Aspiring parents, genotypes and phenotypes: the unexamined myth of the perfect baby .

• Author: Gurmankin, Andrea D.

ABSTRACT

Summary

Although many have argued that assisted reproductive technologies ("ARTs") attract those with a desire to genetically engineer their offspring, this claim has yet to be verified. To address this question, we surveyed three groups: the general public, people enrolling in an in vitro fertilization ("IVF") program, and pregnant couples. We asked subjects which traits they would select in their children if it were possible to use a magic wand to do so and to value genetic relatedness. In our sample, the potential parents who were using ARTs were less likely to express a desire to select traits in their offspring than were the general public, and just as likely as the pregnant couples. Those using ARTs, however, placed greater importance on having genetically related children than the others. Thus, the widely held view that reproductive technology is utilized by those most likely to favor genetic engineering is falsified by our findings.

Key Words

Assisted Reproductive Technology, Genetic Engineering, Enhancement, Cosmetic Procedures, In Vitro Fertilization, Gamete Donation (egg & sperm), Infertility, Autonomy, Pregnancy, Obstetrics, Bioethics, Psychology of patient decision making.

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Since the birth of Louise Brown, technology has progressed rapidly in the areas of human reproduction and infertility medicine. (2) After the birth of a cloned mammal in 1997, (3) most governments (4) and clinical associations (5) renewed efforts to regulate and study the ethical limits of specific forms of assisted reproduction or of the practices of assisted reproductive technology ("ART") in general. In making recommendations, some of which resulted in new law or policy, (6) these groups were able to rely on a number of studies that examined how assisted reproductive technology affects those who participate. (7) However, one and perhaps the most important question about the effects of ARTs has remained a matter of mere conjecture in the service of political argumentation for or against specific ARTs: Do those who utilize ARTs differ from others in their attitudes about altering the characteristics of their future children? Do those who utilize ARTs demonstrate a preference, held consciously or otherwise, for phenotype or genotype when making the decisions required of those who use ART to create a baby?

The argument, has been made that ARTs, taken collectively, represent the dawn of a new eugenics movement. (8) Preimplantation diagnosis, sex selection and gamete donation have each been characterized as morally ambiguous, unethical or even "evil." (9) However appealing these arguments may be to those who, for a variety of reasons, find ART objectionable, such claims have never been grounded in data. For example, while it is argued both by some feminists and fundamentalists that sex selection through ART represents "the ultimate sexism," such a claim is simply false and not reflected by evidence that those who use ART sex selection have gendered notions of ideal offspring. (10) Without data about what couples who use ARTs want from children, or how their desires differ from those who do not use ART or do not have children, the commonly articulated supposition that ART is dangerous, irrevocably linked to a desire by parents to genetically engineer in new and special ways, is in the most meaningful sense groundless. Consequently, it is critical to conduct empirical research to assess the attitudes of those using ARTs.

We conducted this study to identify the ways, if any, in which those seeking ARTs differ from other parents-to-be or members of society in their desire to prevent disease or enhance traits in their future offspring. Do those using these technologies care more than others about their offspring having specific or enhanced traits, or is their concern only about a genetic link to their child? In order to answer this question, we compared the attitudes of those using in vitro fertilization to members of the general public and to those who became pregnant without the use of IVF.

MATERIALS AND METHODS

Subjects

This study involved a questionnaire administered to three groups: members of the general public (prospective jurors in Philadelphia, "prospective jurors"), couples enrolling in an IVF program ("IVF couples"), and couples who became pregnant without the use of IVF ("pregnant couples").

Prospective jurors were surveyed in the Philadelphia County Courthouse in Philadelphia. In that county, prospective jurors are selected from voter-registration and drivers' license records. We recruited prospective jurors to participate in the study by announcing that those who completed the questionnaire would receive a candy bar. We recruited consecutive IVF couples at the time of their enrollment in the IVF program at Pennsylvania Reproductive Associates, at that time part of the University of Pennsylvania Health System. Couples who were entering the program filled out, on enrollment, a comprehensive set of forms, of which our questionnaire was one, in the waiting area of the clinic. Completion of this paperwork was a prerequisite of enrollment in the program. Pregnant couples were recruited to participate by filling out the questionnaire at the beginning of evening parent education classes at the Hospital of the University of Pennsylvania. For IVF and pregnant couples, where both husband and wife completed the questionnaire, subjects were asked by attendants in the waiting area to fill out their questionnaire independent of their spouse.

Survey instrument

The instrument was developed through the distribution of a variety of possible questions followed by interviews with clinicians at the World IVF Congress in Philadelphia, and a subsequently created pilot instrument was tested on prospective jurors as well as on the first fifteen IVF couples that were eligible for the study. The fifteen couples, as pilot subjects, were asked to make comments on the questionnaire regarding any comprehension and clarity problems they encountered...