INFORMED CONSENT: Patients have the right to know the details of the prescribed treatment. AFP Graphics by Garygee Bhattacharyya Roy

2025. You have sex only for fun. Want babies? Head to a fertility clinic that takes your sperms or eggs and cooks up a baby for you.

Absurd science fiction? Maybe not. Enormous advances in reproductive science are set to change the world of making babies. Already, the portents are clear. Women are set to exercise their choice in the kind of baby they want: they could choose the sex, intelligence level and even hair colour of these “designer kids”.

But what is wrong with plain, old-fashioned sex as a way of making a baby? Experts say natural reproduction can lead to a one in 16 chance of a child having a serious physical or mental genetic defect. In addition, smaller genetic factors could lead to major illnesses later on in life. Artificial reproduction, on the other hand, is getting safer by the day, as genetic screening of the embryo is getting more sophisticated and discriminating.

For couples suffering from infertility, in vitro fertilisation (IVF) has been the standard treatment for having a baby. Here, the female egg — called oocyte — is plucked out and frozen in a cryopreservative. It is then mated in a dish with the sperm of the donor (the husband or someone unknown). A primitive embryo, called a zygote, is formed. This is then implanted in the uterus of the woman at the most suitable time for getting accepted by the lining of the uterus. In the best centres, IVF is safe and has a 30 per cent success rate, but does have several possible side effects like twins or triplets, premature babies and birth defects. Also, mothers-to-be commonly suffer from emotional burnouts.

Preimplantation Genetic Diagnosis (PGD) is set to change all this. A woman can have many of her eggs fertilised with sperms, leading to a bank of multiple embryos. PGD can select the best embryos by eliminating the ones that test positive for obvious genetic disorders like Down’s Syndrome or cystic fibrosis. Greater knowledge of the genetic maps of intelligence, skin and hair colour, emotional and creative makeup etc can in the future lead to the selection of the embryo as per the specific choice of the parents. In addition, women can store their eggs or embryos for use later, whenever they are ready for it. They could even sell their eggs. Cryopreservation techniques now allow the storage of viable embryos for many years.

As recently as the first week of November, a Yale University School of Medicine group led by Emre Seli presented a paper at the American Society of Reproductive Medicine annual meeting at New Orleans and claimed an 80 per cent success rate in IVF fertilisation rates, more than double the best current results. They have used sophisticated Raman and Near Infrared spectrophotometric tests that identify embryos that show metabolic signs of “oxidative stress”. Those embryos that do show such signs are eliminated, and those that do not are chosen. This technique, by selecting the best embryos, is slated to reduce the number of IVF attempts before successful pregnancy is achieved. This technology of metabolic profiling of the embryo is now ready for commercial availability from a company called Molecular Biometrics.

Another development is set to increase IVF fertility rates. Researchers in Massachusetts have found they could select embryos with better chances of successful implantation. The cells are kept in a fluid whose surface oxygen concentration is measured. If the zygote is viable, the oxygen levels are low, because it “breathes” and uses up oxygen. Higher levels mean a non-viable embryo that is to be sacrificed.

So in the future, these forms of artificial reproduction may result in fewer birth defects and premature births, especially when genetic testing becomes cheaper. Scientific futurologist Randall Parker says, “I predict most prospective parents will choose IVF over natural sexual reproduction.” Simon Fishel, one of the original workers in the path-breaking 1978 “test tube baby” team, agrees. “It is technically possible,” he says.

Scientific progress by accident is well known, going back to Isaac Newton and the apple. Scientists at the Weizmann Institute in Israel accidentally found that women being treated by IVF had more successful results after they were subjected to a biopsy of the uterine lining. Three Israeli hospitals have now adopted endometrial biopsy as a standard part of their treatment protocol and are expecting the Americans to follow suit.

As with all super-modern technologies, the main problem with artificial reproduction techniques is the cost. “You have to pay per cycle,” points out Fishel, while “natural reproduction costs you nothing.”

As competition in the global embryo market hots up, we could soon see Lamarck's Natural Selection Theory standing on its head, as Man scientifically eliminates Nature’s genetic lottery of natural birth and adopts customised artificial births.