Musk Family Engineering
Advances in science and technology, coupled with modern medicine, has impacted the way in which we look at life. Reproduction is not an exception. It is no secret that the most prolific innovator on the planet, Elon Musk, took an engineering approach to reproduction, and his first five boys came into this world via IVF, and the last girl was delivered using a surrogate mother. The Tesla mogul and his former wife, author Justine Wilson, welcomed son Nevada Alexander Musk in 2002. Nevada died of sudden infant death syndrome, or SIDS, at only 10 weeks. After losing their firstborn, Musk and Wilson turned to IVF to grow their family. She gave birth to twin sons Griffin and Xavier Musk in April 2004. The couple also used IVF to welcome triplet sons Kai, Saxon and Damian in January 2006. Later on, Musk began dating singer Grimes, who gave birth to their son X AE A-XII. Earlier in March, Grimes revealed that she and the SpaceX founder had welcomed their first daughter, Exa Dark Sideræl Musk, via surrogate in December 2021. And there are claims that Elon and Amber Heard had a legal battle around the cryopreserved embryos. In recent weeks rumors surfaced that he had two more kids with the board member of OpenAI and executive at Neuralink. Sex of the babies was not disclosed. Considering how busy Elon is, business ethics of such a relationship, and the fact that there are two babies, there is a chance that he just served as a donor.
While this approach raises many ethical questions including: “Were his first babies selected to be male at the preimplantation stage?”. While there are regular attempts to build moral and ethical framework for allowing sexing for non-medical reasons, sex selection is illegal in many countries. We recently observed one of the IVF boys taking matters into his own hands changing both name and gender and distancing herself from her father. A very brave move deserving recognition and support.
But the smartest and most accomplished man on the planet is not the only one opting for IVF instead of the traditional approach. Several people in my network recently told me that they chose IVF and surrogacy. Some decided to do this to improve the chances of having a healthy baby. One of my friends decided to reproduce via a surrogate to have undisputed legal rights and ensure that his plans to invest substantial resources into the upbringing and education of their offspring do not go down in flames due to the unexpected divorce. And some chose surrogacy for health reasons.
Also, there is a myriad of startups working on reproductive health and longevity including the two I recently covered, Dr. Dina Radenkovic’s Gameto, and Oviva, and several research groups and startups are working on artificial wombs.
Can this method of reproduction become mainstream? Are we going to see this trend accelerate as the artificial uterus technology matures and the natural reproduction declines? Let’s take a closer look at this emerging and rapidly expanding field.
The History of IVF
Louise Brown in 1978 became the world’s first baby to be born by in vitro fertilization, or IVF. Her birth revolutionized the field of reproductive medicine. Given that approximately one in eight heterosexual couple has difficulty in conceiving, and that homosexual couples and single parents need clinical help to make a baby, the demand for IVF has been growing. In fact, IVF is so common that over 5 million babies have been born through this technology. On a side note, critics of cryopreservation should note that these babies were cryopreserved before they were implanted…
COVID has also changed the way we view reproduction and IVF. Pew Research estimated there were close to 300,000 fewer births in the U.S. in 2021 as a result of the pandemic and low levels of sexual activity. Many women of reproductive age were perhaps worried about the vaccine, or were concerned about the vaccine’s effect on future fertility, current pregnancy, and breastfeeding, among other concerns. During the pandemic, there was a decline in the number of concluded assisted reproductive technology cycles as compared to the previous years. This decline can be attributed to many factors: the local restrictions and the fear about SARS-Cov-2 infection, being among the primary. However, a study published the same year by the National Center for Biotechnology Information reported that couples are actually prioritizing IVF treatment in the post-COVID era. No information exists in the literature regarding the effect of coronavirus on the IVF cycle attempt. In fact, a study titled “Does COVID-19 infection influence patients’ performance during IVF-ET cycle?: an observational study” concluded that COVID did not affect patients’ performance or ovarian reserve in their immediate subsequent IVF cycle. There needs to be more data available on IVF, both pre and post COVID.
Let’s dive deep into IVF and learn how it works.
In order to understand IVF, we first need to look at the natural process of reproduction. Believe it or not, it all starts in the brain. Roughly 15 days before fertilization can happen, the anterior pituitary gland secretes follicle stimulating hormone (FSH), which ripens a hand full of follicles of the ovary that then release estrogen. Each follicle contains one egg, and on average only one follicle becomes fully mature. As it grows and releases estrogen, this hormone not only helps coordinate growth and preparation of the uterus, it also communicates to the brain how well the follicle is developing. When the estrogen level is high enough, the anterior pituitary releases a surge of luteinizing hormone (LH), which trigger ovulation and causes the follicle to rupture and release the egg. Once the egg leaves the ovary, it is directed into the fallopian tube by the fimbriae. If the egg is not fertilized by the sperm within 24 hours, the unfertilized egg will die and the entire system will reset itself, preparing to create a new egg and uterine lining the following month.
