It will enable a holistic ‘big-picture’ view of relevant ethical, legal, and social issues
A staff member shows a mock-up of work being done on women's eggs in the laboratory at the KL Fertility Centre in Kuala Lumpur. (Photo: AFP / UCAN files)
In recent years, Singapore has increasingly leveraged new reproductive technologies to overcome the country's rapidly aging demographics and dismal fertility rate, which hit a new low in 2022.
Hence, it would be timely for Singapore’s Bioethics Advisory Committee (BAC) to critically examine relevant ethical, legal and social issues associated with newly emerging reproductive technology platforms, which are thus summarized as follows;
In Vitro Gametogenesis (IVG) refers to the generation of artificial lab-grown sperm and eggs from other cell types within the body such as skin cells. Utilizing advanced molecular biology techniques, skin cells can be reprogrammed into an embryonic stem cell-like state, which can then be induced into functional sperm or eggs by various chemicals and growth factors within a laboratory dish.
Several research groups in Japan and China have already demonstrated the birth of live healthy offspring from IVG-generated sperm and eggs derived from the skin cells of mice and rats, which could in turn reproduce normally and give rise to the next generation of healthy offspring. It is highly plausible that these will soon be replicated in humans within the near future.
Artificial Womb Technology (AWT) refers to bioengineered systems for the gestation of human offspring outside the human body, technically referred to as Ectogenesis or Ectogestation. To date, studies with animal models, particularly sheep, have developed artificial womb systems that are capable of sustaining the life and development of preterm fetuses.
It is anticipated that clinical trials of AWT to save lives and nurture the development of extremely premature human babies will commence very soon. Nevertheless, complete ectogenesis to sustain the development of human embryos over the entire gestation period will likely not be feasible in the near future.
Synthetic Human Embryos refer to embryo-like structures generated entirely from stem cells, thereby bypassing the natural process of fertilization without the need for either sperm or eggs. An Israeli research team at the Weizmann Institute of Science achieved this feat with mouse and human stem cells in quick succession, in 2022 and 2023 respectively.
These synthetic embryos were reported to display brains, beating hearts, as well as foundational structures of all other organs within the body, in addition to also possessing rudimentary placenta, yolk sac, and other external tissues that could potentially ensure their continued growth and development upon transfer into a womb.To date, no animal or human-derived synthetic embryos have yet generated a live offspring, but given the rapid pace of scientific advancements in recent years, this hurdle may likely be overcome soon.
Overlying these three key reproductive technology platforms are artificial intelligence (AI)-based embryo polygenic screening and human germline genome editing, which can not only prevent and cure genetic diseases but can also be utilized for human enhancement. This refers to the screening, selection or genetic engineering of non-disease socially desirable traits in human offspring, such as higher IQ, tallness, and fair complexion; which has at least been partially or wholly discussed in previous BAC-led public consultations.
A future public consultation on newly emerging reproductive technologies initiated by Singapore's BAC should therefore address the following pertinent issues:
In conclusion, given the rapid progress that has been made in these aforementioned newly-emerging assisted reproductive technology platforms in recent years, it is imperative to initiate a multi-disciplinary discussion of the relevant ethical, legal, and social issues among policymakers, medical professionals, biomedical scientists, religious leaders and various members of the general public.
Dr. Alexis Heng is an associate professor of biomedical science at Peking University, China. He is ranked among the top 2 percent of scientists worldwide in 2022 by Stanford University. To date, he has published 50 international journal articles on legal, ethical, and sociological issues relating to new reproductive technologies, besides having around 300 scientific journal publications.
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