Technology customizes kids by sex

Choice: A technique to identify healthy embryos for implantation can also be used to select gender.

Medicine & Science

May 10, 2004|By Julie Bell | Julie Bell,SUN STAFF

Darra and David Williams were running out of hope for having a baby without cystic fibrosis when they heard about technology capable of helping them select healthy embryos - as well as their child's gender.

At an Irvine, Calif., clinic, now-familiar technology was used to fertilize her eggs with his sperm. But in a Brave New World twist, doctors at Coastal Fertility Medical Center then pulled a cell from each resulting embryo to test it for defects such as the cystic fibrosis that runs in David's family, as well as for its sex. Four were healthy - three boys and a girl.

"We had one goal in mind, and that was to have a healthy baby," Darra said, and the couple decided to put all four healthy embryos in her womb. Twin boys resulted.

The Williams' clinic doesn't allow parents to use the process - pre-implantation genetic diagnosis, or PGD - solely for sex selection. But a small but increasing number of clinics and parents are making a different decision, employing technology once used exclusively to avoid disease to select the sex of their babies. In the process, they're rejecting embryos considered undesirable because of their sex.

It is only a matter of time, experts say, before PGD can be used to select embryos for other characteristics parents desire in their children, such as eye color or athletic prowess. Already, some have used PGD to choose embryos that are immune-system compatible with a sick son or daughter, thereby custom creating a child to provide a transplant for a sibling already born.

Last week, Chicago researchers published a study in the Journal of the American Medical Association showing that PGD had been used by five couples to make a baby that was a match for an older sibling in need of a stem-cell transplant.

For many, it's morally permissible to select for a child that will save the life of another, or to avoid the birth of a baby destined to suffer a slow, agonizing death from a childhood disease such as the nervous-system destroyer Tay-Sachs. Reproductive rights are the purview of doctors and patients, they say, and a matter of choice.

Besides, they point out, PGD enables parents to select embryos before they're put in the womb, avoiding what many consider a more wrenching decision - whether to have an abortion if prenatal tests show a fetus has a genetic disorder.

But for others, the trend puts America on a perilous path, one in which custom-kid technology available only to those who can afford its $12,000 to $15,000 price could change the way society values the disabled or warp our view of the worth and purpose of a child.

"We are already sliding down a slope," said Amy Laura Hall, an assistant professor of theological ethics at Duke University. "With selective reproductive technologies, parents and society are involved in a kind of negative eugenics."

Adding to critics' concerns is the fact that this latest evolution of test-tube baby technology is happening in the largely unregulated U.S. fertility industry. It's also becoming increasingly popular, even though there have been few studies looking at whether removing one cell of an embryo might damage the remaining cells and, ultimately, the child.

Nationwide, 40,687 infants were born in 2001 using all kinds of assisted reproductive technology, according to the most recent federal data. In contrast, about 1,000 babies have been born worldwide using PGD since the first clinics began using it in humans, the Washington-based Genetics & Public Policy Center estimates.

There's no question the pace of those births is quickening.

In Great Britain, the government regulates when PGD can be used. Without such regulation in the United States, some doctors look to the American Society for Reproductive Medicine for guidance. But the society hasn't taken a position on screening embryos for tissue type. It supports screening to prevent disease or to "balance" the sex makeup of a family after the birth of a first child.

The bottom line: In the United States, doctors and patients decide when to use PGD.

Fertility centers associated with the University of Maryland, the Johns Hopkins University and the Greater Baltimore Medical Center don't allow the process to be used solely for sex selection. Nor does a PGD lab affiliated with Shady Grove Fertility Center in Rockville.

"The last time I checked, sex was not a disease," said Dr. William G. Kearns, Shady Grove's PGD director, explaining why gender selection isn't allowed unless it's associated with the propensity for a disease.

But in Houston, Dr. Joe Leigh Simpson of Baylor College of Medicine said he's considering asking an ethics board there to consider a study in which families that have a child could use PGD to select the opposite sex for a subsequent child.

In the Denver area, Conceptions Women's Health and Fertility Specialists began offering PGD for family balancing after a couple with three boys came in and asked whether it would.

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