The Miracle of Modern Baby Making

Rife with Ethical Issues

The term ‘designer babies’ is a burr under the saddle blanket of most fertility specialists. It conjures up frivolous images of a couple choosing desired features from a catalogue to create their ‘perfect child’ – sex, hair and eye colour, talents and character traits. Check the bank balance, sign up and a baby to match a designer lifestyle is guaranteed.

The reality is that fertility specialists in Australia and the UK are focused on preventing serious and life-threatening diseases in newborns, assisting couples unlikely to bear a healthy child naturally. All accredited Assisted Reproductive Technology (ART) clinics in Australia must comply with the National Health and Medical Research Council ethical guidelines regarding the use of assisted reproductive technology. Sex selection, for example, is recommended only to reduce the transmission of a serious genetic condition. Otherwise, the guidelines say ‘…admission to life should not be conditional upon a child being a particular sex’. 

This doesn’t mean that the issues are clear-cut and the answers set in stone. The ‘designer baby’ scenario is looming and many scientists, doctors and ethicists describe assisted reproductive technology as a ‘minefield’. Scientists are developing increasingly sophisticated technologies with the potential to do enormous good. The public reaction is a mixture of excitement about new possibilities, religious and moral objections to ‘playing god’ and vague fears about where it all may lead. There is fierce debate on all sides revolving around the basic question – just because we can, does it mean we should?  

Manipulating Mother Nature

Louise Brown, born in 1978 in Britain, was the first reported live birth conceived by in-avitro fertilisation. ‘Test tube’ babies had arrived, giving hope to infertile couples everywhere. 
In 1996 reports of the first mammal cloned (Dolly the sheep) were followed by the cloning of different animals in later years. It was a short step to the cloning of human embryos, successfully achieved in the US in 2001 and subsequently replicated in other countries. Human clones living next door, thankfully, as yet only exist in Hollywood movies.

When The Human Genome Project announced in 2003 that it had mapped the first complete sequence of the genetic code of a single human, claimed to be accurate to 99.999%, genetics took a giant leap forward. Fertility experts now know the genetic makeup of over 200 diseases.

Today, IVF clinics offer a range of fertility services including pre-implantation genetic diagnosis (PGD). The PGD procedure involves extracting several eggs from the mother via IVF which are then fertilised by the father’s sperm in a Petri dish. After three days, several eight-cell embryos will have developed. Fertility specialists examine the genetic make-up of the embryos, screening for genetic disorders and sex (where the disorder is sex-linked). Healthy embryos are then implanted in the mother. Additional healthy embryos may be cryo-frozen for future use.

Specialists using the procedure can now screen for almost any single gene disorder such as cystic fibrosis, sickle cell anemia and Tay-Sachs disease. PGD provides couples with vital information within days of conception as an alternative to invasive testing in an established pregnancy. If difficult decisions must be made, many couples opt for the earliest diagnosis possible. 

Pros and cons of PGD

Dr Joyce Harper, based at University College London (UCL), is one of the world’s experts in PGD having worked in the field of IVF since 1987. In a UCL paper Dr Harper wrote:
“The patients that present for PGD are those who have experienced repeated terminations of pregnancy after prenatal diagnosis, those with moral objections to termination of pregnancy, and patients carrying chromosome abnormalities who experience infertility and/or recurrent miscarriages…”
In regard to ethical concerns Dr Harper said:

“There has always been concern that PGD will be used for examining non-disease genes and this has already been applied. PGD has been used in several countries for sex selection for social reasons … In the future, it may be possible to use PGD for other characteristics, or even for predisposition to certain characteristics… However, PGD is being used for an increasing number of genetic and chromosomal abnormalities and offers a viable alternative for those couples that feel that prenatal diagnosis is not suitable for them. It is therefore important that all countries establish strict criteria for the use of PGD to avoid eugenics…”  

Should PGD be allowed for non-medical reasons?

