FERTILITY AND EMBRYOS
Three-parent procedure raises issues
We live in an era where technological advances seem to be accelerating at a pace that makes it harder and harder to keep up with issues such as safety and ethics.
Reproductive technology has now entered uncharted waters in such a way that at the recent annual meeting of the American Academy of Pediatrics (AAP) in San Francisco, a plenary session was given with the title of Who’s Your Mommy? Who’s Your Daddy?
Dr. Lainie Friedman Ross, Professor of Clinical Ethics at the University of Chicago, explained to her audience the implication of the so-called Three-Parent Embryo technique.
This form of reproductive technology involves genetic materials of three parents — one man and two women.
While it gives hope to infertile couples, and specifically to mothers who might be genetically predisposed to conceive children with fatal genetic diseases, it has also led to intense disagreements between politicians, ethicists, fertility experts and religious groups who accuse scientists of “playing God.”
Scientists who are on the cutting edge, breaking ice by providing leadership, justify their work as ethical — after all, they are saving lives and alleviating suffering.
Those who oppose them are fearful that the era of designer babies will take our society down a slippery slope.
In September of 2016, the journal New Scientist published a landmark paper entitled: Exclusive: World’s first baby born with new “3-parent” technique.
However, the baby was not born in September, but rather five months earlier in Mexico and delivered by a U.S. doctor. The parents were from Jordan and they were delighted to have a healthy child after struggling for twenty years to reach their goal. (The mother took ten years to become pregnant; she had a number of miscarriages and gave birth to two children who died from a mitochondrial condition related to the mother’s genes.)
Why was the baby born in Mexico and why did it take so long for scientific journals and the mainstream media to report this event? Ethics.
In 2015 after a fierce debate in the British Parliament, the U.K. government passed the Human Fertilisation and Embryology Regulation. This made mitochondrial donation legal in the U.K. But it is not legal in the U.S. or Canada.
Dr. John Zhang, a fertility expert based in New York City’s New Hope Fertility Center, made it possible for the Jordanian couple to have a healthy baby who, so far, continues to show no other problems. When asked by media why Mexico was chosen as the place of birth, Zhang answered, “Because it has no rules.”
Mitochondria have a very important role to play in the energy regulation of cells. Although rare, mitochondrial disease affects a wide variety of organs, muscles, and the neurological system. Most patients with mitochondrial disease die before reaching adulthood.
This dilemma has led to the development of mitochondrial replacement procedures. But the U.S. Congress in 2015 prohibited the use of government funds for experiments that genetically alter human embryos.
In Canada, both Health Canada and the Canadian Medical Association (CMA) thus far are either opposed or do not yet have a firm position. When the news of the child born in Mexico to Jordanian parents broke in September, a spokesperson for the CMA declined to comment on the ethical concerns of the treatment.
As expected when scientific breakthroughs unfold, there is a wide spectrum of opinions.
Dr. Arthur Caplan, director of medical ethics at New York University is quoted as saying “It more accurately might be described as a 2.05-parent baby.”
Caplan points out that when we remove the faulty genes from the mother who carries mitochondrial disease and replace them with healthy genes from a female donor, that although three parents are involved, technically their contribution is unequal.
Other ethicists argue that mitochondrial disease is rather rare and that it is far too early to get excited about technology which may not pass the test of time. Mito Canada, a resource-based organization, says that one in 5,000 people are affected by some form of mitochondrial disease. If the “three-parent technique” passes the test of time it will give hope to families who desire a healthy child who is also genetically related.
Dr. Ross’s comments at a recent meeting of the AAP summed it up well.
“It’s going to be really hard to convince the rest of the scientific community to proceed with caution, although that’s something I really think we should be doing.”
Ultimately legislation around the globe will have to address many unanswered questions on safety, who will pay for the procedure, and who has legal rights.
Will we ever enter an era of designer babies where genetic tinkering will be available, not only to give hope to childless couples, but also to couples who want a perfect looking child or a future Olympian or NHL star?
That question may end up in a future Supreme Court decision, but only after scientists first sort through their own unanswered questions about new reproductive technologies.
It’s going to be really hard to convince the rest of the scientific community to proceed with caution.