Innovations for Fertility

Many people argue that fertility rates are lower than they should be and that society is approaching a phase of where population begins to decline, ending our main source of economic growth and prosperity. To this point, fertility rates are already below replacement in many developed countries and are rapidly decreasing in developing countries, creating potential demographic problems as the population of countries (like Japan) age quickly.

But how do we get more people?

There is an existing literature examining the reasons for the decline in fertility along with policy remedies. But I want to take a different tack and look at what technological advances might get populations in developed countries growing again.

This is important because innovations which increase fertility seem understudied compared to their potential benefits. This is probably due to the fact that the choice to have children is a very private topic. Additionally, many of the technologies in this space have associated cultural taboos. This makes it even more valuable to look for progress here, since not enough people have actually looked.

Admittedly, some of these innovations may seem strange in the modern day (and for some, it is hard to imagine them reaching cultural acceptance), but they are still worth considering. The strangeness of a new technology has rarely stopped the next generation from adopting it, and, even in our era, many strange technologies have become widely accepted, so who are we to judge?

Note that innovations which increase overall fertility involve reducing the global costs associated with having a baby. These range from the literal monetary costs of raising a child, to non-monetary costs (such as health risks) associated with childbirth.

Easier Pregnancy and Delivery: Pregnancy and childbirth are already a huge investment of time, money, and discomfort. This means that finding ways to reduce the difficulty and complications involved in bringing a child to term reduces the associated cost. Simply increasing global access to high quality obstetric care would lead to massive reductions in birth complications and child mortality.

Better Infertility Treatment: Finding ways to help infertile couples conceive has long been a topic of research. Stem cell therapies might help create viable sperm or eggs in people who do not produce gametes normally. Taken further, utilizing stem cells to generate sperm or egg cells would allow much older couples to have children via gestational surrogacy. The research in this direction seems promising.

Scalable Childcare and Education: Some of the predominant financial costs of raising a child stem from the costs of childcare and education down the road. Finding ways to care for and educate children at a higher quality and lower price would dramatically reduce the financial burden of raising a child. Perhaps robotic caretakers and online education will provide solutions to this problem.

Cheap, Easy IVF: IVF is not only an important treatment for many infertile couples, it is also a prerequisite for gestational surrogacy. However, IVF cycles are very expensive and have high failure rates. Innovations which make IVF cheaper and more effective would have downstream benefits for many other technologies here.

Long-Term Sperm and Egg Storage: This would allow couples to expand the window of possibility for having children long past the window when they are fertile. By storing eggs and sperm over the long term, couples can wait until they are personally and financially ready to have children via surrogacy.

Embryo Selection: By sequencing the genes of several embryo’s, parents can then select an embryo for implantation in the womb. This gives parents more control over the offspring they have and reduces some of the uncertainties associated with having a child, thus reducing the overall cost.

Sperm-Egg Inter-conversion: This would allow same-sex couples to have children who share both of their genes, opening up childbirth to a large number of couples who are typically excluded from it. This would involve either swapping the genes of a sperm into an egg (so that gay couples could have children) or putting the genes of an egg into a sperm (so that lesbian couples could have children). It would also require changing the sex chromosomes in the egg/sperm appropriately (since a child cannot have 2 Y chromosomes).

Gene Editing: The ability to edit an embryo’s genome is a fraught topic in bioethics circles. But regardless of whether it is deemed ethical, the existence of cheap, legal genome editing would increase the choice parents have when deciding to have a child. At an extreme, this would give parents precise control of their child’s attributes. Additionally, combining large tracts of DNA would also allow for children with more than 2 genetic parents.

Cloning: Like with embryo selection and gene editing, the ability to create a genetic copy of someone gives parents more choice. In fact, cloning removes the need to have a second genetic source involved in childbirth and reduces the uncertainties associated with the sexual recombination of genes.

Artificial Wombs: Being able to carry a child to term without the need for a human mother would drastically reduce the obstacles to having a baby. This technology conjures up images of Huxley’s Brave New World, where each citizen is grown in a vat before being artificially birthed. Regardless, we are far from being able to implement this technology.

What might be some of the side effects of these inventions? Technologies which allow for the selection of different genes can inadvertently cause a reduction in global genetic diversity. Because genetic diversity is important for overall population resilience, it might make sense to institute a gene-selection tax to prevent children’s genomes from being too heavily selected. Other technologies (such as stem cell production of gametes) could actually increase overall genetic diversity since they give new couples the chance to have children.

Of the listed innovations, improvements to IVF and production of gametes from stem cells seem like the most important possibilities to study in the near term. IVF is complimentary to many of the other innovations on this list while stem cell therapies would make it possible for virtually everyone to have a child. In terms of reducing costs, making education and childcare cheaper would have the largest effect, though arguably policy interventions in housing or parental tax breaks would have a bigger influence on overall costs.

Each of these innovations gives people who are typically excluded from having children the chance to have kids of their own. I would argue that this is a good thing, not just for the parents and the child, but for society as a whole.

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