Ethical quandaries around expanded carrier screening in third party reproduction

Given the limited benefits and important drawbacks of expanded carrier screening for gamete donors, a credible argument for a moral obligation to perform expanded screening cannot be made.

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Volume 109, Issue 2, Pages 190–194

Authors:

Heidi Mertes, Ph.D., Steven R. Lindheim, M.D., M.M.M., Guido Pennings, Ph.D.

Abstract:

Although current screening methods of gamete donors are capable of reducing the incidence of genetic anomalies in donor offspring below general population levels, targeted screening for a large number of conditions (expanded carrier screening or ECS) could be considered as part of the routine selection procedure for gamete donors. There are, however, important drawbacks to its practical implementation. Excluding all carriers of severe recessive monogenic pediatric disorders would disqualify virtually all donors, and other approaches negatively affect cost (and therefore access), present dilemmas in regard to disclosure of genetic findings, and/or overburden the intended parents. In all of the scenarios considered, adequate genetic counseling will be of central importance. Besides looking at benefits and drawbacks of possible ways of implementing ECS, we also examine whether a moral obligation exists to adopt ECS at all and on whose shoulders such an alleged obligation would rest: policymakers, medical staff at fertility clinics, sperm and egg banks, the intended parents? We argue that given the small risk reduction brought about by ECS, the possible negative effects of its implementation, and the absence of widespread preconception carrier screening in the general population, it is inconsistent to argue that there is a moral obligation to perform ECS in the context of donor conception. Finally, implications for the donors are discussed.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

1 Comments

Go to the profile of Steven R. Lindheim, MD, MMM
Steven R. Lindheim, MD, MMM over 2 years ago

I applaud the authors for their thoughtful insights into this controversial topic.  Screening oocyte donors for a Trio Panel vs ECS remains a challenge in our practice.  Full disclosure remains the easiest of algorithms, but industry standards would assist all of us.