Looking back on the events of 2022 through the lens of reproductive medicine, biology, and genetics, it is difficult for anyone, no matter their discipline or specialty, to wonder where the future lies with respect to the coming year. This is an especially daunting task at a time when outside the nanotube within which we work, we have reached a staggering population of 8 billion globally (some 8 million of which were products of our doing), and witnessed a war and poverty alongside the tridemic at hand-what more could have been done? In fact, we have witnessed a most eventful year.
Overseeing the content of JARG and facilitating our readership’s interpretation of what has happened that could alter the pathway to treatment paradigms for the growing population of consumers seeking assistance for present and future fertility needs has become a serious challenge for our team of section editors, editorial board members, and the many reviewers who have weighed in during the peer review process. This month in JARG, we close 2022 examining the context, content, and currency that is driving our collective disciplines towards the coming year that promises to be laden with more, not less, controversy destined to impact both the underlying science and practice of human ARTs.
From a context point of view, 2022 has demonstrated just how powerful the business aspect of ARTs and genetics has become. An important corollary to the waning academic and private practice clinical infrastructure during this time of business enterprise takeover concerns the very foundations of training the next generation of clinicians and basic scientists. How will standards of care and investigative excellence ever reach, respectively, patients in need who lack the financial resources or the emergent population of Ph.D.’s destined to become lab managers? To some extent, for the latter, the scarcity of Ph.D.’s choosing academic careers (who would be likely candidates for embryology laboratory managers of the future) finds its roots in a burgeoning business of biotechnology that in many cases we now find building on human ARTs and genetics for purposes of futuristic goals such as making gametes and embryos from stem cells, automating laboratory procedures and record keeping, and deploying big data and artificial intelligence into the IVF marketplace. Has the gatekeeper between the world of patient care and big business stepped to the side as the important questions as to equal access, inclusion, and a conundrum of biomedical ethics remain on the fringe of our discipline? Difficult questions, answers for which only time will tell.
From a content perspective, there is indeed much to celebrate. Matters of access to care and inclusion directives have caught the attention of many organizations and as is the right and obligation of academic institutions, the ten-year cycle of curriculum reform in US medical schools is finally asking some serious questions with respect to, for example, how will future physicians and scientists come to grips with teaching human genetics (and epigenetics) in today’s non-Mendelian world?
On the front of basic science advances, 2022 has been nothing short of remarkable. Gene editing technology has materially advanced such that base pair nanosurgical manipulations have become exacting (relative to past years off target edits). Constructing tissue equivalents from stem cells in the form of “oids” have placed all manner of reproductive and non-reproductive tissues and organs on a stage set to uncover new models for drug screening and perhaps providing replacements for aged or diseased gonads—a theme that has been reiterated for decades now in ARTs within the purview of extending reproductive lifespan. And, of course 2022 witnessed a surge in reports of making human “embryo-looking-entities” (call them synthetic, artificial, blastoids, and more to come) capable of recapitulating many of the morphological milestones we associate with “normal” development of blastocysts. Finally, the ability to make gametes from stem cells or support ex vivo development to the beating heart stage in mice carries with it the prospects of a “Brave New World” in the twenty-first century approximating the notion of ectogenesis proposed 90 years ago. These matters remind us that “Just because we can do it, does not mean we should.”
So, as we await what lies ahead in 2023, keeping in mind the currency driving our collective ambitions to meld technology and business to advance the cause of medicine gives many reasons to pause and reflect upon our responsibilities to society broadly and our patients in particular. Whether it be the allure of financial rewards, or satisfaction of providing new knowledge that could make a difference in diagnosis or treatment, our field has an obligation, now more than ever, to look outside for advice, direction, and guidance if we are to meet the intentions of our forebears for the practice of human ARTs.
We thank you our readership for continuing to support our efforts through this past year and, as always, we welcome your input and feedback to make JARG’s journey better for all.
Happy Holidays!
Footnotes
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