With recent advances in genetics, there are several inherited disorders which can now be diagnosed at a molecular level. For couples who are carriers or affected by any of these conditions and are at high risk for transmitting it to their offspring, it is currently possible to detect the disorder during pregnancy. This is done by one of two approaches: amniocentesis or chorionic villus sampling (which involves taking a small sample of the placenta at an early stage). However the couples have the dilemma of whether or not to terminate the pregnancy if the genetic abnormality is present. In some cases this may also not be a viable option for religious or moral reasons. An alternative would then be to diagnose the condition in embryos before the pregnancy is established. Only the unaffected embryos would then be transferred to the uterus. This technique is referred to as preimplantation genetic diagnosis and would obviate the need for screening during a pregnancy and hence prevent the physical and psychological trauma associated with possible termination.
Research towards developing techniques for early genetic diagnosis in humans were initiated in the UK in the late 1980s (Handyside et al, 89, Lancet.347. and Dokras et al, 90, Hum Reprod, 5.821.). In vitro fertilization (IVF) techniques are used to obtain ova (eggs) from the mother which are then fertilized in the laboratory with sperm obtained from the father. One or more cells are then removed from the developing embryo 2 to 4 days after fertilization. This highly sophisticated technique called micromanipulation does not adversely affect further development of the embryo. The cells removed are then used for analysis, and the results can be obtained within 12-24 hours. The embryos without the genetic defects are then transferred into the uterine cavity to develop into a normal pregnancy. Almost all genetically inherited conditions that are diagnosed in the prenatal period can also be detected in the preimplantation period. At the 8 cell stage, each cell of the embryo is still totipotent (each cell has the capability of forming an entire new organism). Thus, one cell can be removed for genetic testing without altering the development of the rest of the organism.Diseases which have a high risk of transmission (25-50%) and are usually associated with significant morbidity and mortality can be screened for by this technique. The first report of the successful application of this technique came from the Hammersmith Hospital, London, UK which currently is the centre with the highest number of births following preimplantation diagnosis
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Now the UK Human Fertilisation and Embryology Authority has given permission to Leeds parents, Shahana and Raj Hashmi, parents of a boy from Leeds who suffers from a potentially fatal genetic disorder that they can use IVF to create a sibling whose cells could cure him. This effectively means that doctors can use the procedure to ensure their next child can provide their son Zain with a viable bone marrow transplant. The process requires doctors to artificially inseminate eggs from Hashmi's parents, then select one embryo that matches his blood type that can produce the antigens needed to fight the disease. Embryos that did not match the correct type would most likely be destroyed.
Doctors say that the odds of success for this procedure are about one in two, but moral and ethical dilemmas surrounding the procedure have meant that the case involves some very complex issues. Effectively, the Hashmi family want to create a child who would be a suitable donor for Zain, who suffers from thalassaemia - a rare blood disorder. This decision comes after the authority decided in principle in December to approve PGD in cases of serious genetic disease, but that all applications by clinics to undertake treatment should continue to be decided on a case-by-case basis only after rigorous examination of the ethical and medical implications of the treatment and the welfare of the children. The case is similar to that of Adam Nash, an American boy conceived in order to provide transplanted tissues to his ailing sister. The procedure raises serious concerns about the ability to identify the gene defect and using a child as a commodity. The Human Fertilisation and Embryology Authority in the uk also recently give permission to Dr Taranissi at the Assisted Reproduction and Gynaecology Centre in London by to use the technique.
When an embryo becomes a person with "human rights" is probably the most controversial debate of our time. It is an issue that has perplexed the wisest philosophers and the average citizen. In Ireland. although our moral attitudes are based on deeply held religious and ethical beliefs, it is becoming difficult to obtain consensus on almost any issue although public policy must ultimately represent an effort to arrive at a reasonable accommodation to differing interests. Despite the Irish peculiarities regarding the wording of the last amendment to our constitution, when human rights and protectability commence should not become an all-or-nothing matter. Some people say prior to implantation that the embryo does not have human form or genetic uniqueness, as it is a growing collection of cells which can divide into two and naturally produce identical twins, it is unable to survive outside of the womb, does not have any organ structures including even a primitive brain and it has no degree cognitive development. They also say that after conception following intercourse some 60 percent of human embryos are discarded by nature at this stage of development, often even before the mother ever realises that she was pregnant. Hence it would be difficult for society to ascribe "rights" to something that has such a high natural mortality. Others feel that the creation, destruction or manipulation of human embryos by any method for any purpose, can never be justified.
Whatever your personal opinion, there is little doubt that the technique should greatly increase the chances of predicting which embryos are likely to result in a successful birth with much greater accuracy and effectively this technique is a big step forward for IVF as it means that doctors can now weed out problem embryos before a woman becomes pregnant. The UK legislation means that problem embryos in certain circumstances can now be discarded, and only those with a good chance of success implanted into the woman's womb. However, this system is far from perfect, and up to 50% of embryos that look normal under a microscope in fact contain defects in their genetic material.
Personally, I believe that in Ireland we need a panel consisting of bioethicists, sociologists, physicians, basic scientists and professionals in public policy to re-examine the sensitive issues surrounding reproductive medicine and embryo research, and then make recommendations about the areas of medicine and science on which the Government should legislate. I also personally believe that the human embryo is precious and deserving of our profound respect because of its enormous potential and both its existence and status shold rest in the moral belief of the couple from whom it came.
Is PIGD (Preimplantation Genetic Diagnosis) Another Form of Abortion?
Dr. Patrick Treacy is a cosmetic expert. He is Medical Director of Ailesbury Clinics Ltd and the global Cosmetic Medical Group. He is Chairman of the Irish Association of Cosmetic Doctors and is Irish Regional Representative of the British Association of Cosmetic Doctors. He is European Medical Advisor to Network Lipolysis and the UK's largest cosmetic website Consulting Rooms. He practices cosmetic medicine in his clinics in Dublin, Cork, London and the Middle East.
Dr. Treacy is on the Specialist Register in the UK and Ireland and holds higher qualifications in Dermatology and Laser technology and skin resurfacing. He was amongst the first doctors worldwide to use the permanent facial endoprosthesis BioAlcamid for HIV Lipodystrophy patients. He was also the first person to introduce many techniques such as Radiofrequency assisted lasers, Fibroblast transplant and Contour Threads to Irish patients.
Dr. Treacy is an advanced aesthetic trainer and has trained over 300 doctors and nurses from around the world. He is also a renowned international guest speaker and features regularly on national television and radio programmes. He was invited to speak about stem cells and cosmetic medicine at the World Aesthetic Conference in Moscow this year.
The Irish College of Cosmetic Doctors
The British Association of Cosmetic Doctors
The British Medical Laser Association
The American Society for Aesthetic Medicine
The American Society for Lasers in Medicine and Surgery The European Society of Laser Dermatology
The European Society for Dermatological Surgery (ESDS)
The International Society for Dermatologic Surgery
The International Academy of Cosmetic Dermatology
Dr. Treacy is the European Representative for the NetWork-Lipolysis where he is on the Medical Advisory Board and the Scientific Advisory Board.
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