FERTILE women with genes that predispose them to breast and ovarian cancer are using IVF to select embryos without the genes so their children are free of the distress they cause.
In a new trend that has heightened ethicists’ fears of ”designer babies”, Australian IVF specialists said women with mutations of genes called BRCA1 and BRCA2 were spending thousands of dollars on a technique called preimplantation genetic diagnosis (PGD) to select normal embryos
Females who carry mutations of the BRCA 1 and BRCA 2 genes have a 60 to 80 per cent chance of getting breast cancer during their lifetime. Those with BRCA 1 also have a 30 to 60 per cent chance of getting ovarian cancer while those with BRCA 2 have a 5 to 20 per cent chance of getting 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 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 about 10 couples had used the procedure for the breast and ovarian cancer genes since a 2008 change in reproductive treatment laws allowed such use.
The medical director of Melbourne IVF, Dr Lyndon Hale, said some couples may chose to use the procedure to avoid the trauma of prenatal diagnosis which raises the question of abortion. Some had also seen family members endure breast cancer from a young age or had had their breasts removed to reduce their risk of cancer.
”Cancer is a horrible disease … so these people want to get rid of it from their family tree,” he said.
Dr Hale said he believed clinics in other states, including NSW, were offering PGD for BRCA mutations.
Dr Elissa Osborne, from Monash IVF in Melbourne, said couples wanting to use the diagnostic tests had to wait about three to six months for the one to be created for their particular mutation. This cost about $2000.
They could then 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 roughly doubled the cost of IVF cycles from about $3500 to $7000.
While 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 remained 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.
Professor 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 ongoing research and needed to be monitored.
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