Like a Virgin by Prasad, Aarathi (recommended reading txt) 📕

develops into a mature, ready-to-be-fertilized egg. This is why the key hormone in timing of conception and in IVF treatments is called follicle-stimulating hormone (FSH): the hormone stimulates the follicles to grow and eventually erupt, releasing the egg during ovulation. This means, however, that acquiring a healthy ovary, or even strips of tissue from a healthy ovary, and transplanting it into a woman is another way of getting around the problem of scarce good eggs. If the tissue has follicles that are still receptive to FSH, a woman would once again be able to generate eggs, no matter what her age. Take the case of Susanne Butscher, a woman who became infertile at the age of fifteen when her ovaries failed, causing her to experience a very early menopause. In November 2008, at age thirty-eight, she became the first woman to give birth after receiving a transplanted ovary.

Ovary transplants were developed for women, like Butscher, who suffer early menopause, or for those undergoing chemotherapy or radiotherapy to treat cancer. While strips of ovary can be removed from a woman without ill effects, removing the ovaries themselves can trigger premature menopause, with all of the associated ill health effects. However, Dr Sherman Silber, who performed Butscher’s transplant surgery, sees the potential for using the procedure as allowing women who have delayed motherhood for any reason to improve their chances of having a baby later in life. Rather than freezing eggs and undergoing IVF with them, a whole ovary could be frozen; the tissue would be viable for up to a decade. While the extraction and transplant surgeries are invasive, they could circumvent some of the problems associated with other fertility treatments. Children conceived through ICSI or IVF, even those conceived simply through the use of drugs to induce a woman’s eggs to be released for harvest, appear more likely to have problems with genetic imprinting, growth, and defects. And, unlike with IVF, a preserved or new ovary gives women the option of conceiving a child via sexual intercourse with a fertile partner. After her transplant, Butscher started having periods again, for the first time in twenty-three years, and she and her forty-year-old husband used no other fertility treatments. Indeed, the oestrogen, progesterone, and testosterone produced in the ovaries affect the female body in many ways, including protecting the bones from osteoporosis, and Butcher’s bone health improved as well.

Not everyone found good news in Susanne Butscher’s case. Just as happened when Louise Joy Brown entered the world as the first test-tube baby in 1978, the delivery raised moral and social concerns in many quarters. Chief among them: were surgeons using science as a tool to alter the child-bearing age for women? The UK’s Royal College of Midwives, for instance, stated that it would be preferable for surgeons to limit ovarian transplants and other reproductive technologies to women who are ‘truly’ infertile – meaning that they have become infertile in their twenties or earlier – and who are desperate to conceive. This would include Susanne Butscher, of course, but also survivors of childhood cancers who show evidence of normal ovarian function, but who will require a therapy that would otherwise destroy their ovaries. Right now, women battling cancer at a young age must either become a mother before treating the cancer, or treat the cancer – hardly a happy choice to make. But is it fair to say that some women, because of a medical condition, ‘deserve’ to benefit from these technologies, while others, because of societal and economic conditions, do not?

Those working on the frontline with people who are infertile argue that modern lifestyles are altering the child-bearing age for women – making it difficult for women to have children earlier in life. And then there is the question of how to define a ‘truly’ infertile couple. Yes, a man or a woman may be biologically ill-equipped to have a child together because of the health of their sperm and eggs, but a lesbian couple could make the case that they fall into this category, too: they don’t have the healthy sperm they need to have a child. In a statement on why IVF treatments for infertile couples should be a priority for the National Health Service, the British Fertility Society wrote that those ‘involved in infertility services are all aware that we are not just dealing with a physical pathology. Infertility is a disease, but it also has fall-out beyond that… causing mental health problems, depression, stress-related illnesses, and so on.’ These are serious health conditions, and if we have the tools to treat the underlying problem – the inability to have a child, at a time in life when a child is desired – shouldn’t we do so?

Susanne Butscher, for one, would probably agree with that idea. She and her husband named their baby Maja, for the Roman goddess of rebirth and fertility, and Butscher said Maja gave her ‘a sense of completeness [she] would never have had otherwise’.

Ovary transplants require a supply of compatible ovaries, so the problems that come with the trade in eggs and sperm – replete with misstatements, privacy violations, skirting regulations across borders, and criminal scandal – may well apply here too. And there are documented reports of a black market in body parts for transplant surgeries, so the infrastructure is already in place for ovary trafficking if the surgery is allowed to go forward on a larger scale. So scientists are considering how to take the idea behind ovary transplants and apply it to reproduction, without the demon of a limited supply of organs to meet demand.

Eggs and sperm are collectively called germ cells for their potential, somewhat like seeds, for growth to emerge after a period of dormancy. Early in evolution, a process of segregation must have happened so that germ