It used to be that reproduction was a seemingly straightforward thing: A man’s sperm met and clung to a woman’s egg. If the the stars aligned and the sperm successfully fertilized the egg, nine (and some change) months of waiting would result in a baby.
But it’s not always that straightforward. Couples deal with infertility, they may not always be a male-female pair, they don’t always want the sperm to meet the egg, and even when things work out, a baby might enter the world much sooner than it should. Reproduction was never as straightforward as the story we got told in sex ed class, but science didn’t have any answers for those offshoots.
In 2017, however, the possibilities that didn’t sit neatly within the standard narrative of reproduction were boldly broached: Could infertile women have babies? Could male contraception be a thing? Could artificial organs make people feel empowered to make the reproductive choices they want?
Yes, yes, and yes.
Here are five advances in babymaking (or lack thereof!) that are going to not only dramatically transform how we think about the birds and the bees but also the very way we think about reproduction.
1. The artificial ovary that cocoons cancer patient egg cells
Earlier this month, Belgian researchers announced they’d developed ovaries that could be transplanted into infertile women whose ovaries have become compromised by chemotherapy. The artificial ovaries rely on an innovative protein formula that mimics the natural tissue lining of ovaries prior to a patient’s chemotherapy. It improves on an older technique for creating ovaries that was first detailed in 2010. Many cancer patients have utilized cryopreservation to save their ovary and testicular tissue in order to use them after treatment. In essence, cryopreservation freezes healthy ovaries before chemotherapy, but there’s the risk the technique doesn’t get rid of malignant cancer cells in frozen ovarian tissue. That’s where the new Belgian technique comes to play, by isolating egg follicles that house hormones key to the development of egg cells, then enveloping them with fibrin, the protein mimicking tissue that has been found to help with blood clots and therefore allow for a secure “scaffolding” of ovaries. That fibrin encased follicle is then grafted into a patient—restoring hormones, kicking off reproductive cycles with the body recognizing the artificial ovary as legitimate, and potentially allowing a patient who might otherwise not have a child to do so.
2. The ‘Biobag’ gives preemies a fighting chance
Sure, it’s not the sexiest name, but the Biobag holds hope and promise for the teensiest of humans born. Being born ahead of a baby’s due date is often a recipe for, at the very least, a stay in intensive neonatal care with breathing tubes, round-the-clock watch, and the unspoken but very understood chances that a little one might not make it without the viscous home and nourishment a mother’s womb provides. But an artificial womb, the Biobag, reduces the dismal statistics that stalk preemies with an artificial womb that incubate preemies in their vulnerable state. At the Children’s Hospital of Philadelphia, researchers tested a form with premature lambs at the human equivalent of 23 weeks—considered by medical experts to be “extremely pre-term” and carrying with it risks of permanent mental and physical damage. The lambs have not only survived, but thrived, with the oldest ringing in their first birthday recently. While futurists have long dreamed of “ectogenesis”—the ability for women to have children in a uterus-like environment outside of the body—and the Biobag is not ready for human use, let alone ready for testing whether embryos can survive outside their mother’s womb, there’s hope for the kiddos who come out before they’re due for a normal, healthy life.
3. Vasalgel, the gel that could make vasectomies obsolete
Researchers at the University of California, Davis’ California National Primate Center announced in February that Vasalgel—a non-toxic gel that has been used on the vas deferens of male rabbits and rhesus macaques and been shown to keep them sterile for two-and-a-half years and counting—could become a viable way for human males to not only practice birth control but essentially be (mostly) reversible and allow them to have children when they want them. The thing is that monkeys, while similar to human males in their ability to have children into later ages and possessing very similar reproductive systems to their Homo sapien counterparts, are not humans. Vasalgel’s ability to be used in humans hasn’t been studied at all, and would require years of research to understand if it indeed could become a reversible, less painful, and more malleable alternative to a vasectomy. It’s also worth noting we don’t quite understand why sperm quality has been nosediving in recent years, which could affect how a future gel for humans would be used. Drug companies, however, aren’t funding research just yet because of the immense time, energy, and cost it would take to make a viable human form, with some experts estimating that it would cost at least $2.6 billion to launch a male contraceptive. That said, Vasalgel is considered by many a frontrunner in that race, with clinical trials starting in the next couple years.
4. H2-gamendazole, the chemical cock blocker
On the heels of Vasalgel is another promising male contraceptive that made its mark in 2017, the hard to pronounce but scientifically remarkable H2-gamendazole, a synthetic compound originally studied as a way to treat cancer. Back in the early 2000s, researchers noticed the compound prohibited sperm from developing to their full potential by snipping away a crucial tether that allows Sertoli cells to incubate the sperm until they are ready to be released into the wild landscape of male reproduction. H2-gamendazole’s sneaky letting go of these not-quite-ready sperm means that while these guys could still swim, they’re doomed to be slaughtered by the testes, which pinpoints the fact that the sperm isn’t actually mature and therefore blocks its entrance into a female and the ovary for conception. What makes H2-gamendazole enticing as a potential male contraceptive candidate is the fact that it’s non-hormonal and reversible in rats, rabbits, and monkeys. It’s not quite ready for human clinical trials, but H2-gamendazole offers a sneak peek into what could be the future of a non-condom male contraceptive.
5. The uterus transplant that could alter how we see infertility
Of all the reproductive technologies being toyed with in the lab right now, the only one that has proven to work in actual, real, living, breathing humans is the uterus transplant. In early December, Baylor University in Dallas announced an anonymous woman had given birth to a healthy baby with a uterus that was not her own. It was the first in the United States; in Sweden’s Sahlgrenska University Hospital in Gothenburg, eight successful births have resulted from another uterus transplant. That a woman can have a baby even if her uterus does not work is wondrous and amazing, proof that medicine has been able to create a scientific miracle that allows someone whose biology otherwise dictates that a child cannot be born to them to do so.