The Only Child: Imagining the Future of IVF

A science-fiction scenario exploring the emergent future of fertility — and what happens when technology meets the womb.

It felt more like getting a bank loan than having a child, right down to the office furniture. Leather chairs, potted plants, a wooden desk and a bookshelf filled with fancy-looking antique books, weirdly out of place — why would a doctor have every volume of “Remembrances of Things Past” on their office bookshelf? Theresa found herself in the strange position of longing for the familiar decor of a traditional OB-GYN clinic, craving that uncomfortable table covered with wax paper; a defibrillator on the wall, maybe some hanging stethoscopes. Something that felt medical and committed.

“I’m May,” said a young woman in a lab coat, closing the door behind her to sit in a large leather office chair on the other side of a thick wooden desk. “My official title here is Fertilization Manager, but you can think of me as your stem-cell doula,” she said, smiling. “I know you’ve been here before, but before we start, I want to give you the opportunity to ask any questions you might have about the procedure?”  

“There’s just one thing I’m not clear about,” Theresa joked, nervously: “and that’s everything.”  

“So, we have your partner’s skin cells on file,” May said, smiling gently. “I see here that she’s not with us — I’m so sorry to hear that.”

“It was nothing genetic,” Theresa responded. “A few weeks ago.”

Theresa’s partner, Lilith, had biked to fetch tomatoes at the farmer’s market when she was struck by a drunk driver, her bike and body sent sideways into oncoming traffic, killing her instantly while Theresa chopped basil and boiled water in the kitchen.

“I’m so sorry,” May said.

“I called and they said that I need to go ahead soon if I’m going to do this with her,” said Theresa, concentrating stripping emotion from her words and longing for a return to the scientific. The last thing she needed was to have another breakdown at the IVF lab.

May understood, and took the silence as a cue to move forward.

“When you two first came in, you remember, we took skin samples. From those, we’re able to obtain stem cells, which we can modify back to a sort of embryonic state. We call these iPSCs, ‘induced pluripotent stem cells.’ Once cells are in that state, which we’ve done in the lab, they can transform into pretty much anything in the human genetics playbook — including eggs and sperm. So, this entire procedure took place in our lab, outside of your body, but is 100% the genetic offspring of you and your partner. Today, you select the embryo, and then we send you to the lab, within the next few days, to transfer the embryo into your womb.”

The Family Rejects

Theresa recalled talking to her parents about the procedure, on the day that she and Lilith had gone to get a tiny piece of their flesh removed by calipers. Her parents warned her that it was unnatural, a sudden religiosity intersecting with the non-GMO lifestyle of aging hippies. They had expressed their resistance to IVF with a devastating coldness while in the midst of a “raw-water phase,” claiming that they had lost their trust in government filtration systems.

Theresa sat in the midst of their kitchen — filled with draping vines and exposed soil, life blooming everywhere, in artificial environments, without any social or legal regulation — to tell her parents that she and her partner of seven years would be having a child in a laboratory, their own offspring. It was supposed to be a joyous occasion. Her parents responded by looking at each other without saying a word. Within an hour they had arrived at a bombshell declaration by her mother — “I think God put gay couples on Earth to adopt children” — a line she’d picked up from some op-ed or another opposed to “same-sex conception of genetic offspring.” That was how it was constantly named, since the technique was made available to the public in 2028: never the simplest term, thought Theresa, which was “having a baby.” These conceptions, these babies, came wrapped in the language of clinical distance, like they were talking about surgery.

Theresa and Lilith went to the clinic, a small piece of flesh was taken from their arms, and three weeks later Lilith was killed.

The Politicians Decide

“This is all ready to go?” Theresa asked, snapping back to the conversation taking place across the enormous lacquered desk. May nodded.

“All we need is for you to choose which embryo you want to carry. We have one we can highly recommend, one that factors out most of the genetic risks that could be passed on through you and your partner.”  

“What kind of risks?”

“Both of you were carriers of Tay-Sachs disease. That’s really reduced the number of viable embryos that are available to you — we could make more, but it’s an additional fee, and with your partner gone...”

“Was there anything else?” Theresa interrupted. “Any other reason not to use the embryos we have?”  

“Yes,” May said, a bit hesitant. “But before we carry on, I have to introduce you to a computer simulation of your recommended child. It’s part of the CRISPR-PGD Regulatory Act of 2029.”

Theresa had followed it all in the news: the legislative bill that banned the editing of genes in the womb and highly regulated the selection process for planned embryonic fertilization. The law was intended to minimize over-engineering of potential offspring through the direct use of gene-editing technology. But some politicians worried about the possibility of creating thousands of potential combinations of eggs and sperm until hitting “jackpot” on a desired combination of traits, which, they argued, achieved the same end as editing cells directly. The law required that the most viable egg — defined in a purely political process as the most likely to come to term and least at risk of genetic disease — had to be “introduced” to the parents through a simulation, intended to create an emotional response that might minimize any desire to “shop” for offspring that looked or behaved in certain ways.

It was a questionable law that was already being challenged in courts, but various circuits had come to quite different rulings and the Supreme Court had yet to intervene.   

“Using a machine-learning algorithm — Artificial Intelligence, basically — and potential DNA sequences, we can guess — with a high amount of accuracy — how your child will look,” May went on. “With a lesser degree of accuracy, we can predict how they behave. I want to make it clear that it’s against the law — and beyond the capacity of our specific lab — to go in and change these things. Instead, you’re being offered possibilities, and you choose one to continue through to term. You are allowed to say no just once, unless the pregnancy doesn’t take, and so we’re presenting you with the best option first.”

