Love in the Time of PGT

Sex and IVF, Reproductive and Otherwise

Of all the opinions that really smart and forward thinking people in our field (like Santiago Munne, for whom I have an abundance of respect and admiration for and who posted below), the concept that fertile people having children by sexual reproduction will be replaced by widespread use of assisted reproduction in order to design (yes, that is the most accurate word) their children’s traits is the most implausible and least defensible.

Why? Let’s start with three broad areas.

1. Hubris. Humans have been around for 300,000 years, accounting for 15,000 generations of evolution. The notion that we can do better 25 years after the human genome project, armed with WGS reports and a mixed bag of genetically and non-genetically characterized trait sets (what is the word “syndrome” if not an admission that we don’t know understand cause and effect) is a bit aggressive.

(To be clear, I am talking about unenriched populations, not families that carry arithmetically-defined genetic disease.)

2. Practical: who’s going to do the IVF or future equivalent to produce 130 million babies a year? Our 25 billion dollar, less than one million babies a year industry manages 4–8% growth a year. I worship at the temples of standardization, automation and scale as much as anyone, and I marvel at what AI can do, but sufficient growth in ART and sequencing throughout to achieve ART dominant human reproduction doesn’t model.

3. Opportunity cost. A lot of really smart and committed people are working their tails off to get the cost of an IVF cycle (without sequencing, embryo analysis and the requisite genetic counseling down to the mid to low thousands of dollars (regardless of who pays.) if we drive the cost down to $7500 per baby, not per cycle, including the genetic work, the bill (which someone has to pay) approaches a trillion dollars.

I am an amateur bioethicist at best, so I will leave the many issues of reproductive justice, fairness, medical overreach and resources being triaged away from medical indications (infertility, recurrent pregnancy loss, onco-fertility, LGBTQ fertility) to consumer discretionary uses to those better trained.

I am no Luddite. I did my first PGD cases (as they were called back then) in the mid 90’s and cofounded (with Santiago Munne and Jacques Cohen, as fine a scientists as our field has ever produced) one of the first reproductive genetics companies, Reprogenetics, later acquired by Cooper. We should be doing a hell of a lot more IVF than we do now, and a lot more disease prevention.

But most of our babies from IVF so that every can pick and choose what seems to be the optimal combination of 10,000 genes based on that particular year’s understanding of genetics?

Ain’t gonna happen.

(To be clear, I’m not calling for a ban and I’m not telling anyone what they should or should not do. Just handicapping what I think is a misguided, albeit fairly common, prediction.)