There is a vast wealth of academic literature examining the regulation of assisted reproductive technologies, but the important part of the title of Dr Amel Alghrani's new book, New Horizons, indicates that the content goes beyond a typical analysis of the current legal issues troubling scholars in the field of medical law and ethics. Instead, it focuses on future developments. The book is separated into two distinct parts: Part I is entitled ‘Regulating reproductive technologies: challenges old and new’. It provides a compact account of the regulatory framework governing the more established, and perhaps now less controversial, reproductive technologies available, such as IVF. In that regard, the book assumes some prior understanding of the legislative development of the law and related socio-political issues leading up to the passage of both the Human Fertilisation and Embryology Act 1990 (HFEA 1990) and the Human Fertilisation and Embryology Act 2008 (HFEA 2008). Part II of this book, however, focuses on the law's complex relationship with what is to come with reproductive medicine in the future. Alghrani's resounding emphasis is that in order to develop laws within a society that is democratic, and adopt such divergent views on the new horizons in reproductive technologies, the laws should embody a progressive and proactive approach. The law needs to keep pace with an ever-evolving field of medicine which is, arguably, no longer futuristic given the development of two reproductive technologies which Alghrani explores in depth: uterus transplantation and ectogenesis.

In part, Chapter 1 offers a descriptive examination of the relationship between law and human reproduction and the regulatory challenges therein. It is Alghrani's stated to aim to provide an account of the UK's comprehensive regulatory framework through ‘a past, present and future lens’Footnote ¹ and this chapter delivers precisely that. The analytic and liberal influences from the likes of John Harris, Roger Brownsword and Emily Jackson are immediately identifiable in the earlier sections of the chapter, setting in place the foundations for Alghrani's staunch critique of the current regulatory framework as we approach what she describes throughout as the third wave of human reproductive technologies. No sooner has she provided a detailed chronology of the legislative development of the HFEA 2008, than she systematically reinforces her previous criticism,Footnote ² argued a decade ago, that the government missed an ideal opportunity to consider how better to equip the regulatory framework. It is convincingly argued that despite there being a very well-established reproductive industry, legal challenges charged against the HFEA 2008 have consistently exposed the framework's vulnerabilities, such as the growing market in reproductive tourism. What Alghrani does well is to challenge the present system of regulation whereby the Human Fertilisation and Embryology Authority (HFEA) maintains its discretionary power to formulate public policy in this area. She claims it might lack the required courage to prioritise and make decisions about the licensing and use of novel reproductive techniques – such as artificial gametes – and the implications of using them in a legal, ethical and modern scientific sense.

Following on from the detailed account of how the first wave of assisted reproductive technologies are regulated in the UK, Chapter 2 moves on to examine the second wave of human reproduction: resolving disputes between gamete progenitors over the fate of frozen embryos. This thought-provoking section gives us a clearer insight into Alghrani's line of argumentation. Building upon the previous chapter's exploration of the arguably less controversial aspects of the law's regulation of traditional methods of procreation, here she argues for the rights of gamete progenitors – the patients providing eggs and sperm in order to have embryos created – when reproducing in alternative methods. Alghrani rightly points out that reliance on precedent to govern novel techniques ‘may serve to confine scientific advance to the very inequality it was designed to alleviate’.Footnote ³ Two UK legal challenges are microscopically examined to illuminate her overall critique, Evans v Amicus and ARB v Hammersmith Ltd [2017]. In line with the promotion of gender equality in assisted reproductive technologies, Alghrani utilises both cases to highlight the potential impact and consequences of ill-equipped regulation when it comes to embryo disposition disputes. Three alternative models of regulation are then considered as possible methods of resolving such unenviable legal disputes. First, the ‘natural pregnancy model’, which is subsequently rejected on grounds that women should not have a paramount say over embryos. Second, the more complex ‘contractual model’ is reviewed but not wholly supported, given the uncertainty as to whether such an amendment would receive judicial support in light of the ruling in Evans. Furthermore, any contractual agreement concerning the fate of embryos after the issuing of a divorce would be contrary to public policy and statutory rights regarding withdrawal or variation of valid consent. Lastly, the ‘last chance model’, where the right not to reproduce prevails only when the other gamete progenitor has another means of achieving genetic parenthood. However, if existing frozen embryos represent the last chance for a person to have genetically-related offspring, then under the last chance model Alghrani argues that a person should be allowed to use the gametes and override the other progenitor's wishes. Alghrani convincingly argues that the last two models do offer alternate regulatory frameworks to regulate people's disputes and concludes again by emphasising the growing number of complexities, both legal and moral, which will arise when reproductive regulation lacks transparency and consistency in practice.

