Genetics and reproduction Personal Genetics Education Project (pgEd) Harvard Medical School - Wu Laboratory

If you could choose specific traits or qualities that you would want your child to have, what would you choose? Why? Are there traits you would not want your child to have? What are they? Why? Discussion questions:

Gain genetic information about an embryo or unborn fetus. Help individuals conceive. Allow individuals to select embryos based on their genetic makeup. Genetic reproductive technologies can be used to:

Invasive testing: Amniocentesis and chorionic villus sampling Prenatal testing

Fetus and mother share a blood supply. Fetal cells release DNA, which can then enter the maternal blood stream. Maternal blood now contains a mixture of fetal cell-free DNA and maternal cell-free DNA. Non-invasive prenatal testing (NIPT)

In vitro fertilization is a technique used to treat infertility. A woman has eggs harvested from her ovaries, after taking hormones to stimulate egg production. The eggs are then combined with sperm in a petri dish. After 3-5 days, the embryos are assessed, and a doctor/embryologist determines which embryos are of the highest quality. One or more embryos are then placed in the woman’s uterus. The embryo(s) may or may not attach and lead to pregnancy. What is in vitro fertilization (IVF)?

What is preimplantation genetic diagnosis (PGD)? The embryo is created via in vitro fertilization. Typically, a single cell is removed from the embryo at the 8-cell stage (3 days after fertilization). Genetic testing is performed. The results of testing are used to decide which embryos, if any, to implant in the prospective mother’s uterus.

PGD: Pre-implantation Genetic Diagnosis Schwartz 2011 Jewish News

A Real Family impacted by PGD: Molly and Adam Nash Fanconi anemia (disorder of DNA repair) Cure: PGD, umbilical cord blood stem cells

What % of IVF clinics provide testing for the following reasons? aneuploidy autosomal disorders chromosomal rearrangement X-linked diseases non-medical sex selection avoid adult-onset disease HLA typing HLA typing w/o single gene test Select for a disability

Public attitudes regarding acceptable uses of PGD: FatalHLA matchAdult onset disease SexIntelligence/ strength

Want a total ban on PGD Support government regulation of safety and quality Think government should regulate ethics only Support no government regulation Believe government should regulate safety, quality and ethics Opinion poll: What role, if any, should the government of the United States play in regulating PGD?

Discussion Questions What are the potential opportunities that PGD can provide and what are the challenges of PGD? Now that you have discussed PGD, have you changed your opinion about whether you would want to choose certain traits for your child? If your parents had applied PGD to you, should they tell you? Or would you prefer not to know? Do we need rules to guide how PGD is used? If yes, what sort of rules? Whose job would it be to make and enforce such rules?