Integrating preimplantation genetic diagnosis into the ART laboratory

Abstract

Technology has become the driving force in the field of assisted reproductive infertility medicine. The ability to conduct in vitro fertilization, embryo micromanipulation, and cryopreservation allows the clinical embryologist to obtain an ever increasing ability to observe and test the viability of the human embryo in the laboratory. At the same time, molecular genetics and molecular biology have developed to the point of allowing the laboratory to detect and determine various aspects of the embryonic genome and knowledge of the detailed structure of human chromosomes. These technological abilities are now used not only to identify single gene mutations linked to specific diseases, but identify chromosomal abnormalities residing in the in vitro cultured human embryo as well. Selection of mutation-free and chromosomally normal embryos is now a reality that brings new hope to couples at risk for giving birth to affected offspring. There are also mounting indications that these technologies are also able to benefit couples facing other infertility issues such as failure to conceive during ART procedures. Ethical issues, concerning the use of these new technologies, have arisen from a number of quarters where it is troubling to think of, no less accept, the possible outcomes derived from their applications. One long sought after outcome, being requested by prospective parents, is to select the gender of the desired offspring for purely non-medical motives. Infertility programs throughout the United States and the world are now capable of utilizing these advanced technologies to make gender selection a reality for interested couples, as well as, enhance the ability to treat a variety of problems relating to infertility. Reproductive genetic programs may want to consider early on how they wish to utilize these technical abilities within their individual programs. There should be serious consideration of the pros and cons of developing these highly technical, time consuming and expensive procedures within a given facility. This chapter is designed to consider and help answer those questions. © Springer Science+Business Media, LLC 2010.