Designing Babies: We Are Here, But Are We Ready?

New technology allows new ways of creating children but pose issues.

Posted Sep 29, 2019

In November, 2018, Dr. He Jiankui announced that he had created twin girls in China from embryos whose genes he had technologically altered.  He hoped to build a baby-designing business. 

On September 6, 2019, a 74 year old Indian woman gave birth for the first time -- to twins.  The next day, her 82 year old husband was hospitalized with a stroke.  

These incidents may seem distant from many of our lives, but increasingly, they are not.  

Since 1978, when the first child, Louise Brown, was born using in-vitro fertilization, assisted reproductive technologies have expanded enormously, creating over a million babies. 

About 12% of all couples are infertile. Increasingly, women who delay childbirth to pursue careers, single men and women, and gay and lesbian couples are also using assisted reproductive technologies, which account for about 7% of all births in Denmark. 

But these technologies also pose profound psychological questions that have comparatively received little attention.  New technologies are revolutionizing the ways we create children, but are we ready for them?  

While the European Union nations and other industrialized countries closely regulate this industry, in the United States, many observers call the IVF industry "the Wild West."

Through preimplantation genetic diagnosis, physicians now routinely test embryos for hundreds of genes. Parents can thereby select embryos with certain genes to avoid particular diseases, such as breast cancer -- or to pick the sex of their future child.  Many prospective parents just want a boy, for social reasons, and the US lets parents do so.  

The US is also one of only three countries that legally allow adults to buy and sell human eggs –the practice is illegal in all of Western Europe.   Here, a huge industry has developed, letting prospective parents choose, through online dropdown menus, the donor’s hair color, eye color, height, race, ethnicity, religion and other traits.  Prices increase with the donor’s SAT scores.

Powerful new gene editing techniques, known as CRISPR, allow labs to insert or remove various other genes, posing additional social and ethical challenges.

These technologies can fuel science fiction scenarios, as in Aldous Huxley’s novel Brave New World and Margaret Atwood’s Handmaid’s Tale, but also raise very real questions today.

To avoid misuses, the American Society for Reproductive Medicine has rightly issued guidelines concerning several areas, such as choosing embryos for sex and social reasons. But these documents lack monitoring and enforcement.  Most clinics have failed to follow certain guidelines. -- which should thus be strengthened. The US Centers for Disease Control and Prevention (CDC) gathers certain basic statistics from IVF clinics. But these clinics are not required to provide this information, and many don't. 

Unfortunately, many clinicians appear to oppose additional reporting requirements and stronger guidelines. Nonetheless, governmental agencies should mandate that IVF clinics submit patient data so preimplantation genetic diagnosis and other practices can be monitored.

Due to high costs, assisted reproductive technologies, including preimplantation genetic diagnosis, are not available to everyone and are thus altering how thousands of affluent people -- but not poorer individuals -- thrive and live. Wealthy individuals are eliminating certain lethal mutations from their offspring while the less affluent cannot. Several types of cancers and other diseases that have affected both the wealthy and the poor alike will disproportionately affect the poor as a result. 

Since preimplantation genetic diagnosis allows parents to avoid transmitting mutations to children, CRISPR will unfortunately probably be used to enhance progeny with socially desired traits such as height, certain athletic abilities or intelligence. Such uses will be very profitable.   Luckily, altering nature is far more complicated than many think. Scientists have investigated hundreds of genes for links to intelligence. The gene with the strongest effect raises IQ by only about 1 point. Undoubtedly, multiple genes and other factors are involved. 

Still, with rising racism and economic divides in our society, we need to be better prepared for these ongoing technological advances that are changing generations of people and our species as a whole. 

But what should parents tell children created using these technologies?  Many parents avoid telling their child at any point that he or she was created using a stranger's sperm or egg.  But these offspring may then discover, through direct-to-consumer genetic testing companies such as 23andme, that they have half- siblings elsewhere.  What if parents who choose the genes for their child are disappointed - or if the genetic tests prove wrong?  What is it like to be a child created in these various ways?  Little research has been conducted to answer these questions.

Hopefully, doctors won't insert CRISPR-edited embryos into wombs until the risks are better understood -- but even then, the dangers will not be fully known until these gene-edited children are created. Extensive studies will have to be conducted over the course of their lifetimes, along with the lifetimes of their own eventual offspring. 

Nevertheless, in the competitive, profit-driven assisted reproductive technology industry, some doctors may well end up performing these procedures with little regulatory or administrative hindrance.

Infertility treatments can help countless adults become parents and avoid certain diseases in their offspring.  But we should work to increase awareness of the potential risks of these technologies and sure they are used for as ethically as possible.  Otherwise, we may soon enter a Brave New World - if we haven't already.