We live in an age of endless optimization. Fitness trackers help us measure our lifespan, people consume tons of protein in an attempt to perform at their best, and there is even a desire to maximize our morality. In a world of constant self-improvement, it is no wonder that the journey has reached our attempts at reproduction.
Kristen V. Brown is a journalist and author of the forthcoming book The immortal womb: the centuries-long quest to control the female body and hack human reproduction. As the title suggests, she writes about all the ways people try to exert more control over the childbirth process.
“I think what we’re seeing right now is that people will do whatever they can to have the healthiest baby possible,” she told Vox. “So much is out of your control, and people are just trying to figure out: How can I get more control? How can I tip the scales in my favor?” She says one of the ways people are trying to get more action is through a technology called PGT-P, or preimplantation genetic testing for polygenic risk.
“If you’re going through IVF, a lot of times they’ll do a basic genetic screening that can detect things like Down syndrome. This screening goes even further,” Brown said. “It uses the same preimplantation genetic testing to look for the likelihood of complex genetic diseases – heart conditions, like diabetes – to, quote, ‘enable people to have the healthiest baby’.”
But what can potential parents do with this knowledge? How far can this technology go? And what are the ethics of using it in the first place? We discuss this and much more in the latest episode of Explain it to meVox’s weekly podcast.
Below is an excerpt from my conversation with Brown, edited for length and clarity. You can listen to the full episode on Apple Podcasts, Spotify, or wherever you get your podcasts. If you would like to submit a question, email Askvox@vox.com or call 1-800-618-8545.
What other things do they test embryos for?
For diseases that are only affected by a single gene, like Huntington’s disease, it’s very easy to say, “Does this embryo have it or not?” with a fairly good degree of confidence. But that’s not how this technology works. For example, heart disease is influenced by hundreds of genes. Plus, something like heart disease isn’t just genetic. It depends on the environment and lifestyle.
I think what motivates most people is the health aspect. But many of these companies market these tests, claiming they can also look for size. They can observe eye color. Some of them promise IQ. How do you even define intelligence, let alone how do you define the genetics of intelligence? Alzheimer’s disease, longevity, which embryo will live the longest. So this already goes beyond the disease and into some of these more aesthetic concerns.
Do we know how many people do this?
I think it’s a very small number of people at this point. But I think we’re seeing more and more companies in the space, and we’re seeing more and more support from fertility doctors.
I want to point out that most mainstream medical societies oppose this. Most IVF doctors I know don’t think it has value. Most in the genetics field don’t think this technology has value for either embryos or adults, but I think we’re seeing growing support.
I think a lot of people in the fertility field are already envisioning a future where it becomes more commonplace because the idea is so appealing, even if the technology has flaws.
What about embryo editing? Is this something we are seeing? Can people come in and change things?
Not now. Embryo editing is completely illegal in the United States. It is illegal in most countries. How can you be sure enough that it’s safe? Because you won’t know for sure until an embryo becomes an adult if something went wrong.
Currently it is illegal, but interest is growing as the technology improves. Currently, most of the support for embryo editing is aimed at diseases. The argument for this is that, let’s say you are a carrier of Huntington’s disease or you have Huntington’s disease. Right now you can do something. You can use polygenic screening to select embryos that don’t have the disease, but in IVF, even if you don’t have a terrible disease hidden in your DNA, it’s difficult to get lots of embryos.
You have these situations where couples have to do rounds and rounds of IVF to get one or two embryos that don’t carry a harmful variant, right? So the argument for that is: let’s give these people a better chance.
But I imagine there are people who are not interested in editing just to make children more resistant to disease. They look at things like eye color and height.
There’s actually a name for it. This tech guy called Brian Armstrong coined this term, the Gattaca pile, (named) after the movie. The vision is to use a suite of fertility technologies to create the perfect human.
The first thing they want to use is this technology called in vitro gametogenesis, which involves taking a skin cell and turning it into an egg and a sperm, and then making it into an embryo, so women don’t have to go through IVF cycles.
The idea is that you can get tons and tons of embryos, then use PGT-P to select the best ones, and then use an artificial uterus to incubate and grow them.
This reminds me of a certain E-word, and that word is eugenics. What are the ethics here?
Because on the one hand, I can understand that there are parents who say, “I just want to have a healthy baby. I want to bring a child into the world. I just want to do the best I can with this human that I’m going to bring to Earth.” And then on the other hand, it gets a little weird.
It gets weird quickly. In some ways, we have already been down this slippery slope. Currently, even if you don’t go through IVF, we screen for Down syndrome early in pregnancy. Down syndrome is a condition in which you have a disability, but you can live a full, happy, healthy life. For a long time, parents of children with Down syndrome argued that the selection and screening of Down syndrome pregnancies already constituted a form (of eugenics).
As technology advances, we see this same question applied to more and more conditions. I think one of the things we don’t talk about enough is that the genome is complicated. You can’t just go there and say, “I want a big baby with blue eyes and a good laugh.”
I think becoming a parent is an exercise in giving up control, and it’s easier for some people than others. I have so much sympathy and empathy for people who try to stack the cards. But I think there are so many variables when it comes to human reproduction that we will never be able to fully control the process, no matter how much we want to and no matter how appealing it may seem.
Gn Health
