【每天一篇经济学人】Making babymaking better 让育儿变得

文章来源：《经济学人》Jul 22th 2023 期 Leaders 栏目 Fertility technology

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After louise brown was born in Manchester in July 1978, her parents’ neighbours were surprised to see that the world’s first “test-tube baby” was “normal”: two eyes, ten fingers, ten toes. In the 45 years since, in vitro fertilisation has become the main treatment for infertility around the world. At least 12m people have been conceived in glassware. An ivf baby takes its first gulp of air roughly every 45 seconds. ivf babies are just as healthy and unremarkable as any others. Yet to their parents, most of whom struggle with infertility for months or years, they are nothing short of miraculous.

1978年7月，路易丝·布朗在曼彻斯特出生，她的父母邻居们惊讶地发现，世界上第一个“试管婴儿”是“正常的”：两只眼睛，十个手指，十个脚趾。在此之后的45年中，体外受精已成为全球不孕不育的主要治疗方法，至少有1200万人在试管中受孕。大约每45秒就有一个试管婴儿“降生”了。试管婴儿和其他婴儿一样健康和普通。然而对于他们的父母（大多数都经历了数月甚至数年的不孕不育之苦）来说，他们简直就是奇迹。

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In a world where one person in six suffers from infertility, such successes are rightly celebrated. Less discussed are the problems of ivf. Most courses of treatment fail. That subjects women and couples to cycles of dreaming and dejection—and gives the fertility industry an incentive to sell false hope. The obstacle is a lack of progress in understanding the basic mechanisms that determine fertility. At last, however, the science is making headway, holding out more promise and less heartache for generations of parents to come.

在一个六分之一人口患有不孕症的世界里，这样的成功值得庆祝。但很少有人讨论试管婴儿技术的问题。大多数治疗都失败了，这让女性和夫妇们经历了一次又一次的希望和失望的循环，这也让生育产业有了销售虚假希望的动力。障碍在于对决定生育能力的基本机制缺乏了解。然而，科学正在取得进展，这为未来几代父母提供更多的希望和更少的心理痛苦。

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Over the years ivf has become better at making babies and safer for the women who bear the brunt of the treatment. The rate of twin and triplet deliveries has plummeted, reducing the number of risky pregnancies. Hormone treatments are safer. Combined with egg and sperm freezing, donation and surrogacy, ivf has given many, including same-sex couples and singletons, a path to parenthood where they had none.

多年来，试管婴儿技术在孕育婴儿方面变得更加出色，对于承受治疗压力的女性来说也更加安全。双胞胎和三胞胎分娩的比例已经大幅下降，这减少了高风险妊娠的情况。激素治疗也更加安全。结合卵子和精子冷冻、捐赠和代孕（中国目前是禁止的），试管婴儿技术为包括同性恋伴侣和单身人士在内的本来无法成为父母的许多人提供了一条成为父母的道路。

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Yet the process remains gruelling and costly. It is physically painful for women, and emotionally draining for both sexes. For many, fertility treatment is an unaffordable luxury; in America, for instance, a cycle can cost $20,000. Some countries ration treatment according to a conservative moral code. Until 2021 French law permitted ivf only for married heterosexual couples. Many countries including China forbid egg freezing, which extends reproductive years.

然而，试管婴儿技术的过程仍然是艰苦且昂贵的。对于女性来说，这是一种身体上的痛苦，对于男女双方来说都是一种情感上的消耗。对于许多人来说，不孕不育治疗是一种无法承受的“奢侈品”；例如在美国，一次疗程的费用可能高达20,000美元。一些国家根据保守的道德准则来限制治疗。直到2021年，法国法律仅允许异性婚姻夫妇进行试管婴儿技术。包括中国在内的许多国家禁止冻卵，这会延长生育年龄。

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All too often, the pain and the cost come to nothing. The 770,000 ivf babies born in 2018 required some 3m cycles. Many women go through round after round of hormone injections, sometimes moving from one clinic to the next. In America and Britain roughly half go home with a baby in their arms, even after several years and as many as eight cycles of treatment.

然而，大多时候，这些痛苦和费用都付诸东流。2018年诞生的77万试管婴儿需要进行约300万个疗程。许多女性需要经历一轮又一轮的激素注射，有时还需要在不同的诊所之间转移。在美国和英国，即使经过数年和多达八个疗程的治疗，大约一半的人最终仍然无法如愿以偿。

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This has fostered a fertility industry selling to repeat customers desperate to conceive. When a cycle fails, many clinics offer poorly regulated menus of “add-ons” that do not demonstrably raise the chances of success, and may even reduce them. They can charge hundreds to thousands of dollars for a treatment.

这种情况催生了“生育产业”，它们向那些渴望怀孕的“回头客”销售产品。当一次治疗失败时，许多诊所会提供一些“附加服务”，这些服务的效果并没有得到充分的监管，也不能证明可以提高成功率，甚至还可能会降低成功率。他们可以为这种治疗收取数百到数千美元的费用。

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These problems all share a fundamental cause. Although reproduction is one of the most basic aspects of human biology, scientists have an astonishingly poor grasp of how a new life comes about. The essentials are obvious: a sperm and an egg must meet. But many of the cellular, molecular and genetic underpinnings of babymaking remain a mystery.

