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A Girl or a Boy, You Pick

Embryo sorting makes it possible to screen for gender and diseases. But the embryos no one wants raise profound ethical questions.


She had the name picked out since high school: Logann Rae, taken from a soap opera. She had two dolls waiting in a closet, both saved since childhood. Tanya had always dreamed of having a daughter, and of the intimate bond that would grow as they picked out dresses together, styled their hair and painted their fingernails. But Tanya's first child was a son. Then came another. When an ultrasound showed that her third child was also a boy, she struggled to hide her tears from the nurse.

And that is why this year she drove 400 miles to a doctor's office in Westwood. Using methods common in fertility clinics, doctors mixed Tanya's eggs with her husband's sperm to create five embryos in a laboratory dish. Then, using a new technique, they examined the embryos to determine which had the DNA to become boys, and which were programmed to be girls.

The three male embryos were frozen, their fate to be decided later. The two female embryos were transferred to Tanya's womb in an attempt to create the daughter she always wanted.

The embryo-sorting technique--called PGD, for pre-implantation genetic diagnosis--is quickly becoming the most controversial development in high-tech reproduction. Doctors are able to screen embryos not only for gender, but for whether they carry the genes involved in cystic fibrosis, sickle cell anemia and more than 100 other inherited diseases. They can even tell whether an embryo would grow into a good cell donor to help a sick person. The information is helping parents choose which embryos they want--and which to reject as unhealthy, or merely undesirable. The cost is about $10,000, including the price of in vitro fertilization, the procedure that creates "test-tube babies" and which is a required part of embryo screening.

But as the number of doctors offering the service leaps upward, embryo screening is raising some profound questions: Is it proper to discard an embryo based on its genes or gender? Which lives are not worth living? Who decides?

"It's scary to have this power," said Tracy Otte of Fountain Valley, who is trying to have a child and avoid the muscular dystrophy that killed two brothers in their early 20s. "If this technology was there, would my brothers ever have been born? It becomes: Did their lives have value? Absolutely, they had value. But it was also tragic to see how young they died."

Some fertility specialists say the questions will only become thornier, as scientists are bound to create tests not only for disease but for various traits. "There will come a day when we can determine height or weight or skin tone characteristics, and the question is: What do we do with that information?" said Dr. Jeffrey Steinberg of the Fertility Institutes in Tarzana, which has offered embryo screening for about a year. Society at large "has to give us feedback, because this is as new to us as it is to the rest of the world."

"We've arrived at the point where we need a national debate--no doubt about that," said David Hill, scientific director at ART Reproductive Center of Beverly Hills, which offers embryo screening services.

It is far from clear if parents will ever be able to test for intelligence or athletic ability, which are presumed to involve many genes and environmental factors. Still, embryo screening is one of several developments that could give parents significant control of their children's genetic makeup.

Armed with data from the Human Genome Project, researchers are probing the genetic foundations of obesity, mood and disease. Testing devices called "gene chips" are allowing scientists to track the activity not of one gene, but of thousands at the same time. Cloning and genetic engineering have enabled biologists to augment the genetic makeup of animals, adding genes so that the animals grow faster, bigger or more resistant to disease.

But even before scientists gain additional powers over human reproduction, there is worldwide debate over how to handle the information embryo screening can reveal.

Debate Began in Late '80s

The debate has been building since the late 1980s, when doctors at London's Hammersmith Hospital learned how to tease a cell from a 3-day-old embryo and study its chromosomes for gender. By weeding out male embryos from the females, the doctors aimed to help parents avoid such gender-linked diseases as hemophilia and Duchenne muscular dystrophy, which are inherited overwhelmingly by boys.

Later techniques allowed doctors to screen for the genes that cause a variety of diseases. The screening, however, has become widely available only in the last two years, as more companies have begun handling the sophisticated laboratory work for fertility doctors.

While no one keeps complete numbers, specialists say about 50 U.S. clinics now offer the service to patients. Nearly 2,000 embryo-screened babies have been born worldwide since 1992.

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