Sunday, March 23, 2008

Changing Some Facts: The Tony Randall syndrome

Burning in the breast of many a middle aged woman is one fact of gender inequality: a basic unfairness that no law, no politics could remedy. You may be too young to think about it, but some of us aren't.

The Tony Randall syndrome.

Men can have children, even a first child, when they are old, gray, senile and unlikely to live long enough to see the infant teeth. Women can't. Not even close. Women go through menopause, and even if they didn't, their eggs get old and decrepit. Babies born to women over the age of forty have thirty times greater chance of suffering Down's syndrome or a myriad of other mutations.

Little can turn a woman bitter faster than to see the man she stuck with for years, giving up her dreams of family, security . . . she finally gives up and dumps him and he falls right into a relationship with some young you-know-what, gets married, and starts having babies.

Believe me, if it happens to you, it can hurt.

A Solution In Sight

So it is not without a certain glow of triumph that I found out about Stanford University biochemist Carl Djerassi's latest creation (since the Birth Control Pill). Djerassi has written a play. His wants to use art to communicate the social impact of ART: artificial reproduction technology. He calls the play -- in production off Broadway -- "The Immaculate Misconception," and uses it to tell the story of a woman scientist who makes her own baby in a petri dish.

The story showcases a technique called ICSI, pronounced ick-see, and Djerassi believes it has the power to finally liberate women completely, by severing the last ties between reproduction and sex. Specifically, ICSI is intra-cytoplasmic sperm injection, and it means the separation of a sperm's head from its tail and injection of that head directly inside a woman's microscopically isolated and pinned-down egg.

There are about 10,000 ICSI babies already. Mostly they are the children of fathers who are born without vas deferens, the tubes that carry the sperm to the penis (and promote sperm maturation on the way.) The sperm can be taken directly from the man's testicle, and even though too immature to fertilize an egg naturally, it will work if injected directly into the egg.

ICSI has the power to finally liberate women completely, by severing the last ties between reproduction and sex.

This provides women more than in vitro fertilization, because it allows them to select just one sperm, even an incompetent one. Since we will soon have detailed genome maps, we will be able to select far more than the baby's gender.

Women won't need to fall in love with the man anymore, just his sperm.

And they could go for variety: the first baby could have blue eyes and an aptitude for art, the second brown eyes and hair and math; they could come from the same or different fathers.

The hidden impact, not unlike the unpredicted impact of the Pill, comes because it means a woman can store her eggs and conceive when it's convenient. With artificial insemination, on the other hand, she must have the baby right now. With in vitro fertilization she gets frozen embryos -- combinations of egg and sperm -- only if she already has a man willing to contribute.

Since women are living healthier longer, it would not be out of the question for her to have a healthy child in her fifties and see it graduate from college while still able to enjoy the experience.

But with ICSI a woman can make other plans. She can work on her career and her life and not worry that she "forgot to have children." Even years past menopause she can take hormones to tone up her uterus, pick out a good sperm and one of her saved, healthy young eggs, and procreate. Since women are living healthier longer, it would not be out of the question for her to have a healthy child in her fifties and see it graduate from college while still able to enjoy the experience. And she wouldn't need a man, in toto, at all.

In your face, Tony Randall.

The Cons

Of course, there are some worrisome implications of this technology. In at least one case sperm was collected from a man's testicles after he had been dead for over 24 hours. Theoretically you could create instant orphans -- babies created from the frozen gametes of long dead women and men. Also, it is used now to help infertile men have children, which is mostly positive -- but adds a risk to overall human fitness. The sperm may not be healthy. In the case of men with no vas deferens, one in four of them also carry genes for cystic fibrosis, a devastating disease.

The Pros

But Djerassi thinks the profoundest social effect will be on women's freedom. He may be trying to make up for missing predicting the social impact of the pill. He didn't see it coming, but, he says, "no one else did, either, and if they say they did they're lying."

Wiser now, he is using this play to prepare the rest of us.

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