Taming the Wild West

At first, the British government typically only allowed couples to toss out in vitro fertilization embryos if the embryos tested positive for serious childhood illnesses. Recently, it extended the allowance to include embryos with a chance of developing inherited cancer such as breast cancer as adults.

Now, the Sunday Times reports, doctors at the University College Hospital in London are asking the government to allow parents to choose the sex of their child if they have a family history of autism-a non-fatal condition that affects more boys than girls.

Bioethicists and bloggers around the world pounded their keyboards with fury when the United Kingdom announced the new allowances for cancer in May. Since then, journalists around the world have parsed and evaluated every aspect of embryo screening in the United Kingdom, from recently announced scientific advances in genetic testing to the preparation of the application to screen embryos for autism.

Some of the light shed on embryo screening in the United Kingdom has also shined on similar practices in the United States, where doctors have for years freely used genetic testing on embryos, also called pre-implantation genetic diagnosis (PGD), to help couples select ideal embryos. Some U.S. clinics screen embryos so well that people travel here from as far away as China and Australia to get their own "designer baby," a buzz word coined in the media blitz over embryo screening.

The United States has a global reputation for being conservative on bioethics issues. The U.S. government refuses to fund human cloning research. Its policy makers still cannot agree on an ethical approach to embryonic stem cell research. So how did it become the world's build-a-baby store?

The contrast between the way the British and U.S. governments handle embryo screening offers one possible answer. The British government handles it; the U.S. government does not. The U.K. Human Fertilisation and Embryology Authority regulates and monitors anything having to do with embryos that were not created the old-fashioned way. In Huxley-esque fashion, it grants licenses for artificial insemination, in vitro fertilization, human cloning and, yes, PGD.

If the United Kingdom is the Brave New World of embryo screening, then the United States is the Wild West. Fertility doctors who offer embryo screening here are limited only by how much a parent is willing to pay. The Reproductive Specialty Center in Newport Beach, Calif., advertises on its website that for an additional $4,500, a couple undergoing IVF can pick the sex of their baby to achieve "family balancing."

The Centers for Disease Control requires IVF clinics to report annually their success rates and statistics about their patients, but no information is collected nationally about the use of PGD.

"There is a desperate need for the data," said Susannah Baruch, a director at the Genetics and Public Policy Center at Johns Hopkins University. The center recently finished questioning the country's IVF clinics about their use of PGD. The data, when compiled, should better inform the ethical debate over embryo screening in the United States.

But even more necessary, Baruch said, is a long-term plan for keeping tabs on PGD. That way, the public could spot changes in embryo screening practices and weigh in on them before they become widespread. She praises the U.K. system for its "open, public discussion of new applications of PGD. As a result, citizens of the U.K. have a better idea of what's going on."

The Genetics and Public Policy Center is working with some of the country's leading IVF clinics to start a voluntary reporting system for PGD statistics.