LAUSR

The conception of a new human life is more relevant in terms of the medical future for the unborn baby than the delivery. If deliveries are often performed in hospitals under strict medical supervision and care, why shouldn't conception, a fundamental first step for a healthy newborn, be conducted with similar care? ‘‘Mother nature’’ is not as wise as we were told. We know that ‘‘natural’’ conception results in congenital defects in 3%–5% of newborn infants. Genetic diseases affect 1% of live births leading to 18% of pediatric hospitalizations and a 20% of infant mortality. Eighty-five percent of human beings carry recessive or X-linked genetic mutations that remain unnoticed unless we perform extensive carrier screening tests (1). Overall, if left to ‘‘mother nature,’’ the risk of a live-born baby with chromosomal anomalies such as Down Syndrome or sex-linked chromosomal abnormalities that alter quality of life and shorten life span is 0.6%. Occurrence of trisomy 21 varies depending on mother's age and ranges between 1:40 and 1:2000 deliveries. These are the statistics for newborns even after the advent of modern prenatal medicine and preconception counseling. In the case of failed conception, embryo aneuploidies cause 6% of stillbirths, and 60% of clinical miscarriages that occur in 15% of all pregnancies complicating future pregnancies with additional potential iatrogenic and psychological impact. As further proof of the limitations of nature, the tip of the iceberg is infertility, considered a disease by the WHO, affects an absolute number of 48.5 million couples worldwide in 2010 (2). In the U.S. alone, among married couples of reproductive age, 1.5 million suffered from infertility according to the Centers for Disease Control. Based on the previously presented facts, at the time of conception, mother nature looks more a like a gamble than a reliable partner in which we can always trust. Some will believe for religious or other reasons that we should ‘‘let nature take its course,’’ or that we should allow ‘‘God's will’’ accepting the pathology without medical intervention. Some will think that is safer to be in this comfort zone accepting the status quo including the indicated ‘‘collateral effects’’ than attempt to change it because there are many questions to be understood, uncertainties to be addressed, concerns and fears. But, the future is coming, and progress is unstoppable. Marie Curie (1867–1934), a visionary, stated almost a century ago ‘‘Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.’’ To accomplish the purpose of using knowledge to improve natural fertility outcomes, two main areas of research deserve our focused attention: the creation of artificial gametes; and the exome/genome sequence in its