PGD in the US and Israel

Two recent articles in the Times on Preimplantation Genetic Diagnosis, or PGD. The first article focuses on ethical issues and a couple in the US, while the second follows the fertility travails of a Times writer in Israel, where PGD and IVF are covered by national health insurance.

NYTimes: ... Genetic testing of embryos has been around for more than a decade, but use of the procedure has soared in recent years as methods have improved and more disease-causing genes have been discovered. The in vitro fertilization and testing are expensive — typically about $20,000 — but they make it possible for couples to ensure that their children will not inherit a faulty gene and to avoid the difficult choice of whether to abort a pregnancy if testing of a fetus detects a genetic problem.

But the procedure also raises unsettling ethical questions that trouble advocates for the disabled and have left some doctors struggling with what they should tell their patients. When are prospective parents justified in discarding embryos? Is it acceptable, for example, for diseases like GSS, that develop in adulthood? What if a gene only increases the risk of a disease? ...

There is no question that the method’s use is increasing rapidly, though no group collects comprehensive data, said Dr. Joe Leigh Simpson, vice president for research at the March of Dimes and past president of the American Society for Reproductive Medicine.

The center in Chicago that tested the Kalinskys’ embryos for the GSS gene, the Reproductive Genetics Institute, has tested embryos from more than 2,500 couples and sought to identify 425 gene mutations. The institute’s caseload has risen 40 percent in just the past two years, according to its director, Svetlana Rechitsky, an author of the new paper on the Kalinskys’ case.

Ms. Kalinsky’s gene causes a particularly dire disease. Her grandfather, great-aunt, uncle, father and cousins died of it. Sometime between her mid-30s and her mid-50s, Ms. Kalinsky, who is now 30, will begin to stumble like a drunk. Dementia will follow, and possibly blindness or deafness. Five years after the onset of symptoms, she will most likely be dead. ...

Meanwhile, in Israel:

NYTimes: ... We knew what treatment we wanted: full-force I.V.F. using Preimplantation Genetic Diagnosis or Screening (P.G.D./P.G.S.), which genetically screens embryos before implantation. The method can be used to search for specific diseases such as Tay Sachs or Gaucher, but it can also weed out aneuploidy (abnormal number of chromosomes in a cell), the reason for many first-trimester miscarriages.

Some worry about the use of P.G.D. for gender selection (“Will this become a form of eugenics?”). But I wonder if genetic screening will be the future of reproductive medicine, especially since new technologies keep emerging. Then again, reproductive medicine is still in its nascent stages, so who knows what the future will bring? Maybe all women will freeze their eggs at age 25. Maybe no one will ever have fertility trouble again.

Genetic screening may not increase my chances of having a baby, but it would greatly reduce my chances of miscarrying or bearing a baby with genetic defects. After three miscarriages, it seemed like the best option: I couldn’t put myself through another such trauma. Besides, if all our embryos were bad, we would definitively know it was time to move on.

Embryo screening costs at least $5,000 for one to eight embryos in the United States, but in Israel it would be covered by national health care. ...