Since the birth in 1978 of the first “test-tube” baby, more than 8 million children worldwide have been born thanks to reproductive technologies. In 2017, the last year for which there is published data, there were 284,385 ART cycles, primarily IVF cycles, in the United States, resulting in 78,052 live infants. The technologies carry medical risks and raise ethical questions, but the industry is much less regulated in the U.S. than in other industrialized nations, Klitzman says.
Klitzman began exploring these issues after a friend asked him to donate sperm so she could have a child: “I would be the biological father, but would or should I also take on the social role of being one? ... What if I disagreed with her about how to raise our child?” He wondered how others made decisions about questions like this.
In his book, Klitzman zeroes in on recent technologies that allow patients and doctors to select and transfer embryos with the traits they desire. Doctors who perform IVF have begun testing embryos for dozens of genes through preimplantation genetic testing. While most of those procedures are done to prevent disease by allowing physicians to select mutation-free embryos, many U.S. clinics have used the technology to enable parents to select their child’s gender, assuming a successful pregnancy resulted.
How about purposely selecting for traits such as deafness and dwarfism — viewed as diseases or disabilities by some parents and clinicians, but as normal by others? Klitzman doesn’t attempt to answer that question, but writes: “In helping to create a child, [physicians] arguably have a degree of moral responsibility and thus need to consider the child’s best interests, which at times may outweigh the prospective parents’ rights” to choose these traits for their future children.
A new gene-editing technique, known as CRISPR, goes further, allowing labs to insert or remove various genes. “The problem is the technology could be used for many socially desirable traits — you could put in genes for height or perfect pitch,” he says. That worries Klitzman: “Choosing socially desirable genes constitutes eugenics, which led to horrific outcomes in Nazi Germany,” he says.
Klitzman notes the potential for other inequalities as well. The price tag for the technologies — he says IVF treatments cost more than $24,000 on average — typically makes them unaffordable for all but the affluent. He writes: “Wealthy individuals are eliminating certain lethal mutations from their offspring while the poor cannot. ... Resources and research to battle these conditions may then fall, while stigma rises.”
Klitzman says there is insufficient data to adequately monitor these advances and calls for greater mandatory data collection and better education and guidelines. “We need to proceed with great caution,” he says, “and instead we are racing ahead.”
Klitzman ultimately declined to donate his sperm; he felt he was not ready to take on the commitments that would be required. “I have often wondered if I made the right decision,” he writes. “But the choice helped me understand the predicaments that countless potential parents confront.”