EMBRYO SELECTION WITH POLYGENIC SCORES

Context

• A special report published in the New England Journal of Medicine raises serious questions about the benefits, risks and ethics of a new service offered by companies called ESPS or "embryo selection based on polygenic scores."

What is ESPS?

• ESPS allows in vitro fertilization patients to select embryos with the goal of choosing healthier and even smarter children.
• Polygenic scores are a "weighted average of the contributions of all of the genes we have information on in the genome, to try to predict whether one person has a higher or lower rate of a disease or some trait."
• Thus, parents are tempted to use polygenic scores to pick embryos predicted to have specific traits they treasure, hoping to produce kids who are taller, smarter, or less likely to develop cancer or heart disease.

Benefits

• Improved embryo selection
• Prevent genetic transmission of unknown chromosomal abnormalities.
• It might help prevent genetic diseases such as Alzheimer’s, Huntington’s Disease, down syndrome, Spinal Muscular Atrophy, and many others.
• Reduce the heredity of genetic diseases from generation to generation. Conditions such as anemia, obesity, diabetes, cancer, and much more.
• Optimized chance of a successful pregnancy
• Reduced monetary burden: Since it gives the insight into which embryos are worth transferring and freezing.
• Reduced level of uncertainty in patients, a lower risk of pregnancy loss, and less emotional stress
• Reduce the risk of future miscarriages
• Individuals ‘tailor-made’ to show desirable characteristics.
• Reduce abortion rate due to embryo carry one or more genetic abnormalities.
• Can be used to determine the sex of a child and prevent selecting the embryo with a sex-linked genetic mutation.
• It allows parents to give their child a healthy life.
• Taking folate during pregnancy will reduce the risk of a child developing autism. It is an example of medically altering a child and it is considered ethically acceptable.
• It helps to eliminate mitochondrial disorders.
• Parents can set their own limits for genetically engineering their baby.
• The government does not have the right to control means of reproduction.
• It allows parents to give the child genes that they do not carry.
• It can increase human lifespan for up to 30 years.
• Provides a better understanding of genetics for biologists and medical professionals.
• Eliminates the occurrence of known diseases in future generations
• In a nutshell, ESPS is the drive to create the population of perfect people.

Ethical concerns associated with ESPS

• Designer Babies: A baby cannot consent to have its body altered; it’s right as parents do not “own” their children.
• ESPS has the potential to alter population demographics.
• Might lead to overpopulation.
• It can exacerbate socioeconomic inequalities and devalue certain traits.
• Use of ESPS could exacerbate existing health and other disparities, as ESPS is largely only accessible to the relatively wealthy. It would create a world of haves and have nots.
• There are broader concerns about the long term effects of embedding inequities in our genes.
• Genetic engineers are not perfect people and cannot 100% properly evaluate every gene. They are more than likely mistakes will be made.
• The technology used is not 100% safe yet. It is only in the experimental stages at this point.
• Many things aren’t controlled by genetics. There are many environmental and lifestyle factors to consider, in addition to genetics. It’s not possible to make happy/healthy humans just with genetic engineering.
• If everyone wants to have a certain trait, this will create less diversity in the world.
• Might lead to modern day eugenics. (Historical eugenics was defined by government and political groups trying to modify the gene pool through force.)
• Parents may use this technology for superficial purposes, such as purposely seeking out a blonde-haired, blue-eyed baby for appearance concerns only. Hitler wanted to create a superior Aryan race.
• Another part could be to eliminate the strains of “so called” defective races or individuals example Jews, LGBTQ, disabled etc.
• May accidentally give rise to new forms of illnesses that scientists are not yet aware of.
• Takes away from the child’s individual personality.
• May remove certain genes that could have been good for the baby’s overall development and growth.
• People with disabilities may experience devaluation.
• The problem with designer babies is that when their population has grown to a considerable size, more individuals will have the same set of genes. With this, there will be less variation in the gene pool. As a result, the new generation will become very susceptible to various disorders.
• “The more control people have over the ability to design their children, the bigger the moral questions that raises - up to and including, who decides what constitutes a genetic problem that needs to be ‘fixed’?”
• Healthy but “different” individuals may be selected aborted, contributing to the potential for a super class!
• The use of genetic manipulation has led some parents to conceive children who will be genetic matches for ill siblings, known as “savior siblings,” for the express purpose of acting as donors for their siblings.
• Discarding embryos that are deemed less fit than others is sometimes viewed as taking a human life.

Conclusion

• The increased ability to control and manipulate embryos presents many possibilities for improving the health of children through prenatal diagnosis.
• But these possibilities are coupled with potential social repercussions that could have negative consequences in the future.
• Thus, there remain many ethical questions that need to be addressed.

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