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Year in Review: Public secrets of the assisted reproduction industry (Part 1 of 5)

Genetic Crossroads
December 14th, 2006

2006 saw both front-page headlines about human biotechnologies and many significant developments that were less widely noticed. The year began with news of fabrications and fraud by cloning researcher Hwang Woo-Suk. Embryonic stem cell research triggered the first veto of the Bush administration in September, and figured in the country's November midterm elections. Debate about using women's eggs for research heated up, and a few policies were put in place. Here's a look at some of the year's key events.

Public secrets of the assisted reproduction industry

bullet Reproductive tourism: Class and conception in the global economy

Reproductive services including surrogacy, egg procurement and sex selection are increasingly being "outsourced" to take advantage of countries where wages are low or regulations lax. In an article titled "Wombs for Rent, Cheap," the Los Angeles Times reports on growing numbers of foreigners who are paying women in poor Indian states to act as reproductive surrogates.

"It's win-win," says a former health secretary of Gujarat state. "It's a completely capitalistic enterprise. There is nothing unethical about it." The article says women are paid between $2800 and $5600; other sources report lower payments of about $1000. The Indian Council of Medical Research estimates that reproductive tourism "could bloom into a nearly $6-billion-a-year industry."

Reproductive tourism is also driven by regulatory differences among countries. According to news reports this year, more and more wealthy people from countries in which sex selection is illegal-including Canada, Australia, the UK, and China-are traveling to obtain it in the United States, the "Wild West" of assisted reproduction.

bullet The business that dares not speak its name

The main argument of Harvard Business School professor Debora Spar's The Baby Business is that assisted reproduction is in fact a thriving market enterprise-a "fertility-industrial complex"-but that neither those who work in the business nor those who use its services want to acknowledge its commercial nature. Spar estimates that assisted reproduction is a $3 billion-a-year sector; other estimates run much higher, including one of $16 billion from the Cato Institute. Spar offers persuasive reasons and policy recommendations for filling the regulatory vacuum in which the U.S. industry currently operates.

bullet Selecting embryos for sex and arthritis

The screening and selection of embryos, a procedure known as pre-implantation genetic diagnosis (PGD), was developed to target fatal childhood diseases such as Tay Sachs. It is widely known that PGD is increasingly being used for other reasons, some of them medically questionable, some medically irrelevant. But there have been almost no hard data about current PGD practices in the United States due to the notorious under-regulation of the assisted reproduction industry.

A survey of U.S. fertility clinics that offer PGD, released in September by the Genetics and Public Policy Center [PDF], found that 42% have used it for "non-medical sex selection"-a practice that is illegal in many countries. In addition, fully 80% of the clinics let parents decide the future child's sex if PGD was performed for other reasons.

The survey also found that 28% of clinics have used PGD for adult-onset diseases, including some that are treatable. The New York Timesreports that a woman with an inherited arthritic condition was planning to use PGD to select for a child that won't have the gene-though four of five who do inherit it would never develop arthritis, and of those who do, only some would have severe cases of what is an increasingly treatable condition.

Commenting on the new findings, Will Saletan writes, "If PGD were evil, it would be easy to head off such abuse by banning it. But it's not. PGD prevents hellish diseases. In those cases, you have to say yes. And once you start saying yes, it's hard to say no. That's why they call it a slippery slope."


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