A silver lining of the octuplets-induced media storm is the attention it's rained on efforts to reduce the numbers of twins, triplets and beyond that IVF creates. This is a goal driven by the startlingly high risks of IVF multiples for mothers and babies. It's shared by nearly all reputable fertility doctors, and endorsed by the voluntary guidelines [PDF] issued (but not enforced) by the American Society for Reproductive Medicine.
Thankfully, the trend is in the right direction. But the US still lags very far behind the countries that take a less laissez-faire approach.
The latest available US figures, for 2006, show that "single embryo transfer" - which is recommended for most women younger than 35, and which does not significantly reduce the rate of successful pregnancies - was used in only 3.3% of cycles. By contrast, single embryos are transferred in 60% of cases in Finland, and in 70% of cycles in Sweden. Unsurprisingly, that pushes twin rates way down and makes triplets very rare.
In the UK, the government agency that regulates assisted reproduction (the Human Fertilisation and Embryology Authority) recently issued rules requiring fertility clinics to reduce their multiple birth rates from the current average of 24% to 10% by 2012. And a group of British assisted reproduction experts, professional organizations, and patient groups has launched an attractive and persuasive campaign called "One at a Time." Its website about the IVF-multiples situation compiles current numbers and trends, documents the risks, and calls clearly for the remedy - the eponymous "one at a time."
On the heels of the explosive and fascinating saga of the IVF octuplets, Los Angeles has produced another controversial development in assisted reproductive technologies. And it is adding more fuel to the fire of calls for oversight.
What’s particularly striking is that the "more" referenced by the Fertility Institutes, led by Jeffrey Steinberg, includes selecting "complexion." While the Journal article notes that this is not presently available for "other ethnicities such as Asians or Africans because key pigmentation markers for those groups haven't yet been identified," the writing is on wall. In fact, such research is actively ongoing.
While I generally avoid the phrase, this is clearly another step down the proverbial slippery slope. PGD can be a critical tool in avoiding the births of children with serious disease, but these new applications are about breeding babies that suit aesthetic preferences based upon social prejudices. My colleague Osagie Obasogie brought up these points in a 2007 article in the New Scientist, "Racial Alchemy." And another fellow BP blogger, Marcy Darnovsky, captured the hazards well in the WSJ article: "If we're going to produce children who are claimed to be superior because of their particular genes, we risk introducing new sources of discrimination."
One of the prospective parents in an early use of PGD wrote in a Los Angeles Times op-ed put it differently: "Abusing that hard-won knowledge to capriciously choose hair color, eye color and other cosmetic traits in a baby is wrong and repugnant."
Profiting from social prejudice is not new. Here's an ad from India for a skin lightening cream:
The world's most famous octuplets (think about that) were produced by the West Coast IVF Clinic in Beverly Hills. The fertility practice that's now advertising the "coming" availability of embryo screening for "gender, eye color, hair color and complexion" is headquartered in Los Angeles.
Using the embryo screening procedure known as pre-implantation genetic diagnosis (PGD) for sex selection is prohibited by law in some 35 countries. Like the transfer of more than two embryos into a woman under 35, it's also discouraged by the American Society for Reproductive Medicine [PDF]. The ASRM could put a bit of force behind its voluntary guidelines - suspending the membership of violators, for example - but there's no apparent evidence of it ever doing that.
Southern California isn't the only place where some fertility practices openly flout professional guidelines, but it does seem to be a center of questionable conduct. A few minutes of web searching turned up six clinics in the LA region (1, 2, 3, 4, 5, 6) whose sites make it clear that they happily screen embryos for social sex selection.
Posted by Osagie K. Obasogie on February 23rd, 2009
Recreational genetics leader and Google-backed 23andMe has added a new service. The company is now advertising that it is able to tell its customers whether they have BRCA cancer mutations that may significantly increase their chances for developing breast and ovarian cancer.
Secondly, 23andMe got into hot water last year with the California Department of Public Health for offering "clinical tests" directly to consumers without a doctor's oversight. While 23andMe ultimately received a license to continue to offer these services, its move into the BRCA testing business seems to belie its previous argument that it offers personal genetics information, not medical diagnoses. It will be interesting to see if these new services bring renewed attention from the State of California.