Fertility agencies offering embryo selection for IVF and surrogacy have been accused of promoting eugenics and misleading consumers about the power of genetic testing.

Some US clinics claim to be able to “classify” embryos for IVF using Preimplantation Genetic Testing for Polygenic Risk (PGT-P), a genetic screening system that is illegal in the UK. They say this process can detect the likelihood that an embryo will later develop diseases such as schizophrenia and breast cancer.

An analysis published in the medical journal Nature reveals that this new method, used by clinics to sell fertility services, “is not sufficiently efficient or robust for embryo selection”. The study also warns that PGT-P “could be used eugenically to determine the value of embryos as well as any desirable characteristics for consumers.”

PGT-P tests can cost between $2,000 and $6,000, on top of the price of IVF and associated costs, which can already be in the tens of thousands. The global fertility market is estimated to be worth more than $34 billion and is expected to nearly double in value over the next decade. The industry is unregulated in many countries, opening the door to clinics offering high-cost testing services backed by flimsy scientific evidence. Using clever marketing materials, they imply that parents can select the perfect child.

One clinic, the Virginia Center for Reproductive Medicine, claims to be able to test embryos for conditions as diverse as schizophrenia, coronary heart disease and various types of cancer. They even claim to be able to judge whether the child born from the embryo will be more likely to suffer a heart attack as an adult.

“All disease risks for each embryo are grouped into a single number: the Embryo Health Score (EHS). The embryos are then classified (from lowest to highest risk), using this unique EHS number,” the center’s website states. Thanks to this number, the embryos “are hierarchical in a clear order”. The website claims that PGT-P testing can reduce the incidence of disease by more than 70 percent.

Experts suggest such claims are difficult to substantiate. PGT-P and polygenic risk score (PRS) are an active area of ​​research and may hold promise in assisting patient diagnostic and treatment decisions. However, while this remains to be proven, it has been widely exploited and commercialized by IVF providers, according to a group of researchers from elite Japanese universities.

Japanese scholars go on to argue that the PGT-P presents multiple problems. First, the purported health benefits of selected embryos may be “too small to be validated or have clinical significance.” Additionally, researchers found that the same embryo can receive a high or low score, depending on the methodology used to judge the test results. In other words, hypothetically, one clinic might say that an embryo is a perfect choice for IVF, while another might say that the same embryo should be rejected.

Judging traits in a “eugenic” way

The researchers’ views are echoed by the Human Fertilization and Embryology Authority, the UK regulator of IVF treatment. The regulator states that PGT-P “does not meet the criteria for genetic testing and is not currently supported by evidence from scientific studies.”

Explaining why its use is banned in the UK, he says risk scores can be “interpreted too rigidly” and that maintaining a healthy lifestyle is “likely to have a greater impact on disease prevention”. It’s important to note that for couples seeking fertility treatment, using PGT-P may actually reduce the chances of having a baby, as viable embryos could be rejected, according to the regulator.

“These scores don’t tell you anything concrete or reliable about the presence or absence of a specific genetic variant,” says Sarah Norcross, director of the Progress Educational Trust (PET), a charity for people affected by dementia. infertility and genetic diseases. “The data obtained simply doesn’t give you the kind of certainty you need to meaningfully select embryos.”

Because embryos used for IVF typically share the same parents, “it’s unlikely that the genomes of the embryos will differ enough” for the tests to provide much information, she adds. “These are just some of the reasons why PET – and many other organizations… – believe it is wrong to offer PGD-P to patients. »

Technical shortcomings are only part of the problem. In addition to the risk of arbitrarily discarding perfectly viable embryos, scientists fear that this method could be used to judge characters in a “eugenic” manner.

Some customers in the international surrogacy and IVF market have already attempted to source sperm and eggs for “tall and blond” children, as The Telegraph reported in August. The idea of ​​PGT-P being used for similar purposes does not seem far-fetched.

Researchers also worry about the impact these tests could have on parent-child relationships. How might parents view a child born from a low-scoring embryo? How would a child feel knowing that he or she was chosen out of the group, based on a numerical value? These situations require careful consideration.

The PGT-P method is the newest among a variety of tests available to detect potential health defects in embryos, such as the more widely available PGT-A, which is used to determine whether embryos have the correct number of chromosomes. An embryo with an incorrect number of chromosomes may fail to implant, result in miscarriage, or lead to a child with chromosomal disorders such as Down syndrome.

Although evidence for the effectiveness of PGD-A is mixed, studies suggest that it may improve live birth rates in certain age groups. PGT-P differs in that it analyzes genes in more detail, judging risks for polygenic disorders; that is, medical problems associated with genetic variants in multiple genes. The clinics provide the testing point for studies supporting its potential and present a universally positive view of this technology. The broader medical and scientific community, however, is more skeptical.

Ultimately, the PGT-P has only been in use since 2019, making it impossible to draw conclusions about the long-term health outcomes of anyone born after having this test. This is a scientifically controversial process, and questions regarding technical shortcomings and ethical issues have not yet been conclusively answered. Despite this, clinics continue to charge thousands of patients undergoing IVF for genetic testing, regardless of voices calling for caution.

The Virginia Center for Reproductive Medicine has been contacted for comment.

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