所有这些问题都有一个根本原因。尽管“繁殖”是人类生物学中最基本的方面之一，但科学家们对新生命的形成方式的了解仍然非常有限。基本的原理显而易见：精子和卵子必须相遇。但是，关于制造婴儿的许多细胞、分子和遗传学基础仍然是一个谜。

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Little is known about how a woman’s stock of eggs is set before she is even born; or why they fade in number and quality until menopause, which among mammals is known to occur only in humans and five species of whale. The intricacies of how an embryo buries into the womb and connects to the blood supply are also mysterious. Infertility is often classed as “women’s health”, yet male factors play at least some role in roughly half of heterosexual infertile couples—though how is often unclear.

人们对女性在出生前如何形成卵子储备以及为什么卵子数量和质量会随着时间的推移而逐渐减少，直至绝经期，知之甚少。在哺乳动物中，绝经期仅出现在人类和五种鲸类中。胚胎如何进入子宫并连接到血液供应的复杂性也是一个谜。不孕不育通常被归类为“女性健康问题”，然而，在大约一半的异性不育夫妇中，男性因素至少起到了一定的作用ーー尽管通常不清楚这种作用是如何产生的。

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In the face of all this, ivf is woefully inadequate. It was devised as a fix for the blocked Fallopian tubes that prevented Ms Brown’s mother from conceiving. But today, when more couples try for children later in life, a woman’s declining stock of eggs is increasingly likely to be the problem. Here, ivf works by giving people more rolls of the dice, by collecting more eggs and maximising the odds that they will be fertilised. That will work for the lucky few, but without an entirely new approach and new treatments, many aspiring parents will endure one disappointment after another.

面对所有这些问题，试管婴儿技术显得非常不足。它的设计初衷是为了解决布朗女士母亲因输卵管堵塞而无法受孕的问题。但今天，当越来越多的夫妇晚年尝试生育时，女性逐渐减少的卵子储备可能是导致不孕的问题。在这种情况下，试管婴儿技术通过收集更多的卵子并最大限度地增加其受精的可能性来增加人们的成功率。这对于幸运的少数人可能有效，但如果没有全新的方法和治疗，许多有生育愿望的父母将经历一次又一次的失望。

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As our Technology Quarterly reports, recent scientific work offers some hope. Researchers in Japan and America are exploiting stem cells, which have the ability to become any of the body’s many specialised tissues, to make eggs from skin and blood cells, a process called in vitro gametogenesis (ivg). In Japan healthy mouse pups have been created from cells that originated on the tips of their mothers’ tails. Earlier this year researchers announced that they had delivered mouse pups that shared two genetic fathers. One had contributed sperm, the other skin, which was first turned into stem cells and then into eggs.

正如我们的Technology Quarterly中所报道的，最近的科学研究给我们带来了一些希望。日本和美国的研究人员正在利用干细胞，这些细胞具有成为身体许多特殊组织的能力，从皮肤和血液细胞中制造卵子，这个过程被称为体外配子生成（ivg）。在日本，已经可以通过从母亲尾巴顶端的细胞中产生健康的小鼠幼仔。今年早些时候，研究人员宣布，他们已经产下了拥有两个遗传父亲的小鼠幼崽，其中一个提供了精子，另一个则提供皮肤细胞，皮肤细胞经过转化成干细胞后再变成卵子。

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Some teams are working towards applying these techniques to humans. If cells safe enough to make healthy babies will ever be available, they are still far off. But the research is providing new insights into how sperm and eggs are made. ivg means that researchers may no longer need to rely for their studies on donated eggs, sperm and embryos, often generously provided by ivf patients. Other teams are using stem cells to build embryo models (dubbed “embryoids”). These will never see the inside of a womb but they can help show what happens to the real embryos that do.

一些团队正在努力将这些技术应用于人类。要制造出足够安全的细胞以产生健康的婴儿，仍然有很长的路要走。但这项研究为我们提供了新的认识，帮助我们了解精子和卵子的生成过程。体外配子技术意味着研究人员可能不再需要依赖于捐赠的卵子、精子和胚胎来进行研究，这些通常由试管婴儿患者慷慨提供。其他团队正在使用干细胞构建胚胎模型（被称为“类胚胎”）。这些模型永远不会进入子宫，但它们可以帮助我们展示真实胚胎的发育过程。

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In time, novel treatments may follow. Gay couples could have children that are as genetically related to them as those of straight ones. Trans people who are undergoing gender reassignment could possibly do so without sacrificing their fertility.

随着时间的推移，可能会出现新的治疗方法。同性恋夫妇可以拥有与异性恋夫妇一样“有血缘关系”的孩子。正在进行变性手术的跨性别者可能不必牺牲他们的生育能力就能完成手术。

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All this will take time—which is why ivf will remain important, and why it needs investment and regulation. A better understanding of fertility should help raise the success rate of ivf, bringing down its emotional and financial costs.

所有这些都需要时间，这就是为什么试管婴儿技术仍然很重要，需要投资和监管。更好地了解生育能力应该有助于提高试管婴儿技术的成功率，降低其情感消耗和金钱成本。

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New treatments could eventually herald the biggest transformation in fertility technology since Ms Brown was born. Polling shows that in many countries people have fewer children than they would like, partly because they are putting off babymaking until later. Where the sexual revolution of the 1960s and ’70s gave women the choice not to have babies if they did not wish to, emerging technology could usher in a new revolution, empowering women—and men—to have the babies they want, when they want them.

新的治疗方法最终可能会宣告着自布朗女士出生以来生育技术最大的转变。调查显示，在许多国家，人们生育的孩子比他们想要的要少，部分原因是他们推迟了生育。20世纪60年代和70年代的性革命给了女性选择不生孩子的权利，如果她们不想要孩子的话。新兴技术可能会引领一场新的革命，赋予女性和男性在想要孩子时拥有他们的权利。