Part II of the book demonstrates where Alghrani's passions are located – in the third wave of reproductive technologies. Chapter 3 is entitled ‘The road to artificial wombs (ectogenesis) and mechanical reproduction’, closely followed by Chapter 4 ‘Ectogenesis: a regulatory minefield?’. If ectogenesis becomes possible, ‘technology will now make the hidden fetus visible’.Footnote ⁴ Alghrani's primary concern is ensuring that ectogenesis is developed safely into a method of alternative gestation. By examining the breadth of current research underway into ectogenesis in Chapter 3, she eradicates any supposition that the technology is too far-fetched to become a reality.

By setting in place the groundwork in Chapter 3, Alghrani moves on to legitimise her argument in Chapter 4 that there is a clear legal lacuna concerning the regulation of ectogenesis in the UK. In particular, she discusses a range of regulatory questions should it become a viable alternative to conventional gestation and potentially signal the end to abortion. Interestingly, she considers many aspects of the abortion debate, given that ectogenesis would inevitably impact the legislation, which she argues is outdated, and she criticises MPs reluctance to consider possibilities of legislative reform when the HFEA 2008 was debated. Delving into the possibility of utilising aborted foetuses, the mechanics of foetal transfer and the impact upon procreative autonomy provides an insightful chapter. Although she is a clear champion of procreative autonomy, she advocates caution when discussing any suggestion of utilising ectogenesis to promote foetal rights, and successfully argues that any attempts to curtail the procreative autonomy of women in light of ectogenesis may create more harm than good.

The final two chapters of the book sidestep away from ectogenesis but remain firmly in the category of new horizons. Chapter 5 covers the regulation of uterus transplantation, aptly titled ‘When assisted reproduction and transplant medicine collide’. Having discussed in detail the rapid advance in the clinical phase, she argues that it is imperative that considerations begin regarding the current regulatory framework accommodating the collaboration of assisted reproductive technologies and transplantation. The overarching criticism, again, focuses on the functionality of the current dual system of regulation currently provided by the Human Tissue Act 2004 and the HFEA 1990 (as amended in 2008), which is largely silent on points of permissibility. This gives rise to potential anomalies. For instance, a woman could ‘be denied a uterus transplantation after she has undergone the physical, emotional and financial expenditure of IVF without which she has no chance of gestating’.Footnote ⁵ The magnitude of legal and regulatory challenges presented by uterus transplantation is forcefully demonstrated within this chapter, and Alghrani makes it clear that once again the law remains outpaced by the advancement of reproductive science.

Different legal and regulatory problems that arise when considering whether transgender women and cisgender men should be granted access to treatment is addressed in Chapter 6. In that sense, this final substantive chapter is devoted to exploring the possibilities that uterus transplantation raises in the speculative context of trans, non-binary and cisgendered male individuals. Aside from some existing literature on the deconstruction and legal understanding of gender/sex, the parameters of legal parenthood and feminist discourse on gender binaries, this chapter enters a relatively unexplored territory which examines the field of clinical advancement in uterus transplantation and the regulatory challenges that will follow. Moreover, it explores the extent of reconsiderations that will have to take place concerning the use of legal labels in matters of assisted reproduction, such as motherhood and fatherhood, and whether the potential use of uterus transplantation to enable male pregnancy will eliminate or eradicate inequality between the sexes. In that regard, Alghrani's considerations predicted those same challenges raised in September 2019, only a year after publication of her book, in the case of Re TT [2019] EWHC 2384 (Fam).

At first blush, the critique contained in this sixth chapter neatly follows on from the discussion in the preceding chapter regarding the functionality of dual regulation and the complexities of uterus transplantation being used beyond its immediate purpose of restoring issues of infertility is considered. Crucially, the critique goes beyond the routine examination of particularly sensitive, and topical, societal issues pertaining to gender inequality and it draws straight to the surface the plethora of regulatory challenges and ethical hurdles which will have to be addressed in the foreseeable future when new legislation is constructed. Alghrani concludes the chapter perfectly by stating ‘if the government is to monitor and maintain the pace of reproductive technologies, then it needs to be brave enough to tackle revolutionary advances looming on the horizon so that, when they are possible, considered and responsive legislation is drafted as opposed to reactive measures’.Footnote ⁶

Clearly, there are some aspects of law's involvement in human-assisted conception and pioneering reproductive technologies that are not covered in this book, including reproductive cloning, genome editing and human admixed embryos. Nor does Alghrani engage in depth with the ethical wrestling of the best interests or the welfare of children born as a result of the third wave reproductive technologies she explores. But the absence of those topics does not detract from the arguments levied against the legislator about the extent to which the current regulatory framework is outdated and unfit for purpose. A separate binary chapter covering whether access to reproductive technologies, such as ectogenesis and uterus transplantation, should be privately funded or NHS commissioned and the risk of inequality would have further developed the overarching theme here.

This book will undoubtedly be of great use and interest to advanced students who have a particular interest in emerging reproductive technologies, medical law scholars and policy makers. It is, in effect, a very persuasive call to arms. I would be much more optimistic that the law in the future would be able to sustain the pace of change of reproductive technologies and be far more fit for purpose than it is now if lawmakers took note of the arguments raised in this book, and for that reason I would recommend it.