Genetic counseling

Current issues in assisted reproduction and genetic counseling

The specter of the Eugenics movements still hangs over current issues in reproduction. These issues are particularly acute in couples who believe in choice for abortion and high tech assisted reproduction, and who desire children but plan a limited number of offspring. In such cases, especially when there is a family history of genetic disease, parents may not be willing to accept a pregnancy without checking for a diagnosis that may mean the baby will either die in infancy or have a severe disease or disability. In the cases of recessive genes, where each parent is known to be a carrier, then -if tests exist for the gene, embryos or early placental material may be tested for the presence of the gene. If the conceptus is homozygous for the gene, then there is medical certainty of the disease, and parents may choose to end that pregnancy. Although peopke who believe that this is akin to infantide may choose not to end the pregnancy, and instead to have the baby, even then they have forewarning of what to expect. Depending on the exact disease, this may improve the life of the ill infant, and mitigate the impact on other children in the family.

or be faced with results of such tests that indicate probabilities only and no real certainty of extreme disability. For example, the most common abnormalities in chromosomal number (aneuploidy) include Down syndrome and Turner syndrome. 

Even more controversial are tests for conditions in which there may be a specific isolated disabilty, like sensory hearing loss so severe as to preclude normal speech and language development without a cochlear implant, but unlikely to cause any other problem.

With the ability to test for for genetic and chromosomal abnormalities that are associated with disease, many fathers, mothers, and physicians struggle with the ethical implications of selective reproduction.