Artificial gametes: the end of infertility?

An article published recently in the New Scientist alerted readers to ongoing developments in the creation of 'female' sperm and 'male' eggs (1). If - and it is a big if - this technological breakthrough ever comes about, it is suggested that such artificial gametes could offer the possibility of genetic reproduction to people in same sex relationships. In fact artificial gametes offer huge breadth of scope for people to have genetically related offspring regardless of age, gender, relationship status or sexuality. Women could use the technique to produce eggs even after having gone though the menopause. Individuals who cannot find reproductive partners could even use artificial gamete technology to create complementary gametes from their own bodies to fertilise their 'natural' sperm or eggs.

Because of this, it has been reported that artificial gametes would 'democratise reproduction' (2) and even 'end infertility' (3). This makes for some difficult regulatory decisions. How can we determine who should have access to artificial gametes? The New Scientist article quotes MP Evan Harris, who suggests that the provision of artificial gametes to same sex couples is likely to remain illegal in the UK. Instead, they would be made available only in cases of authentic infertility - something which would be far more acceptable to parliament, and perhaps also to the general public.

The underlying assumption here is that some people have a genuine medical need for artificial gametes, while others do not. But is there really a clear clinical rationale for providing treatment to those who are infertile, while excluding those who are homosexual? Already, fertility treatments are routinely sought by - and provided for -individuals who have no specific clinical problem with conceiving. NICE (National Institute for Health and Clinical Excellence) guidelines recommend that men who have very poor semen quality or azoospermia should be offered ICSI, a procedure which involves ovarian stimulation, egg harvesting, IVF and implantation for the man's partner. The fact that women in this situation are given access to IVF is imbued with social meaning and choice and cannot be encompassed or explained purely with reference to biological or medical facts. That is, the woman is infertile by virtue of the partner she has chosen.

For this reason, a woman in perfect reproductive health may be deemed to have a clinical need for IVF. But can the kind of quasi-clinical justification that supports a woman's access to IVF on the grounds of her partner's infertility really support the restriction of these services to heterosexual couples? Imagine two patients seeking treatment, woman A and woman B. Both have chosen partners with whom they cannot reproduce. A's partner is an infertile man. B's partner is a woman. In the current system these women would be treated differently not because of any intrinsic physiological, biological, clinical or medical difference between the women themselves, but because one has a male partner, while the other's partner is female.

Is this a system that could be extended to artificial gametes? I think its arbitrary and unsatisfactory nature is self-evident. If the choice of partner is what generates a clinical need for treatment, it seems highly unjust that same sex couples, who are also infertile by virtue of their choice of partner, are excluded. These problems arise largely from the fact that clinical need has been very broadly interpreted in the case of IVF and related treatments. Intuitively, it may seem right that IVF is perceived to meet a medical need when it is used to help heterosexual couples to have a baby. Yet specifying exactly how it meets this need is conceptually difficult, especially when the treatment is provided to a person who is not physiologically infertile. Because of this, it is not convincing to suppose that some people have a clear clinical need, while others do not.

Artificial gametes have the capacity to put huge strain on a regulatory framework that is already struggling to maintain coherence. The connection between biological malfunction and the need for treatment is extremely tenuous in this context. There is a common assumption that technology, especially medical technology, must inevitably better the human lot, and reduce human suffering. But new technologies cannot overcome social problems, and medical terminology is no longer sufficient to demonstrate who 'needs' fertility treatment. When we talk of reproduction, or of infertility, it is no longer clear to what we are referring in the light of new reproductive technologies which could enable anyone to reproduce. As the philosopher Quine points out, there is no use in reaching for the dictionary in this situation. Those who compile dictionaries have no greater philosophical access to the truth than anyone else, even if they are well versed in etymology and usage (4).

This might not matter if it were not that these definitions impact on our healthcare resources and regulatory environment. But because they do, it is imperative that lazy generalisations and hazy assumptions are challenged. The belief that there are simple medical or biological answers to how technology should be used pre-empts the possibility of reaching an openly-negotiated solution to these ethical and social questions. It is the recognition of this need for renegotiation which is lacking from current legal and bio-ethical debates on the issues raised by new technologies such as artificial gametes.

The advent of a marvellous new technology is of little comfort to people whose reproductive desires could perhaps already be remedied with existing technologies, but to whom access is denied, whether on social or clinical grounds. Artificial gametes could in some respects exacerbate the misery that already exists in the context of reproductive technologies in the UK. Current restrictions are variously regarded as arbitrary, unfair, and unjustly discriminatory (5). In this environment it is utterly misguided to suppose that any new technology, however ingenious, will either end infertility or democratise reproduction.