What if You Could Choose Your Baby?

Time is flying by. It feels like you’re speeding your way through  high school. You’re slowly starting to think about what adulthood might feel like. You might have even pictured yourself five to ten years from now. What does your life look like? Do you see yourself having children of your own?

As you read this article, I’d like you to imagine that your answer is yes. Now, how do those imaginary future children of yours come into the world?

Many people are conceived when a sperm fertilizes an egg inside a woman’s body, either through sexual intercourse or through artificial insemination. However, not all people can conceive children this way. About one in eight heterosexual couples will experience infertility. (1) Doctors diagnose infertility when a couple cannot conceive a child after a year of actively trying. These couples may choose to adopt a child. They might also decide to use assisted reproductive technologies (ART). This term refers to all treatments that involve manipulating eggs or embryos outside the human body in order to create a baby.

Did you know? 

A wide range of people may choose to use ART, including couples (both heterosexual and homosexual) and single people wanting to have children.

 Many people have had children through ART. But this technology can come with some ethical issues. Let’s look at what could happen when you combine an ART called in vitro fertilization with a screening technique called pre-implantation genetic diagnosis.

What is in vitro fertilization?

There are many different ART treatments. A popular one is in vitro fertilization (IVF). The main idea is to extract follicles (eggs) from a woman’s ovaries, fertilize them with sperm in a dish and then insert the fertilized egg into a woman’s uterus. Here are the specific steps:

1. The woman trying to get pregnant takes hormone medication that alters her menstrual cycle. Instead of releasing one egg in a 28-day cycle, she releases several. This is called ovarian hyperstimulation (or superovulation). An embryologist measures the woman’s hormone levels to determine when her levels are right for to get pregnant.
2. Once the woman is ovulating, an embryologist uses a needle and probe to retrieve eggs from her body. This can be uncomfortable, so the woman gets a local anesthetic (pain reliever) and sedation (medication to relax).
3. The sperm is prepared.
4. The woman’s eggs are fertilized with the sperm that same day. This step is called co-incubation (incubated together).
5. The embryo (fertilized egg) is transferred (reinserted) into the woman’s uterus.

What is preimplantation genetic screening? What is preimplantation genetic diagnosis?

There are two other steps that parents-to-be can take just before the embryos are re-inserted. They can use techniques called pre-implantation genetic screening (PGS) and pre-implantation genetic diagnosis (PGD) to select specific embryos. 

In PGS and PGD, embryologists remove a cell in a 5-day embryo. In PGS, embryologists screen the chromosomes of the embryo’s cells. They look for conditions such as Trisomy 21, which causes Down’s Syndrome. 

In PGD, embryologists screen the genetic material of the cell. They look for gene mutations that cause genetic disorders, like cystic fibrosis. This may take up to several weeks. (2) Embryos that turn out to have problematic DNA are destroyed. The others weeks. (2) Embryos that turn out to have problematic DNA are destroyed. The others are kept for future IVF cycles.

Did you know? 

PGD can test for more than 100 genetic disorders.

So what are the issues?

First, IVF and PGD are expensive techniques that many people can't afford. This could create a class divide between people who can afford to eliminate genetic diseases, and people who can’t.

Second, trying to eliminate disabilities with PGD may send a hurtful message to people who already live with disabilities.

Third, there are ethical questions. Critics worry that PGD may be associated with eugenic practices, or creating babies with “ideal” traits. Others critique the ethics in using the technique to create a saviour sibling. This is when a child is born to cure a sibling affected by a disease by donating their umbilical cord stem cells or tissues to their older sibling.

Finally, PGD could open the doors for sex selection. For example, in a technique called flow cytometry, scientists can use fluorescent dye to control an embryo’s sex. The X chromosome (female) will appear brighter than the Y chromosome (male) in a man’s sperm. Parents (with the help of scientists) could then choose what the sex of their baby would be. This technique, however, is not 100% effective.

Where does PDG stand today?

Different countries have adopted different regulations about PGD. In Canada, the Assisted Human Reproduction Act (AHRA) legislates ART. PGD is allowed for medical reasons, but it is unregulated. Sex selection is not allowed unless it is to prevent a sex-linked disorder -- a disorder that tends to be passed down via the X or the Y chromosome. An example is hemophilia, a disorder passed down via the X chromosome. People with hemophilia can bleed excessively because their blood does not clot properly. 

Summing up...

A child can bring joy and happiness. But when that child comes into the world using complicated techniques, those techniques can raise ethical questions. IVF and PGD have helped many people dodge genetic conditions that run in families. But how far will this go?

What about you? If you could choose your baby, would you?

Did you know? 

In Canada, donating sperm, eggs or embryos is legal. But buying, selling or exchanging them is not.