Preimplantation Genetic Testing

How novel genetic testing technologies used with assisted reproduction can usher in a new consumer-driven eugenics.

Today when couples struggle with infertility, often the only intervention that physicians offer is IVF, which is costly, invasive for the mother or egg donor, frequently fails to achieve pregnancy, and comes with a host of ethical issues and complications. Furthermore, IVF does not really treat the underlying causes of infertility, but instead attempts to bypass the problem. Because the assisted reproductive technology industry is so lucrative, very little effort is spent investigating the underlying causes of infertility and trying to correct those root causes. To rectify this, my colleagues at EPPC, Natalie Dodson and Emma Waters, have published a helpful guide, Treating Infertility: The New Frontier of Reproductive Medicine, on restorative reproductive medicine, with contributions from several physicians and scholars.

I was happy to contribute to this report an article on Preimplantation Genetic Testing (PGT) and In Vitro Gametogenesis (IVG), also known as “artificial gametes”. With permission, I am reprinting it here as a two part post, covering PGT today and IVG tomorrow.

---

This article will briefly describe two novel techniques used in conjunction with assisted reproductive technologies like IVF. The first, Preimplantation Genetic Testing (PGT), has been commercially available for several years and is now widely deployed in IVF clinics to detect potential genetic diseases or other anomalies in embryos created in the lab. The second technique, In Vitro Gametogenesis (IVG), is not yet available for use in humans, but likely will be in the next few years. As this paper will explore, both of these techniques have potential for serious harms, including discriminatory eugenics practices in the first case, and a radical restructuring of familial ties and human lineage in the second.

Preimplantation Genetic Testing (PGT)

PGT is a technique used to test embryos created in a lab, via In Vitro Fertilization (IVF), for genetic diseases and other genetic traits. During a typical in IVF cycle, in order to increase the chances of producing a viable pregnancy, multiple human embryos—up to six or eight—are produced in the lab. Prior to implanting one or more of these embryos in the woman’s uterus, the embryos can be genetically tested. Techniques for doing this, which do introduce some risks to the embryos, were originally developed to screen for genetic diseases. Once genetic anomalies are identified, only apparently genetically healthy embryos would be selected for implantation and the opportunity to be brought to birth. Those deemed genetically “unfit” are typically destroyed.

While this method of preimplantation genetic testing (PGT) is sometimes framed as a “treatment” for genetic diseases, it is important to note that the method does not actually treat an individual affected by a disease. It merely identifies that individual and discards him or her, denying that human being in its earliest stage of development the opportunity for continued existence. In short, PGT doesn’t treat or heal maladies, it ultimately destroys the affected embryo altogether.

It is also worth noting that while this technique is often framed in terms of eliminating disease, there are other common uses for PGT. It is frequently employed, for example, for sex-selection. This practice is banned in most of the world, but not in the U.S. Many intentional parents, especially those from cultures that tend to disvalue female children, will use PGT to ensure they do not become pregnant with a girl, thereby perpetuating gender discriminatory attitudes and social practices. Meanwhile, many in the U.S. are now using PGT sex-selection precisely because they prefer girls.^[1]

As our knowledge of the complex relationships between genes and biological traits advances, PGD could also be used not only to eliminate those with diseases or disabilities, but to select for “desirable” traits—to produce bigger, faster, stronger, smarter, or more physically attractive children—or simply children with particular hair or eye color. For example, Orchid is a company that provides a “whole genome embryo report” and advertises their service with the tagline, “have healthy babies.” Another U.S. company, Heliospect Genomics, offers services that go beyond screening for genetic diseases to predicting human behavior, including IQ screening of embryos at a cost of $50,000—a practice that violates U.K. law but is legally permitted in the U.S.^[2]

Some misguided ethicists even argue that this is a more “responsible” way to produce children, and predict that within a few decades most people in developed countries who can afford these services will stop having sex for the purpose of reproduction.^[3] While some celebrate this is a technological advance, we should worry about a dystopian society in which children are “manufactured” using industrial quality-control measures, and only those deemed most “fit” are permitted to survive.

Preimplantation Genetic Testing revives the ugly specter of eugenics: the use of medical technology to eliminate those deemed genetically unfit, whether because of disease or sex or other “undesirable” traits. While our new “liberal eugenics” may not be a top-down, government-mandated eugenics—as we saw with forced sterilization in the United States and euthanasia of the “unfit” in Germany during the 20^th Century—the same ugly attitudes are manifest in these new eugenic practices. Consumer-driven eugenics is not necessarily less discriminatory against women, men, or those with disabilities than a coercive, government sponsored eugenics program.

---

^[1] “One study found that white parents having a first child picked female embryos 70 percent of the time,” while “parents of Indian and Chinese descent were more likely to pick boys,” cited in, “The Parents Who Want Daughters—and Daughters Only,” by Emi Nietfeld, Slate, May 7, 2024. Accessed at https://slate.com/technology/2024/05/ivf-daughters-toxic-masculinity-sex-selection.html

^[2] “US startup charging couples to ‘screen embryos for IQ’,” by Hannah Devlin, Tom Burgis, David Pegg and Jason Wilson, The Guardian, October 18, 2024. Accessed at https://www.theguardian.com/science/2024/oct/18/us-startup-charging-couples-to-screen-embryos-for-iq

^[3] Cf. for example Stanford law professor Hank Greely’s book, The End of Sex and the Future of Human Reproduction (Cambridge: Harvard University Press, 2016).

---

---