Pregnancy and Childbirth Planning for Pregnancy

Selecting Your Genetic Best for In Vitro Fertilization

But Givens has strong reservations about offering this expensive test (which is seldom covered by insurance) to her older patients since the vast majority of chromosomal problems cannot develop and will naturally weed themselves out. "What are we really saving the patient? What are we really offering her?" Givens asks.

Additionally, human error is always a possibility. And while labs generally report success rates of 90 percent and higher, there is always the small chance that a selected embryo will still have a genetic defect, making it all the more difficult for a mother to bear once the baby is born.

Increasing Fertility Success
One of the positives of PGD is that it allows doctors to look into an embryo's genetic makeup, so it also gives doctors insight into why some couples have been unable to have a successful pregnancy.

If a young couple has had numerous miscarriages, an embryologist may find that 9 out of 10 of their embryos are genetically abnormal in a way that will always result in a failed pregnancy. Then, doctors can look to either the man's sperm or woman's eggs as the source of the problem and can better counsel the couple about fertility options.

"It helps people decide to move to a different type of therapy more quickly rather than suffering through a lot of expensive in vitro fertilzation," says Dr. Beth Ary, reproductive endocrinologist at the Reproductive Specialty Medical Center in California, "And then you're able to move on to something that's really going to fix what's wrong."

Picking and Choosing
Even though PGD increases the rate of successful IVF, the biggest concern is that PGD will eventually lead to creation of babies' being tailor-made to parent specifications. While the technology isn't at that point just yet, doctors are beginning to see what the ethicists are worried about.

"Some lab directors just have a policy that they don't want to do PGD because they're afraid people would use it to choose the sex of their baby," says Ary.

Both Ary and Givens say they have had patients undergoing PGD who requested that the doctors select only embryos of a specific sex to be reimplanted. But both doctors report that the tendency is for families to choose a sex that balances out their family tree, requesting a girl, for example, to be added to a family of three boys. "But our most common request is to put back one boy and one girl [embryo] that are normal," says Ary.

And even if a family wants to choose the sex of their child for a religious or cultural belief, some doctors argue in favor of performing a PGD for this purpose, saying that it may prevent an abortion later if a pregnancy is of the undesired gender.

For now, it seems the benefits of PGD outweigh most ethical concerns, as technology is far from the point where scientists can construct babies from the genetic raw materials of their parents.

"The real message is that we are not testing for trivial things like height or hair color or intelligence," says Givens, "We're not trying to create designer babies. We're trying to lower the risk of genetic disease, eliminate the need for people to have to abort pregnancies for genetic diseases, and we are trying to help people to have a healthy pregnancy."

As the geneticist in the sci-fi movie Gattaca says, "this child is still you, simply the best of you."

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