REPRODUCTION: CHANGING PERSPECTIVES 
      By Vinod Scaria
         E-mail: vinodscaria@yahoo.co.in

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    "Change, like sunshine, can be a friend or a foe,
    blessing or a curse, a dawn or a dusk"
                                    - William Arthur Ward
        The birth of Louise Brown in 1978 marked the beginning of a new era – the era of Artificial Reproduction, which radically changed human concepts of reproduction, which was till then considered God’s domain and something beyond human reach. This breakthrough in the art of 'making' children was of course greeted with mixed feelings – of euphemism and apprehension. The initial criticism ranged from scepticism to sheer outrage. While some thought man was trying to play God, others thought it would cheapen human life and lessen the sanctity of human reproduction. But to be sure, that was the moment perhaps any man would rejoice – for he had crossed one of the worst hurdles that nature had laid before his dreams of having a child.
        Time had proved its worth at last. The initial waves of apprehension had weaned away soon and the technique was introduced worldwide in the 80s, and today, a couple of decades later, this unique technique of In-vitro-fertilization (IVF) has created over a million children worldwide, and has emerged as one of the most acknowledged techniques in the treatment of infertility. IVF per se is just another technique in the whole spectrum of techniques that form what is known as Artificial Reproductive Techniques (ARTs in short). In fact,  ARTs range from techniques like artificial insemination and Gamete IntraFallopian Transfer (GIFT) to highly sophisticated techniques like intracytoplasmic sperm injection (ICSI). The science of artificial reproduction has
grown to such a magnitude that about one in every 100 children in the developed countries are born through this technique.
    The miracles of ARTs do not end there. The avenues opened up by this science seems to be endless. Perhaps no other science had kindled human imagination to such an extent. Just consider surrogate motherhood and gamete donation, which were even beyond the wildest dreams in the pre IVF era. Fertilisation outside the human body has its own advantages – the most important being the opportunity to manipulate them at our will. Screening of embryos before implantation, which is virtually impossible in the classical method of reproduction is now possible with this technology. Embryos can be screened for both gross chromosomal abnormalities (like for trisomy of the 21st chromosome in Down’s syndrome) and for molecular markers of genetic diseases – what is known as the pre-implantation genetic screening (PIGS in short). The advantages are two fold – that it allows only perfect embryos to get implanted and that it can reduce the morbidity associated with therapeutic amniocentesis and subsequent medical termination of pregnancies for congenital abnormalities. The availability of embryos outside the body also allows us to manipulate its genetic material by introducing a 'healthy' gene in place of an abnormal one, or harvest stem cells which would later be used in case a need for an organ transplant arises. Though the sciences of gene therapy and stem cell culture have a lot to go before they emerge as a fool proof techniques, reviewing the pace at which new developments occur in these fields. I personally feel, they would become a conventional therapeutic procedures in less than a decade.
        Artificial reproductive techniques have gone a step beyond-by collecting germinal tissues and cryopreserving it for later use (what is known as fertility insurance) – which is certainly Godsend to patients who have to undergo extensive chemo or radio therapies for malignancies, but have not yet formed their families.
The Present scenario:
    As I had mentioned before, ARTs have emerged as widely acclaimed modalities in the treatment of infertility, and is slowly replacing empirical endocrinological and surgical modalities of treatment of infertility. It is roughly estimated that the total annual number of IVF cycles is about half a million worldwide and is certainly on the rise.
    This upward trends means that more and more infertile couples are opting for ARTs. There has been reports that even normal couples are opting for ARTs out of the fact that embryos can be screened before implantation and can ensure that they would have only ‘perfect’ children. The implications of these are yet to be formulated.
Gamete donation is yet another reality, with most specialized centres  maintaining gamete banks where gametes are cryopreserved . This enables gametes to be used very long after the donation and even probably after one is dead. To be frank, gamete donation and its use in helping sterile patients are slowly attaining social acceptance.
        Another interesting field is that of male pregnancy. Researches are going on around the world in this field; and results would probably appear within a couple of years. Male pregnancy if proved feasible for regular practice, would probably free woman from her last natural constraint. The ethical and moral implications of this should be well reviewed as this technology is in itself a double edged sword. While helping males to attain "motherhood" its implications on family set up and the gradual extinction of females from this earth should be thoroughly considered.
         Researchers are also going on the possibility of rearing an embryo outside the human body (gestation in vitro). Though the researches in this field, are at present largely confined to animal models, this would become a reality in a decade or so.
The Future:
         The present trends show that human concepts of reproduction would be totally uprooted in the near future. But before it would happen, technological, ethical, moral and legal hurdles have to be overcome.
It is foolish to think, man in his everlasting pursuit for perfection would set aside just his ways of procreation. The demand for "perfect" and only perfect children would some day spell the death sentence to our natural ways of reproduction. With our ever increasing knowledge on how to manipulate genes, the possibility of "designer children" cannot be ruled out. With technology at his disposal, I cannot think why one would settle with less. The future would prove whether our genome and of course of our children would be enhanced with genetic material from other organisms (transgenics), or whether we would take control of our own evolution evolve into a completely different species.

        The next close possibility is that of human cloning. May be today it is just the sheep, but tomorrow it is sure to be the shepherd. Many ethical and technological constraints have to be overcome before it becomes a reality. "If cloning (of a human) has not happened already, it is going to happen soon, and the world ought to get over it", says Brian Alexander, author of 'You Squared'. 
Ethical Aspects:
        The ethical formulations are expressions of human thought and conscience, which has always changed with time and tide. Ethics per se has never been able to hamper scientific progress, but has been able only to restrict it for the human well being. The use of technology in ways that harm human well being should be restricted, but that does not mean banning the whole technology, turning a blind eye to the benefits mankind could attain from it would justify the purpose. The pictures of technology terror and human benefits merge into one another and cannot be separated.

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