The egg is protected by a thick extra cellular shell of sugar and protein called the zona pellucida. The zona thwarts the entry and fusion of more than one sperm. Each ejaculation during sexual intercourse releases more than a 100 million sperm. But only a 100 or so will make it to the proximity of the egg, and only one will successfully penetrate through the armor of the zona pellucida. Upon successful fertilization, the zygote immediately begins developing into an embryo and takes about three days to reach the uterus. There it requires a couple of days to implant firmly into the endometrium, the inner lining of the uterus. Once implanted, the cells that are to become the placenta, secrete a hormone that signals to the ovulated follicle that there is a pregnancy in the uterus. This helps rescue that follicle, now called the corpus luteum, from degenerating, as it normally would do in that stage of the menstrual cycle. The corpus luteum is responsible for producing the progesterone required to maintain the pregnancy until six to seven weeks of gestation when the placenta develops and takes over until the baby is born approximately 40 weeks later.
Now, how do you make a baby in a lab? Answer: By using modern science and technology.
In patients undergoing IVF, FSH is administered in levels that are higher than naturally occurring, to cause a controlled over-stimulation of the ovaries so that they ultimately produce multiple eggs. The eggs are then retrieved before ovulation would occur, while the woman is under anesthesia, through an aspirating needle guided by ultra-sound. Most sperm samples are produced by masturbation. In a laboratory, the identified eggs are stripped of surrounding cells, and prepared for fertilization in a petri dish.
Fertilization can occur by one of two techniques. In the first, the eggs are incubated by thousands of sperm and fertilization occurs naturally over a few hours. The second technique maximizes certainty of fertilization by using a needle to place a single sperm inside the egg. This is particularly useful when there is a problem with the quality of the sperm. After fertilization, embryo’s can be further screened for genetic suitability, delivered into the woman’s uterus via catheter, or frozen for later attempt at pregnancies. This last process is also called embryo cryopreservation. It involves freezing of the embryos. You may choose to freeze extra embryos and use them later if you: postpone or cancel implantation into your uterus after an egg is already fertilized; want to delay IVF to a later date; want an option in case early attempts at fertility treatment fail; or choose to donate unused embryos to other people trying to get pregnant or to researchers rather than destroy them; or for other reasons.
If the woman’s eggs are of poor quality due to age or toxic exposures or have been removed due to cancer, donor eggs may be used. In the case that the intended woman has a problematic uterus or lacks one, another woman, called the gestational carrier, or surrogate, can use her uterus to carry the pregnancy. To increase the odds of success, which are as high as 40% for women younger than 35, doctors sometimes transfer multiple embryos at once. Which is why IVF results in twins and triplets more often than natural pregnancies. However, many clinics seek to minimize the chances of multiple pregnancies, as they are riskier for mothers and babies.
Millions of babies like Louise Brown have been born from IVF and have had normal, healthy lives. The long-term health consequences of ovarian stimulation with IVF medicines are less clear. In fact, it is possible to avoid the many genetic abnormalities with preimplantation diagnosis. The Human Fertilisation and Embryology Authority of the U.K. published a blog in which they declared that IVF is generally safe, adding that most people who have it experience no problems with their health or pregnancy. They do mention some risks that people should be aware of, including: ovarian hyperstimulation syndrome, having a multiple pregnancy or birth, and having an ectopic pregnancy. The American Society for Reproductive Medicine also notes that although serious complications from IVF medicines and procedures are rare, there are still some risks from injectable fertility medications. Though so far, IVF seems safe for women. Because of better genetic testing, delayed child-bearing, increased accessibility, and diminishing costs, it is not inconceivable that artificial baby-making via IVF and related techniques could outpace natural reproduction in years to come.
Clearly, IVF is gaining popularity every year. According to a 2015 report by the U.S. Society of Assisted Reproductive Technology (published in 2017), one million babies born in the U.S. between 1987 and 2015 were born through the use of IVF or other assisted reproductive technologies. There are many agencies and centers worldwide that provide these services. Some examples of these agencies are: Circle Surrogacy & Egg Donation, Brilliant Beginnings, The Center For Surrogacy & Egg Donation, ConceiveAbilities, Hatch Egg Donation & Surrogacy, and Growing Families. Others include Ambroise Par Group, AMP Center St Roch, AVA Clinic Scanfert, Bangkok IVF center, Betamedics, Bloom Fertility and Healthcare, Bourn Hall Fertility Center, and Biofertility Center and Chelsea and Westminster Hospital.
