Dear Dr. G,

I read with interests the natural ways to boost the quality of sperms in your column last week. I am hoping to pick your brain for similar matters this week.

My wife and I have been married for three years. Admittedly, we got married late, as my wife is already forty and I am one year younger.

As most urbanites in the 21st century, we devoted our lives to our career and only decided to start the family now.

We went to the gynecologist, and went through some investigations. Thankfully, the “crown jewels in the pants” are working well, and my wife is also normal.

The doctor reckons as we are deferring our family planning too late in the game plan, we needed to consider test-tube baby.

After the Chinese New Year break, my wife and I have been pressurized to accept the way of getting a baby is not through sex, but the miracle of science.

Before surrendering ourselves to the doctors, I hate to put Dr. G on the spot, but hope you can elaborate some issues on ART (Artificial Reproductive Technology).

I understand IVF is not risk-free; will my wife suffer in the process?

Since my sperm quality is normal, what will my role be?

Lastly, I understand ART is technically GOD in manipulating human physiology.

Since we are “cheating” already, is it possible to manipulate the miracle of science so that we can get a pair of twins of each gender?

Yours truly,
Manipulative Mike

In-vitro fertilisation (IVF) is a process of fertilising the egg with sperm outside the body. Technically this is bypassing the fun (and stress) of making a baby through sex and increases the chances of pregnancy through the knowhow of science. The process involves monitoring and stimulating a woman’s ovulatory process, harvesting the eggs from the ovaries, and letting the sperm fertilise it under the control of a laboratory.

The fertilised zygote can be artificially cultured in a “test-tube” for two to six days. When matured, the embryo (or embryos) can be surgically implanted into the same or surrogate woman’s uterus, with the hope for a progression into a successful pregnancy and childbirth.

It has been more than forty years since the first test-tube baby was delivered successfully after IVF conception in 1978. Louise Brown was born as a result of a natural-cycle IVF, where no stimulation of the ovulation was made. Four decades of refinement and advancement of Assisted Reproductive Technology (ART) has opened up the avenue of hope for childless couples with astounding success.

In 2018, it was estimated that eight million children had been born worldwide using IVF and other ART techniques. The thrive of better success in ART often translates to pushing the envelope in science and crossing boundaries in ethics.

The utilisation of science to screen for healthy babies is generally acceptable by couples and society. While the pre-implantation genetic diagnosis and screening were originally designed to detect hereditary genetic diseases, the method can also be applied to select for undesirable features unrelated to diseases.

While the selection of embryos has the advantage of being able to eliminate unwanted traits is generally considered harmless, but the morality of eugenics in the creation of “designer babies” relying on science, not by natural selection is frowned upon by many segments of the societies.

The risk of pregnancy as women age increases. Pregnancies beyond the age of forty are more likely to encounter issues of gestational diabetes and pre-eclampsia, which will, in turn, affect the offspring having lower birth weight and some congenital defects. Although there are no additional maternal risks of pregnancies in older women with IVF, lower success rates and risks of multiple cycles of treatments should be taken into account.

Sex selection is an attempt to control the sex of the offspring to achieve the desired gender. This can be accomplished either pre- or post-implantation of an embryo, and of course at childbirth. The politically accepted terminology of sex selection is coined “family balancing”. During the selection and transfer phases, many embryos may be discarded in favour of others.

The ethical issues remain unresolved, whether a human embryo is considered a human. For those who believe that life begins from the moment of conception, IVF becomes a moral question when multiple eggs are fertilised, begin development but only a few are chosen for implantation. The acceptability of discarding unwanted “lives” and the freezing and disposing of the remaining embryos all remain a dilemma for couples and society at large.

Charles Darwin famously encapsulated the concept when he said: “I have called this principle, by which each slight variation, if useful, is preserved, by the term of Natural Selection.” The understanding of science has unravelled the miracle of baby-making, leaving fewer chances for nature to make mistakes, and allowing the technology to handpick the desirable traits. Instead of calling this “natural selection”, Dr. G coined this as “super-natural selection”.

Dr. G is often put on the spot by childless couples wishing to embark on a journey of IVF, with additional requests to twig the process for a better “outcome” of twins, preferred gender and otherwise. Then it is appropriate to spare a thought to the words of E. O Wilson, the American naturalist who once said: “We have decommissioned natural selection and must now look deep within ourselves and decide what we wish to become!”

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