Sex selection for non-medical reasons is allowed in some countries. In the US the Fertility Institutes, headed by Dr Jeffrey Steinberg, offer sex selection, claiming a 99.99% success rate in selecting embryos of the chosen gender. The price tag is around $20,000. In 2008, William Kearns, a leading US geneticist, announced that he had extracted sufficient DNA from a cell to identify thousands of characteristics from the embryo. Shortly afterwards, Dr Steinberg announced that his clinic would offer trait selection services. A storm of protest ensued, led by Kearns and other fertility specialists and backed by the public. Dr Steinberg’s offer was quickly withdrawn. 

Ronald Trent, Professor of Molecular Genetics at the University of Sydney, when asked about Australia’s position on non-medical sex selection, said: “As you would appreciate there are differing views on whether sex selection (also called family balancing) should be allowed. Those for it, base their views on individuals having the right (autonomy) to decide whether they want a boy or a girl and in what order.  Those against base their arguments on:  (1) limited health dollars and so these need to be directed to medical priorities; (2) the uncertainty in the longer term if the usual male/female ratio is altered because of preference for one sex. In countries like China or India for example, the male is preferred and so with the population effect in these countries there may be long term societal implications; (3) the ‘slippery slope’ argument - if sexing is allowed now, what next? (traits such as athletic, musical performance, colour of eyes?), and (4) sex selection is a form of discrimination because one sex is considered “superior” or “preferred” to the other”.

On the notion of trait selection Professor Trent said: “Once you get DNA from a fetus or embryo you can test for lots of things including traits. The technology is the same as sexing (although sexing is technically a little easier than testing for a trait or a disorder). The important question at the moment is - will testing for a trait tell you much? We know that lots of traits have a genetic component but equally important is the environmental effect and so it would be difficult on current knowledge to test and get an accurate assessment of a trait, for example, height, intelligence, sporting or musical prowess.  Despite this, some companies are offering tests to suggest that traits can be measured. I am not sure that they are correct”. 
Assistant Professor Peter Illingworth, Medical Director of IVF Australia, said that he thought current Australian guidelines were in line with community expectations. “The Australian community thinks it is a very good thing to be able to create a healthy child but not a certain type of child”, he said. Trait selection is therefore not under consideration. Assistant Professor Illingworth said that there have been rare cases where a couple has requested PGD to ensure the birth of a child who is genetically compatible, in order to help another of their children who has a serious or fatal disease. These are sometimes referred to as ‘saviour children’. The procedure has been done with medical approval.

The number of PGD procedures is ‘rapidly increasing’, Assistant Professor Illingworth said. There are two reasons why PGD is done, he said. One is to look for a single abnormal gene. There are 50 to 80 of these carried out per year in Australia. The second is where a woman has had repeated miscarriages, the main reason for which is defective chromosomes, and the specialist is screening for healthy embryos. There are hundreds of these procedures per year.

The success rate of the procedure varies with the woman’s age, Assistant Professor Illingworth said. PGD has an overall 30% success rate in the first cycle, with success rates for younger women being higher.
The cost of PGD is prohibitive for many people. Assistant Professor Illingworth estimated it costs $6000 for gene disorder testing. It may take many months to develop a particular test and is very labour-intensive. Screening for healthy embryos costs less, he said. On top of this the IVF procedure costs $3-4,000 after the Medicare rebate.

PGD has great potential to eradicate a particular disease in individual families but it is unlikely to wipe out chromosomal abnormalities across a population. “Many diseases crop up sporadically. The majority of mutations just happen in that gene”, Assistant Professor Illingworth said. 
It seems that at present in Australia, rather than a ‘designer baby’, a ‘selected’ baby is possible whereby healthy embryos are selected for implantation via IVF.

If you are determined to have a baby of a particular sex and you have very deep pockets, you could try researching options in other countries where sex selection for non-medical reasons is possible. This is usually done for ‘family balancing’ reasons, though one wonders whether those of us who have two girls are an ‘unbalanced family’. It doesn’t feel like it!

But if you truly have your heart set upon a ‘designer baby’ – a Hugh Jackman look-alike perhaps – you’re probably going to have to do it the old-fashioned way. Choose your partner carefully and cross your fingers. 

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