Surrogacy – A New Hot Trend in IVF
Like IVF, surrogacy too is becoming a very popular way to have children, particularly for wealthy couples in the West. According to a 2019 WebMD blog post, about 750 babies are born each year using gestational surrogacy. Similarly, PBS reported that in 2018 over 100 children were born in Boise, Idaho, through surrogacy. In Canada, surrogate births have increased by 400% in the last decade. Even celebrities are doing it! News anchor Anderson Cooper used a surrogate for the birth of his son, as did Sir Elton John, who used a surrogate for the birth of his two sons. Other celebrities like Kim Kardashian, Robert De Niro, George Lucas, and Neil Patrick Harris used surrogates too.
This leads to a question: Are IVF and surrogacy changing the way we view family planning?
There are several reasons why IVF and surrogacy are fast becoming a new way of family planning. Infertility is one of the main reasons why prospective parents opt for surrogacy. Another reason why would-be parents opt for surrogacy is the age factor because age plays a big role in a persons’ ability to conceive and carry a baby. Likewise, same-sex couples and single individuals who are unable to conceive a child naturally may choose to turn to a surrogate. Some people may also have medical or physical problems that dissuade them from pregnancy or make birth impossible. At the end of the day, it is a personal and private decision.
Interestingly, many in the generation X and Y are reproducing via IVF after going through a divorce. Recently I spoke with one of my friends in the venture capital world who is looking at IVF via a surrogate as a way to avoid the possible legal problems in the case of a future divorce. “I am planning to go to buy a few egg cells from a very accomplished young scientist and use a service in Georgia (country) to get a surrogate. I want to have a very smart kid that I will invest a lot of resources, time and energy in and I won’t need to share custody over the kid in the case I break up with my girlfriend,” said an accomplished man in his mid-forties who refused to be named in the article. “I went through a very painful breakup once and how I have to share custody of a child and don’t have full control over the upbringing. But children are our legacy and I want to ensure that I can raise the child to be a great person, give great education, and provide amazing care without being pulled into a difficult relationship with the mother. I am sure that my girlfriend will invest a lot of energy into this child or I will find another girlfriend.”
This statement shocked and puzzled me.
Recently, I covered a startup called Gameto, run by Dr. Dina Radenkovic, a wonderful physician turned VC turned CEO. “The reproductive industry is up for disruption. We are going to help millions of women get the freedom to have babies without the time pressure. And postpone menopause. But I am also investing in a company developing artificial uterus technology. In the future, painful childbirth may be optional and without the need of a surrogate,” she told me.
And females also get a lot of freedom to choose the genetic background of their children. Many are choosing to reproduce using the sperm from the validated, healthy, intelligent, and accomplished individuals.
Same week I met a wonderful scientist, a recent PhD from Harvard who also works in the field of reproductive health. “You know, I am an open ID sperm donor. It helped pay my bills during the school years and now I have over 35 confirmed kids worldwide,” he said.
Sperm and Egg Banks At Your Service
There are few reliable figures on the sperm banking industry and the percentage of donations that are made anonymously. Researchers find it difficult to track how many men have donated sperm, and how many children have resulted from each individual’s donation. Approximately, there are about two dozen sperm banks in the United States; each operates independently and with minimal government oversight. Some of the famous ones include Cryos International and California Cryobank. There are others also.
Some of these operations are pretty cryptic and shady. Many clinics have revised their policies — not to eliminate “anonymous” donations, but to make clear that the term only means they will not share donor information. Others are moving toward “open ID” donor systems, in which donors are told that offspring could connect with them when they turn 18 — or sooner — if both parties agree to it.
As debates about women’s bodies and their right to choose continue to rage throughout the world, surrogacy laws remain in infancy. The laws also change as reproductive technology and the very meaning of a ‘parent’ changes. In the U.S., there isn’t a federal law on surrogacy and state laws vary. Some states have written legislation, while others have common law regimes to deal with surrogacy issues. Surrogacy friendly states facilitate surrogacy and surrogacy contracts while others simply refuse to enforce them. Some states only facilitate married heterosexual couples. States that are considered to be surrogacy friendly include California, Illinois, Arkansas, Maryland, Oregon and New Hampshire.
Surrogacy has become so popular that it has given birth to a new form of tourism called reproductive tourism or ‘cross-border reproductive care.’ This multibillion-dollar global industry is perfect for price-sensitive, middle-income would-be parents. The surrogates in this case are usually those who are thought to be of low socioeconomic status in countries like India and Nepal. In India, surrogacy may be worth about $400 million each year, driven by the country’s nearly 3,000 specialty clinics. Thailand, Ukraine and Russia are other popular sources of surrogates for international clientele. Thus, surrogacy is the route to escape poverty for many women in these developing states.
Research on the development of IVF and reproductive technology is still in infancy. However, as it becomes more advanced, we are likely to see more non-traditional families and the reality is probably closer than we think. And with the changing trends in family planning, there is no doubt that science and technology will continue to progress and change the way we live and think. Before we know it, this new trend and demand for babies is likely to further advance science and the procedures. Perhaps in the future, women will not need to go through the painful process of childbirth.