little bit about that? Because I think that kind of intersects with both the sort of core safety concerns and kind of the broader social concerns that other folks might want to weigh in on. Could you talk a little bit about that?

WITT: Yes. So, this technology involves the creation of human embryos. There’s limits on federal funding into that research. There’s restrictions. And that means that most of the money can come from the private sector or from states, but it means that biotech, in the private sector, has a major advantage in doing the research over traditional academic channels. And I guess the worry is that the profit motive might perhaps, you know, obscure some of the basic science that needs to be done that an academic researcher working at a slower pace might be able to achieve more thoroughly.

MARTIN: How do you think that this also intersects with the intense debate going on right now about abortion access, you know, primarily in the United States? I mean, it’s just — it really — we’re just in such an interesting moment because you can’t help but notice that in the United States, there’s kind of a major political push to restrict abortion access. And so, how do you think this research intersects with that — this debate we are having over access to abortion?

WITT: Yes. I mean, unfortunately, in the United States, pretty much any research that has to do with pregnancy, embryos, fetal tissue is extremely polarized and politicized. And that means that this technology likely even if they are able to achieve it, one legal scholar told me that she expects it would be more likely to be approved or tested in, for example, the U.K. before the U.S. because of our polarized political environment. On the one hand, you have a lot of people suffering from infertility, that want to have children. On the other hand, you have these obstacles to scientific research that are rooted in a moral debate about conception and the beginning of life and all of that.

MARTIN: Some of the researchers in your piece fear that this research — we’ll call it IVG research for the sake of, you know, shorthand. And IVG stands for in vitro?

WITT: Gametogensis. So —

MARTIN: Gametogensis. There are some who are concerned that this will mean a return to the idea that a genetic connection is essential for families. What were some of the discussions that you encountered around that question?

WITT: Yes. Certainly, it raises the question of why is a genetic connection so important that you would go to such kind of extremes to achieve it? And for some people, that might seem self-explanatory. For others, I don’t know. Is it worth it? You know, LGBTQ families, in particular, have fought for a couple of generations now for legal recognition of a social relationship with their child that’s as meaningful and important and deserves as much legal recognition as a genetic one. And yes. So, all of these questions will be coming up, I think, if this becomes real.

MARTIN: If and when IVG becomes available to the public, you have to assume it will be very expensive. I mean, in vitro is expensive. So, is there a concern or do this come up in your reporting that this kind of further, I don’t know, kind of widens the gap here between the haves and the have-nots? This is like yet another thing that we’re — you know, if you delay childbearing, then this becomes like the privilege of the few as opposed to something that human beings should be able to do?

WITT: Yes. That’s absolutely a concern. I mean, already assisted reproductive technologies is not — there’s not equal access to it. It’s often not covered by insurance. And even if it is covered by insurance, it still can be very expensive. So, this would almost certainly fall under that inequality. And there’s another question that’s been brought up, which is that, if you have kind of unlimited supply of egg cells and could make more embryos, then it’s also easier to do genetic selection on those embryos. So, you know, people might try to optimize for health outcomes or, you know, any number of factors and it might result in the kind of divide, where you have one part of the population that’s kind of trying to create these extremely healthy children, and another part, maybe, that might not be able to have the access to contraception or terminate a pregnancy that’s unwanted. So, you know, there’s a lot of questions we’ll have to ask about what this means, who has access. Yes, what it offers to the people that have access.

MARTIN: And who gets to have a say in that? You know, what process is there by which the public gets to have its say about this and express its values around this?

WITT: Yes, I mean, it will be — you know, I think we have a lot of historical precedents to go on, even contraception and, you know, access that’s so uneven, so limited, people want it, can’t get it. It’s sometimes covered by insurances, in some places, they don’t want to cover it. It’s, you know, an extremely polarized question and I can only imagine that this will be similarly polarized and that, you know, there will be kind of a feminist — likely I assume, a sort of feminist articulation of what it would mean to have reproductive freedom in this context as well.

MARTIN: And before I let you go, another universal question that affects all of us is climate. There are those who argue that, you know, lower population does benefit the planet, who feel overall, this emphasis on increasing, you know, population, maintaining population, just is the wrong direction to take, given the status of the planet. What are your thoughts about that?

WITT: Yes. I do have thoughts about that. I mean, overall, the population of the planet is still growing and is expected to grow at least towards the latter end of the century. But when you look at many countries, including the U.S., the fertility rate is a little bit below replacement rate, I think, where the decline in people having children in their 20s has not been made up by an increase in people having children in their 30s. I guess I would say that I don’t think this is some kind of pro natalist push, where you are pushing people to have more children than they want to have. I think who this really affects are people that are having trouble even having one child. You know, and I think most of us can agree that having a child for people that want it, you know, we should do everything possible for those people to be able to have a child. And the population question, you know, I don’t — you know, the way the world has been trending, the United States, many countries in the world now, people just don’t want to have a lot of kids. So, I don’t think we really have to worry about how this would affect the kind of macro trend of population stabilization, really.

MARTIN: Emily Witt, thanks so much for talking with us today.

WITT: Yes. Thank you.