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Reproductive Endocrinology

Reproductive Endocrinology

Preimplantation Genetic Diagnosis: Safe Sex in a Gattacan World

July 24, 2015 • By

Earlier this month, 60 Minutes re-broadcast a segment called “Breeding out Disease” which discussed the ethical implications of preimplantation genetic diagnosis (PGD), a technique already in use for several adult onset diseases. You can watch the segment here:

This aired a day after Independence Day, perhaps to imply the ultimate in reproductive freedoms and procreative liberty. The ASRM Ethics Committee endorses the use of PGD for adult onset disorders in its 2013 Opinion under certain conditions, which most bioethicists would agree with (see: “Use of PGD for Serious Adult Onset Conditions” here:

But the recommendation by the experts interviewed for the 60 Minutes segment goes farther: that natural breeding should be discouraged in favor of using PGD to breed out known genetic diseases. Lee Silver, Co-Founder and Chief Science Officer of GenePeeks, stated: “ I see a future in which people will not use sex to reproduce. That’s a very dangerous thing to do.” This certainly puts a new spin on the term “safe sex”.

For years, I’ve been teaching the 1997 film, Gattaca ( as a springboard to discuss the unintended ethical, legal and social implications of “breeding out” natural breeding. In 1997, Gattaca spoke to cultural anxieties about the new reproductive technologies that were defining reproduction for millions, particularly in the areas of sex selection. The film was released before the complete mapping of the Human Genome. Here is the original 1997 New York Times review on the film’s release:

The slippery slope is that PGD could become eugenics “on steroids” once breeding out “undesirable traits” is on the menu. Endocrinologists are already familiar with parents who insist on medically inappropriate growth hormone so their children can be taller. What happens when we can identify specific genes on the autism spectrum? Would we be breeding out future Newtons, Einsteins, or Edisons — all reported to have had Asperger’s?

We already have a society in which the poor die of preventable diseases (note how many cases of renal failure are related to untreated and undiagnosed Type 2 diabetes). Imagine how the gap could widen where half the world selectively breeds using PGD and the other half throws the genetic dice through natural breeding (often unintended). That dystopian world may be closer than we think.

It’s certainly easy to see the benefits of preventing a harmed life; some bioethicists have argued that in select cases, it may even be “unethical” to have a baby if you’re knowingly passing on a terrible disease. In the endocrine world, PGD can have vast implications, including breeding out identified RET mutations in MEN 2 families (See Recommendation 12 in the 2015 MTC guidelines:

The President’s Commission on Bioethics provided an opinion on PGD in 2004:

This  opinion stands the test of time: “Biology is not destiny…The ability to affect the genetic make-up of the next generation may also exacerbate the tendency to assign too much importance to genetic make-up, and so may promote an excessively reductionist view of human life. These new practices may lend undue credence to the notion that human characteristics and conditions are simply or predominantly genetically determined—a too-narrow understanding of human freedom, agency, and experience, and a simplistic understanding of human biology.”

Reproductive Endocrinology

Leggo My Embryo: It’s Not a Frozen Waffle, but a Potential Person

May 11, 2015 • By

Endocrinologists are very familiar with Sofia Vergara, who is the Spokeswoman for a major brand of levothyroxine sodium, after her total thyroidectomy for thyroid cancer:

But her thyroid gland is not the only thing that’s out of her body.  She’s making bigger news in an unusual reproductive ethics case surrounding ownership of frozen embryos she created with her ex-fiancee, Nick Loeb. Recently, the issue aired on the Today Show:

The law is clear that embryos are not legal persons, even when created by celebrities. Personhood occurs at birth. But there is such a thing as “embryo patienthood.” This is a concept that grew out of the “fetal patienthood” framework developed by bioethicist Lawrence McCullough and OBGYN, Frank Chervenak.

So what is the moral status of frozen embryos? It all depends on whether they are patients.  McCullough and Chervenak assert that patienthood status is determined by the parents. If the embryos are intended to be future children, they are patients to which physicians owe beneficent-based obligations. If they are not presented as patients, they do not need to be morally considered.

But what happens when paternal and maternal interests clash? When Dad says the embryos are patients, and Mom says they are not? Reproductive endocrinologists need to ensure their couples have clear Advance Directives before creating potential persons. In the same way that we advocate for Advance Directives for End of Life decisions to avoid family conflicts over dying patients, we need Advance Directives for Beginning of Life decisions, too.