Millions of Americans struggle with the distress of infertility. Even with in vitro fertilization, 70-80 percent of embryos will not implant or carry to term. New genetic tests, including Next Generation Sequencing, can radically improve the odds of a healthy, full-term pregnancy … but where do we draw the line? The Doctors debate the pros, cons and ethical considerations of embryonic genetic testing.
Fertility specialist Dr. Michael Glassner joins the show to explain Next Generation Sequencing, a procedure in which a laser is used to make a hole in the shell around a 5-day-old embryo and two or three cells are removed for testing. The cells are not part of the embryo, but rather are part of what will become the placenta. The results of the test reveal the chromosomal makeup of the embryo, which helps determine whether the embryo is healthy and can be carried to full term.
Dr. Glassner clarifies what is considered "healthy": "Blastocysts, which are the day five embryos, maybe 30 percent of the embryos that somebody will make will develop to that stage. In a 36-year-old ... more than 65 percent will be chromosomally abnormal — and we're talking about fatal chromosomal issues, meaning the embryo doesn't continue to divide, it doesn't implant, has an early miscarriage. So we're not necessarily talking about Down's Syndrome or Turner's Syndrome."
Dr. Glassner says that this new test is readily affordable and can increase pregnancy rate by 50 percent, because doctors will know the embryos are chromosomally normal and will most likely implant and carry to term. It can also decrease miscarriage by 50 percent.
Many Americans have ethical concerns about this sort of testing, particularly in terms of what is done with unhealthy or unused embryos. There is also a fear of where the line is drawn. Instead of deciding between healthy and unhealthy embryos, could we potentially decide between blue-eyed or green-eyed embryos? "The technology is far ahead of society and our ethical structure in order to decide what to do. So the conversation has to happen now," says geneticist Dr. Ora Gordon, director of the Genrisk Genetics Program at Cedars-Sinai Medical Center. "It is a discussion that we the people have to have, not medicine."
Francine Coeytaux, chair of the advisory board for the center for genetics and society, explains that as a public health specialist, she looks at long term consequences. "There are over 40 countries that have signed a declaration that we will not have manipulation of genes — the whole designer baby that you're talking about," she says. "The U.S. is not one of them who has signed it."
ER physician Dr. Travis Stork says that while there may not be any easy answers, he's glad that we're having the discussion.