Jeff Steinberg: Irish Couples using Gender Selection
Wednesday, 3 March 2010
LA-based doctor Jeff Steinberg
The doctor behind the Los Angeles fertility clinic proposing to design the world's first "trait baby" has said he has helped Irish couples select the gender of their child.
Jeff Steinberg said he treated at least "half a dozen" Irish clients at his Fertility Institutes facility, which claims to be the largest "gender-selection service" in the world.
They included a couple who had lost a son in a motorbike accident and wanted their next child to be a boy. He also treated a mother, who already had a son and daughter, but wanted another girl because she wished her daughter to have a sister.
The medic, a member of the team involved in the 1978 birth of Louise Brown, the world's first test-tube baby, was at the centre of controversy last week after he said he would allow parents to choose traits such as eye colour and hair type for their offspring. Such was the criticism of his proposal - which mirrors events in Gattaca, the 1997 sci-fi film starring Ethan Hawke and Uma Thurman - Steinberg has since promised to limit the service to parents seeking to use it for medical reasons.
Steinberg said: "Most people use it for family balancing, and I do not see a problem in helping couples for this reason."
Gender-selection services cost $20,000 (€15,722). One Irish couple is said to have used the company's New York clinic while the others have gone to Los Angeles. Steinberg said he had "not yet" received any "queries" from Irish couples in relation to trait selection.
A number of fertility doctors have criticised Steinberg, suggesting he is looking to capitalise on advances in embryo screening designed to identify dangerous diseases and defects in unborn babies. Others fear it will lead to societal preferences and new kinds of social inequalities and discrimination.
The Fertility Institutes clinic uses a pre-implantation genetic diagnosis (PGD) service to select the gender of a new-born. This method was first used to detect early genetic diseases, whereby couples undergoing in-vitro fertilisation (IVF) can have embryos screened to be evaluated for hereditary problems.
If a family has a particular genetic disease which runs in boys, couples would be allowed to undergo PGD and then implant only female embryos. The gender-selection service offered by the clinic is considered to be 99.9% successful. The trait-selection service is being offered after advances in IVF treatment and technology.
Deirdre Madden is a graduate of UCC (BCL 1987; LLM 1988, PhD 2000), and was called to the Irish Bar in 1989. Her research interests and publications are primarily in the area of medical law and ethics.
In recent years she was a member of a number of national committees including the Commission on Assisted Human Reproduction, the Research Ethics Committee of the Irish College of General Practitioners, the Council of the College of Anaesthetists, and Chair of the Gene Library working group on legal and ethical issues in biobanking.
In 2004 she was appointed by the Minister for Health to the Medical Council for a five year term to represent the public interest and was subsequently re-appointed to the Medical Council in 2008 for a further five year term. She was elected as Chair of the Ethics Committee of the Medical Council in October 2006, and is also current Chair of the Standards in Practise Committee of the Council.
In 2005 she was appointed by the Government to write a final report on post mortem practice and procedure, and subsequently chaired a working group on the implementation of the recommendations in that report in the areas of perinatal and adult post mortem practice.
In 2007 Dr. Madden was appointed Chairperson of the Commission on Patient Safety and Quality Assurance which published its Report entitled Building a Culture of Patient Safety in July 2008. She is currently a member of the Implementation Steering Group for the Report.
Currently Dr. Madden is Chairperson of the University Research Ethics Board in UCC; a member of the Research Ethics Committee for the National Longitudinal Study of Children in Ireland; a member of ELPAT (Ethical, Legal and Psychosocial Aspects of Organ Transplantation); expert evaluator for the European Commission; ethics consultant for the Health Information and Quality Authority on a number of projects; member of two clinical research oversight boards; external examiner in Trinity College Dublin and the Law Society; legal expert for UNESCO Global Ethics Observatory Project; Visiting Professor at the University of Leicester; Fellow of the Hastings Center in the United States; and Chair of the Ethics Committee of two EC funded research projects. She is also a regular media commentator on matters related to medical law and ethics, and a guest speaker at national and international conferences and other educational events.
Trait selection means that Steinberg would allow parents to choose, hair colour, eye colour and skin type of their off spring.
You have been doing gender selection for over 13 years now, can you tell us a bit about how this has developed as a form of IVF in the US, and how big this is as an industry in America?
Business has changed dramatically since I started offering the service, and almost every country in the world has used gender selection at my clinic.
The process means that even fertile couples, who would not be using IVF to conceive, must go through the IVF process to select the gender of their child.
The vast majority of couples using gender selection, are not infertile, the just want to chooses the sex of their baby, and their strong desire to have a girl or a boy makes them decide to go through the IVF process, they would not normally have to do.
You also have had Irish couples that have travelled to you clinics for gender selection?
I have treated up to 50 Irish couples at my clinic.. And I would have gotten a lot more e-mails as well inquiring about the service as well- some have used the New York clinic and some have used the Las clinic.
