Dr. Steinberg, like many, sees the tests as a biological boon that could spare families and future generations from the burdens of disease, while Roger Pierson, a fertility specialist at the University of Saskatchewan, says governments can't ignore the economic implications. “We have an impending storm of health-care maintenance and cost issues.”
“We are not going to slow the technology, so the question is, how do we use it?” Dr. Pierson says. “Twenty years from now, you have to wonder if all babies will be conceived by IVF.”
What has Canadians flying down to Mexico?
It is 6:30 in the morning, and Dr. Steinberg is already on the job at the Fertility Institutes clinic in Guadalajara, which he visits from his base in Los Angeles every six weeks.
He offers IVF with embryos screened for a long list of conditions, and says his clients come from all over the world, including 10 to 15 couples a month from Canada – “a tenfold increase from five years ago, and the bulk of them are fertile.”
Because of “an old-line religious stance or new-line political correctness,” Dr. Steinberg says, most of his international clients can't have babies this way in their own countries.
Barring people from selecting the sex of a child was one of the few federal regulations the Supreme Court left intact, and the only restriction there is on embryo screening. Even still, couples face no repercussions for doing it out of country. Clients from certain cultures choose boys, but Dr. Steinberg finds Canadians tend to want girls.
“I don't see myself as a rebel,” he contends. “I'm just offering what the science allows.”
In the beginning, a way to bolster IVF
The science of embryo testing was born in a small London hospital in 1989. British scientist Alan Handyside, who had trained with test-tube-baby pioneers Patrick Steptoe and Robert Edwards, devised a method to extract a cell from a newly created embryo and amplify enough of its DNA to check for mutations. Doing so would allow doctors to implant in a woman's uterus only those embryos free of the mutation she wished to avoid.
Known as preimplantation genetic diagnosis, or PGD, it was billed by critics as a leap toward designer babies from the outset. But initially, few balked at its noble aims of eradicating hereditary diseases that can kill a child before kindergarten or result in catastrophic impairments, such as muscular dystrophy, Tay-Sachs and cystic fibrosis.
Yet this was before the human genome was mapped, and even Dr. Handyside says in an interview from London that “PGD was born prematurely.” Since then, genetic know-how has grown steadily, as have the uses of PGD, which is now employed to select a child's sex, to create “saviour siblings” genetically equipped with donor tissues to match those of another child in need and, ironically, to satisfy disabled couples who want to have children like themselves, most famously selecting traits to ensure deafness and dwarfism.
But its most common use by far is among doctors hoping to increase the pregnancy rates in women undergoing IVF, which now accounts for about 1 per cent of the 380,000 babies born in Canada every year. PGD can pinpoint abnormal embryos that carry a greater risk of miscarriage if implanted – a risk that increases exponentially with a woman's age.
Even countries that once took a hard line against PGD are changing their rules. Fertility clinics in Ireland plan to seek government approval this year to start screening embryos for serious diseases, and last year Germany gave PGD the go-head, overriding the strict embryo-protection act it had adopted when the procedure was invented.
And as demand grows, so do requests to detect a wider range of disorders: colon cancers, albinism, heart conditions, facial deformities. Natera (formerly the Gene Security Network), a California-based screening lab launched by multimillionaire Web entrepreneur Matt Rabinowitz, has even considered adding psoriasis to the list.
“Virtually any gene that's identified we can include on a test,” Mr. Rabinowitz said after a talk last fall to Canadian fertility doctors in Toronto. His company's ethics board regularly debates what genes to include and has stopped short of cosmetic traits: “We get calls. People want to test for eye colour – we won't do it.”