文章來源：《經(jīng)濟(jì)學(xué)人》Jul 22th 2023 期 Leaders 欄目 Fertility technology

?

[Paragraph 1]

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，路易絲·布朗在曼徹斯特出生，她的父母鄰居們驚訝地發(fā)現(xiàn)，世界上第一個(gè)“試管嬰兒”是“正常的”：兩只眼睛，十個(gè)手指，十個(gè)腳趾。在此之后的45年中，體外受精已成為全球不孕不育的主要治療方法，至少有1200萬人在試管中受孕。大約每45秒就有一個(gè)試管嬰兒“降生”了。試管嬰兒和其他嬰兒一樣健康和普通。然而對(duì)于他們的父母（大多數(shù)都經(jīng)歷了數(shù)月甚至數(shù)年的不孕不育之苦）來說，他們簡(jiǎn)直就是奇跡。

?

[Paragraph 2]

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.

在一個(gè)六分之一人口患有不孕癥的世界里，這樣的成功值得慶祝。但很少有人討論試管嬰兒技術(shù)的問題。大多數(shù)治療都失敗了，這讓女性和夫婦們經(jīng)歷了一次又一次的希望和失望的循環(huán)，這也讓生育產(chǎn)業(yè)有了銷售虛假希望的動(dòng)力。障礙在于對(duì)決定生育能力的基本機(jī)制缺乏了解。然而，科學(xué)正在取得進(jìn)展，這為未來幾代父母提供更多的希望和更少的心理痛苦。

?

[Paragraph 3]

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.

多年來，試管嬰兒技術(shù)在孕育嬰兒方面變得更加出色，對(duì)于承受治療壓力的女性來說也更加安全。雙胞胎和三胞胎分娩的比例已經(jīng)大幅下降，這減少了高風(fēng)險(xiǎn)妊娠的情況。激素治療也更加安全。結(jié)合卵子和精子冷凍、捐贈(zèng)和代孕（中國(guó)目前是禁止的），試管嬰兒技術(shù)為包括同性戀伴侶和單身人士在內(nèi)的本來無法成為父母的許多人提供了一條成為父母的道路。

?

[Paragraph 4]

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，試管嬰兒技術(shù)的過程仍然是艱苦且昂貴的。對(duì)于女性來說，這是一種身體上的痛苦，對(duì)于男女雙方來說都是一種情感上的消耗。對(duì)于許多人來說，不孕不育治療是一種無法承受的“奢侈品”；例如在美國(guó)，一次療程的費(fèi)用可能高達(dá)20,000美元。一些國(guó)家根據(jù)保守的道德準(zhǔn)則來限制治療。直到2021年，法國(guó)法律僅允許異性婚姻夫婦進(jìn)行試管嬰兒技術(shù)。包括中國(guó)在內(nèi)的許多國(guó)家禁止凍卵，這會(huì)延長(zhǎng)生育年齡。

?

[Paragraph 5]

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，大多時(shí)候，這些痛苦和費(fèi)用都付諸東流。2018年誕生的77萬試管嬰兒需要進(jìn)行約300萬個(gè)療程。許多女性需要經(jīng)歷一輪又一輪的激素注射，有時(shí)還需要在不同的診所之間轉(zhuǎn)移。在美國(guó)和英國(guó)，即使經(jīng)過數(shù)年和多達(dá)八個(gè)療程的治療，大約一半的人最終仍然無法如愿以償。

?

[Paragraph 6]

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.

這種情況催生了“生育產(chǎn)業(yè)”，它們向那些渴望懷孕的“回頭客”銷售產(chǎn)品。當(dāng)一次治療失敗時(shí)，許多診所會(huì)提供一些“附加服務(wù)”，這些服務(wù)的效果并沒有得到充分的監(jiān)管，也不能證明可以提高成功率，甚至還可能會(huì)降低成功率。他們可以為這種治療收取數(shù)百到數(shù)千美元的費(fèi)用。

?

[Paragraph 7]

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.

所有這些問題都有一個(gè)根本原因。盡管“繁殖”是人類生物學(xué)中最基本的方面之一，但科學(xué)家們對(duì)新生命的形成方式的了解仍然非常有限?；镜脑盹@而易見：精子和卵子必須相遇。但是，關(guān)于制造嬰兒的許多細(xì)胞、分子和遺傳學(xué)基礎(chǔ)仍然是一個(gè)謎。

?

[Paragraph 8]

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.