Can you tell us a bit about the choices that they have made?
It tends to be 60/50 with the them in favor of a boy... these include included a couple who had lost a son in a motorbike accident and wanted their next child to be a boy.
I also treated a mother, who already had a son and daughter, but wanted another girl because she wished her daughter to have a sister.
How does it work?
What we use is called a a pre-implantation genetic diagnosis (PGD) service to select the gender of a new-born.
The women's egg is fertilized with the man's sperm in a lab dish t create embryos, three days later, a tiny straw, smaller than a human hair is used to extract a cell from the embryos.
The cell is microscopic, but it says a lot of things, most importantly, whether the cell is a boy or a girl. Fertility doctors then only implant only the embryo's they want, and if the couple want a girl, they will implant only the female embryos and this is how it is done.
What is the reason why most couples request the service?
Most couples use it for family balancing reasons and I don't really see an problem in helping couples for this reason.
What is you own personal view on gender selection?
I see it as a very happy form of medicine, and thing about it is that couples go away very happy all the time, so despite the criticisms, it can work out very well for lot of people. Couples longing to have a girl or a boy, can now have their wish granted.
Last year, you said your fertility Institutes Clinic would allow parents to choose traits such as eye colour and hair type for their new born, can you tell us how this is actually possible?
This can be done using a pre-implantation genetic diagnosis (PGD) service to select traits of a new-born.
This method was first used to detect early genetic diseases, whereby couples undergoing in-vitro fertilisation (IVF) can have embryos screened to be evaluated for hereditary problems.
With advances in IVF, we are able to select traits in the embryo, and these traits are: eye colour, skin tone and hair color - that is the three at the moment.
What are the traits?
Eye, skin and hair color.
You have since backed down on this, and only allow the service for 'medical reasons' can you tell us what those medical reasons are?
One example would be if a couple have a child that might be albino, then we can do some work with them. In albino children, there is no pigmentation in the pupil of an eye and this can lead to blindness so what we can do is change this, to make sure that pigmentation will be in the eyes of their child.
Have you have any queries on trait selection from couples, not for medical grounds?
Yes, I would have had a few, these requests are 'on hold' at the moment.
What do you think will be possible in the future of IVF?
Well, at the moment, we are screening embryo's for cancer and things like that, so there is there is a lot of advantages for things like that and I would look at it as an exciting time.
What is you view on trait selection, we know that it can be offered, even though Dr Steinberg has said that he will only use it for 'medical reasons', you have described it as a slippery slope?
We have to understand that IVF treatment is a multi-billion dollar industry and when proposed services for trait selection are offered, we have to start asking questions about where we draw the line and what future consequence this might have. More to be added by her.
Gender selection, when uses for specific purposes, could also be viewed as a discriminatory method, is they your view?
A couple may want to use embryo diagnosis if it is the case where a disease might run in the father's side of the family, for example, which is understandable. Other parents may want to embryo diagnosis to choose a son or daughter if they have three girls, for example, and it is then used as a method of family balancing'.
But it is selection cases outside of this, where ethical questions on discrimination could potentially arise?
Yes, if for example, a couple want to choose a boy as a first child, it may pose the questions as to why this choice alone was made, and it could therefore be seen as discriminatory if a girl is chosen instead of a boy, or vice versa''.
Gender selection has been used regularly in China and India?
The Fertility Institutes Clinic also advertises in Chinese media and the clinics Asian clients are reported to favor boys because of cultural pressures.
After China's one-child policy was instituted in the 1980's, it is believed that this increased pressures within the country to procure a boy as the "one child''. There is a view that it can skew the male female ration in some countries, and I suppose that this is possibly a danger.
Deirdre, you were a member on the Commission for Assisted Human Reproduction (AHR) that in 2005 recommended that IVF embryo diagnosis or PGD to be allowed in Ireland for the treatment of serious genetic disorders?
Yes, we recommended that it would be recommended that IVF embryo diagnosis or PGD to be allowed in Ireland for the treatment of serious genetic disorders.
What type of disorders?
Huntington's disease and cystic fibrosis.
At present there is no legislation in Ireland for AHR and associated procedures and practices and effectively gender selection could be set up in Ireland?
Yes, I suppose now is a good time to be discussing these issues.. It is important that regulation is put in place as there is currently a lack of clarity surrounding many areas of Assisted Human Reproduction in Ireland.
Because of the recent supreme court decision in December, (where the Supreme Court ruled that human embryos outside the womb are not "unborn," and therefore are not protected under the country's constitution), this effectively means that any fertility doctor could set up PGD as a means of gender selection in Ireland.
At the moment IVF is unregulated in Ireland, and the industry is only regulated by the Irish Medicines board, but this from a safety perspective, not on the grounds of regulation of practices.
Trait selection could also be set up in Ireland?
Yes, the same applies to trait selection as it uses PGD as well.