FERTILE women with genes that predispose them to breast and ovarian cancers are using IVF treatment at two Melbourne clinics to select embryos without the genes.
In a new trend that has heightened ethicists’ fears of ”designer babies”, Australian IVF specialists say women are spending thousands of dollars on a technique called preimplantation genetic diagnosis to select embryos without the same genetic issues.
The women involved carry mutations of the BRCA 1 and BRCA 2 genes, which give them a 60-80 per cent chance of getting breast cancer in their lifetime.
Those with BRCA 1 also have a 30-60 per cent chance of getting ovarian cancer while those with BRCA 2 have a 5-20 per cent chance of getting ovarian cancer.
Couples where one partner has such a mutation have a 50 per cent chance of having a baby with the same mutation so the technique allows them to cut this risk to between 0.1 per cent and 10 per cent depending on the accuracy of the diagnostic test developed for their specific mutation.
Doctors from Victoria’s leading IVF clinics, Melbourne IVF and Monash IVF, said 10 couples had used the procedure for the breast and ovarian cancer genes since a 2008 change in reproductive treatment laws allowed such use.
Medical director of Melbourne IVF Lyndon Hale said some couples may choose the procedure to avoid the trauma of prenatal diagnosis, which raises the question of abortion. He said some had also seen family members endure breast cancer from a young age or had had their breasts removed to reduce their personal risk of cancer.
”Cancer is a horrible disease – so these people want to get rid of it from their family tree,” Dr Hale said.
Dr Elissa Osborne, of Monash IVF, said couples wanting to use the diagnostic tests had to wait up to six months for the one to be created for their particular mutation. This cost about $2000.
Once this was done, they could go through the usual IVF procedure of creating embryos that would be tested at day three or day five of life to see if they carried the gene mutation. This allowed couples to select unaffected embryos for implantation. This doubled the cost of IVF cycles from about $3500 to $7000.
While preimplantation genetic diagnosis (PGD) has been used in Australia for 20 years to help couples remove the risk of a growing list of inherited diseases such as cystic fibrosis and Huntington’s disease, doctors and ethicists said using it for BRCA 1 and BRCA 2 gene mutations was controversial for several reasons.
First, the test does not remove all risk of breast and ovarian cancer for the child who will still have a 10 per cent ”background risk” of the cancers which exists for the rest of the population without gene mutations. And second, there is a theoretical risk that hormonal treatments used for these women to go through IVF increases their personal risk of developing cancer.
Willem Verpoest, an expert presenting research on the topic at a European Society of Human Reproduction and Embryology meeting in Istanbul this week, said although there was no evidence of an increased rate of cancer in these women yet, it was the subject of continuing research and needed to be monitored.
Professor Verpoest said a study of 70 couples who had used PGD to eliminate breast and ovarian cancer gene mutations in Europe showed it was safe for their babies, who were born without any increased rate of deficiencies.
”We now believe this technique offers an established option for those couples seeking to avoid the risk of inherited BRCA in their children,” he said, adding that longer-term monitoring was still required to confirm its safety.
Professor Verpoest said the technique could also be used to avoid the use of embryos at increased risk of other cancers, such as bowel cancer, and as more genes were discovered, PGD would be used more often.
”There are between 7000 and 8000 genetic disorders that are caused by gene mutations so there is a lot of work to be done,” he said.
Melbourne ethicist Nicholas Tonti-Filippini said he was concerned about the increasing discrimination against embryos and questioned the idea that people with such gene mutations had lives that were not worth living. He feared it would lead to more genetic profiling to work out other features, such as athleticism or intelligence.
”The more information you can get with PGD, the more decisions you can make and the more discriminatory you can get,” he said.
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