More women die of pregnancy complications in the US than in any other developed nation. The US is the only developed country where maternal mortality is going up, not down. Our mortality rate is almost 400% higher than it is in Canada, 700% higher than in Italy. Maternal safety concerns will drive initial willingness to use ART in the US.
Infant health concerns will also accelerate use of ART. Despite a general squeamishness toward gene editing and human enhancement, 57% of Americans say they would use monogenetic germline editing to prevent severe disease in their own child.
The total average cost per birth in the US—including preterm, postpartum and standard obstetric care—is the most expensive in the world, 2–3 times higher than in Switzerland, the second most expensive of developed countries.
Today, there are 4 million births in the US at a cost of at least $50 billion per year. As interventional options increase, each with a cost, the whole process of reproduction and birth will become at least 2–3 times more expensive. Total revenue in the US for birth-related care through 2050 will be at least $1.5 trillion.
Today, ART contributes to around 64,000 births, 1%–2% of the total.
For the first time in human history, there are dozens of ways to make a baby. Soon, there will be many more. IVF and artificial insemination will be revolutionized by the ability to derive sperm and egg cells—gametes—from stem cells.
This technology will fundamentally alter the process of human reproduction from dating to mate selection to the legal and social understanding of parenthood. Marriage will become less common as it decouples from reproduction. Biologically, a baby will become more than the sum of its two parents.
Stem cell–derived gametes may be labeled by the FDA as drugs or biological products and therefore be subject to approval. As a response, fertility clinics will segregate into non–disease altering (superficial-only traits, non–FDA regulated) and disease altering (FDA regulated).
These genomics companies will patent processes of removing individual diseases from genomes, rather than developing drugs to treat or cure them. Fertility clinics offering ART will pay license fees to—or, more likely, be owned by—genomics companies.
Today there are 500 for-profit fertility clinics, about 1 for every 11 hospitals in the US. As fertilization moves out of the hospital, thousands of birth centers will pop up by 2050, at least one per hospital in the US.
At first, prospective US parents will travel abroad for embryonic implantation and germline editing for basic disease traits but will return to the US to deliver the baby.
Fertility clinics in Europe, Asia and Mexico will offer germline editing at high cost based on less stringent regulations. Those children will be born in the US as full citizens. This will become a social and political issue as groups try to stop the practice by moving to deny “enhanced” children US citizenship.
Clinics could offer a range of technologies before fertilization to predict likely embryonic outcomes. Before having a child, couples may submit blood tests to AI companies like GenePeeks to learn their future children’s genetic probabilities—and whether a union should even happen.
Today, there are around 500 cord blood storage banks. These will evolve to store many types of patient cells, including marrow and enhanced, modified immune cells, ready to be reinserted as medically needed. As patients gain control of their medical records and gain at-will choice for medical service, their loyalty will tend to follow wherever their cells are banked.
Genomic data from almost every ART baby will be stored, eventually finding its way into the hands of law enforcement and hackers. A dramatic reduction in certain types of crime will cause a societal upheaval as forensics teams gain access to genomic databases and more sensitive methods of DNA sequencing.
Micro-term birth will become increasingly more common as synthetic blood and artificial womb technology makes early-term delivery viable. Pregnancies could be one to two terms shorter and much safer.
A fetus, for example, could be removed via C-section during the second trimester and placed into an artificial womb. A natural nine-month course will only be used for dangerous or natural births or for those who cannot afford earlyterm birth. As a result, C-section will become the number one surgical procedure in the US.
This will lead to a dramatic rise in both international and domestic surrogacy. Today, surrogacy costs an average of $100,000 to $150,000. Its popularity will increase as gestation cycles, cost and the risk of complications decrease, allowing a fertile woman to birth up to two children per year.
More than eight in ten women start breastfeeding their children after birth, but only 30% are still breastfeeding one year out. Smart breast pumps that track flow, quality and composition of milk will become a standard postpartum analysis service and revenue stream for hospitals. AI-based at-home crib tracking will alert the parent and hospital to any abnormalities in infant sleep or behavior.
Worldwide there will be at least 3 billion births between now and 2050.
Technologies to generate sperm and egg from either sex and screen them for known genetic risks will allow up to 1 million people per year who cannot otherwise reproduce to have children “of their own,” including infertile and gay couples. These are likely to be the early adopters of stem cell–dependent ART.
Uni-parenting—a single woman using induced pluripotent stem cells to fertilize her own egg with stem cell–derived sperm—will become increasingly common. It will no longer take two humans to create a child.
Legal custody and the concept of parenthood will become much more about rearing as so-called “multiplex parenting” allows a combination of up to 32 or more parental genomes.
When ART becomes safe, cheap, reliable and preferable, permanent sterilization for both men and women at young adulthood will become near universal, drastically reducing or eliminating accidental pregnancies.
Fertilization
Age 18-25
Woman desires children, either with or without partner.
Woman is offered sperm or sperm is collected from partner, either previously frozen or derived from fresh iPSCs.
Embryos are genotyped at around day 5 and screened for risk factors.
Genomes are edited to remove any obvious or strongly indicated risk factors.
Prospective parents are offered a set of embryos to implant.
$1K–$10K to clinic
Egg Harvest
Age 18-50
Woman goes to fertility clinic.
AI-based virtual progeny.
Skin and laparoscopic biopsies are done.
iPSCs converted into eggs.
Eggs frozen and stored.
$1K–$10K to clinic
Gestation
Natural/Dangerous Birth
9 months in mother’s womb
The New Normal
C-Section at 3 months.
6 months in an artificial womb.
$10K-$30K to hospital