“So you can tell me, what? My child’s SAT scores?”

“Not exactly, but we can definitely guess who is likely to have a better SAT score. Basically, researchers have been collecting DNA samples from the public for decades, and we’ve been able to draw correlations between traits and certain genetic variations. Every lab has a slightly different take on it, and I’m legally required to tell you that. So, for example, we can say that we’ve found certain variances in someone’s DNA that are closely correlated to being a late or early sleeper, or being good at math, or athletic. It’s sort of like, you’re more likely to be these things, but it’s not destiny. But we do factor it into the simulation of your child.”

“OK,” Theresa said. “Can I see it?”

Her,” May corrected. “Sorry, we have to use gendered pronouns to refer to the simulation. But, yes.” May spun around and opened a cabinet behind her, revealing a nearly human-sized glass screen, its shiny black surface reflecting Theresa in her chair before the LEDs sparked up to the default Apple desktop screen turned horizontal.

The Machines Predict

The screen went black and there she was: Theresa and Lilith's potential daughter, presented with lifelike accuracy as a young woman of about 21 years old. Lilith's ghost had infiltrated the young woman’s body in winding genetic spirals, unfurled by complex math to appear on the screen as if in some cellular seance. She looked like Lilith: the straight red hair, the pale freckled skin, the gangly legs, deep brown eyes. Theresa saw nothing of herself in the woman, and it was something of a relief.    

“You can ask her questions,” May said.

“Hi,” Theresa said, hesitantly.

“Hello, mom,” the young girl responded, with a wave. Her voice sounded like Lilith, too.

“Her voice is generic,” May said. “She sounds the same for everyone.”  

“Oh,” Theresa said, through tears, feeling a bit ridiculous. “She sounds like...”

“It’s easy to project,” May said. “Don’t worry.”

Theresa couldn’t bring herself to ask this daughter any questions. It felt ghoulish, somehow — instead of channeling the dead, she was channeling the unborn. Or, given the circumstances, a little bit of both. She wondered who thought this was a good idea, and then she remembered: politicians did. She watched the girl on the screen fidget awkwardly in a digitally animated loop.

“You said there was something else,” Theresa said. “Another health risk?”

May nodded.

“We’ve found very few selections without a high correlative risk to anxiety and depression.”

The Genes Determine

Of course, thought Theresa. She’d spent so many months of her late 20’s wrapped in blankets, ostensibly working on a PhD, but mostly drinking tea and staring out of windows, captivated by raindrops and the silent movements of her cat prowling the house. She poked at piano keys, where she had once contemplated a career in performance. She took leave for six months, which turned into eight, which turned into dropping out of school.

All the while, Lillith had been working, cooking, living in a shared apartment with her partner that had been filled with a dense, heavy silence. Theresa’s fog receded, eventually, through some mystical force of therapy and time and medication. She returned to school. She earned her doctorate. The process had separated her from a previous, more care-free life — she had come to value her happiness in a way that she hadn’t, before, as if it had been earned, as if it could once again disappear for reasons beyond her control. She had won an intimate connection to the raindrops and the cat, to the silences that bloomed between the movements of the world. It may have been a masochistic badge of honor, a retroactive coping mechanism for mourning the time she had lost. She took pride in her survival, but she didn’t wish the experience on anyone. It had been painful, isolating, and sad, but it had been hers.

To consider that it could also be her child’s — perhaps the only discernible piece of herself to appear in this child’s body — felt nothing but cruel.

“There’s no embryo without that risk?” Theresa asked. “Didn’t we have 100 viable eggs?”

“I’m sorry, but with two parents carrying a genetic condition, you’re more subject to random chance than most other parents,” May said. “The randomness just was not favorable. And, I want to reiterate, it’s a statistical likelihood. It’s not her destiny.”

Theresa sat in silence for a long time before she asked her algorithmically modeled daughter the only question she could think to ask her.

“Do you want to be born?” Theresa asked the young girl on the monitor, feeling silly and watched, but knowing it was the only question she had for making the decision.

“That’s a bit beyond our machine learning model’s capabilities,” May said. Theresa nodded, and looked back at the screen.

“Who do you want to be?” she asked.

“Thank you for asking,” the girl said after a slight pause for processing. The response came in the awkward, stilted syntax of computerized speech. “I have a very high chance of exceptional musical ability, and likely would thrive in a home with musical instruments and education. Perhaps I could be a musician.”

So there it was, thought Theresa: a less haunting piece of her own ghost, coursing through the veins of this awkward young woman emerging from the software.

“So what do you want to do?” May asked.

***

This is a work of speculative fiction intended to provoke questions on the emergent future of biological engineering, part of swissnex San Francisco’s LifeCycle series. It is inspired by the our panel discussion, “The End of Sex?” and informed by the book, “The End of Sex and the Future of Reproduction” by Hank Greely (who was not consulted and offered no direct input into crafting this scenario).


Written by Eryk Salvaggio
Once called "the Harry Potter of the Digital Vanguard," Eryk Salvaggio is a writer, artist, and futures researcher at swissnex San Francisco. He previously studied new media art and journalism at the University of Maine and Global Media at the London School of Economics.