人們對(duì)女性在出生前如何形成卵子儲(chǔ)備以及為什么卵子數(shù)量和質(zhì)量會(huì)隨著時(shí)間的推移而逐漸減少，直至絕經(jīng)期，知之甚少。在哺乳動(dòng)物中，絕經(jīng)期僅出現(xiàn)在人類和五種鯨類中。胚胎如何進(jìn)入子宮并連接到血液供應(yīng)的復(fù)雜性也是一個(gè)謎。不孕不育通常被歸類為“女性健康問題”，然而，在大約一半的異性不育夫婦中，男性因素至少起到了一定的作用ーー盡管通常不清楚這種作用是如何產(chǎn)生的。

?

[Paragraph 9]

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.

面對(duì)所有這些問題，試管嬰兒技術(shù)顯得非常不足。它的設(shè)計(jì)初衷是為了解決布朗女士母親因輸卵管堵塞而無法受孕的問題。但今天，當(dāng)越來越多的夫婦晚年嘗試生育時(shí)，女性逐漸減少的卵子儲(chǔ)備可能是導(dǎo)致不孕的問題。在這種情況下，試管嬰兒技術(shù)通過收集更多的卵子并最大限度地增加其受精的可能性來增加人們的成功率。這對(duì)于幸運(yùn)的少數(shù)人可能有效，但如果沒有全新的方法和治療，許多有生育愿望的父母將經(jīng)歷一次又一次的失望。

?

[Paragraph 10]

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.

正如我們的Technology Quarterly中所報(bào)道的，最近的科學(xué)研究給我們帶來了一些希望。日本和美國(guó)的研究人員正在利用干細(xì)胞，這些細(xì)胞具有成為身體許多特殊組織的能力，從皮膚和血液細(xì)胞中制造卵子，這個(gè)過程被稱為體外配子生成（ivg）。在日本，已經(jīng)可以通過從母親尾巴頂端的細(xì)胞中產(chǎn)生健康的小鼠幼仔。今年早些時(shí)候，研究人員宣布，他們已經(jīng)產(chǎn)下了擁有兩個(gè)遺傳父親的小鼠幼崽，其中一個(gè)提供了精子，另一個(gè)則提供皮膚細(xì)胞，皮膚細(xì)胞經(jīng)過轉(zhuǎn)化成干細(xì)胞后再變成卵子。

?

[Paragraph 11]

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.

一些團(tuán)隊(duì)正在努力將這些技術(shù)應(yīng)用于人類。要制造出足夠安全的細(xì)胞以產(chǎn)生健康的嬰兒，仍然有很長(zhǎng)的路要走。但這項(xiàng)研究為我們提供了新的認(rèn)識(shí)，幫助我們了解精子和卵子的生成過程。體外配子技術(shù)意味著研究人員可能不再需要依賴于捐贈(zèng)的卵子、精子和胚胎來進(jìn)行研究，這些通常由試管嬰兒患者慷慨提供。其他團(tuán)隊(duì)正在使用干細(xì)胞構(gòu)建胚胎模型（被稱為“類胚胎”）。這些模型永遠(yuǎn)不會(huì)進(jìn)入子宮，但它們可以幫助我們展示真實(shí)胚胎的發(fā)育過程。

?

[Paragraph 12]

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.

隨著時(shí)間的推移，可能會(huì)出現(xiàn)新的治療方法。同性戀夫婦可以擁有與異性戀夫婦一樣“有血緣關(guān)系”的孩子。正在進(jìn)行變性手術(shù)的跨性別者可能不必犧牲他們的生育能力就能完成手術(shù)。

?

[Paragraph 13]

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.

所有這些都需要時(shí)間，這就是為什么試管嬰兒技術(shù)仍然很重要，需要投資和監(jiān)管。更好地了解生育能力應(yīng)該有助于提高試管嬰兒技術(shù)的成功率，降低其情感消耗和金錢成本。

?

[Paragraph 14]

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.

新的治療方法最終可能會(huì)宣告著自布朗女士出生以來生育技術(shù)最大的轉(zhuǎn)變。調(diào)查顯示，在許多國(guó)家，人們生育的孩子比他們想要的要少，部分原因是他們推遲了生育。20世紀(jì)60年代和70年代的性革命給了女性選擇不生孩子的權(quán)利，如果她們不想要孩子的話。新興技術(shù)可能會(huì)引領(lǐng)一場(chǎng)新的革命，賦予女性和男性在想要孩子時(shí)擁有他們的權(quán)利。