State of the ART : Emerging genetic technologies in reproductive medicine are rapidly making real what once was science fiction?are we ready for it?

In 1997, a science fiction film titled Gattaca premiered in U.S. theaters, depicting a society sometime in the not-so-distant future in which people are crafted for and judged by the quality of their genetic material. Unhealthy genetic predispositions to conditions such as heart disease and mood disorders are neatly avoided through the careful selection and manipulation of embryos well before pregnancy. “I have taken the liberty of eradicating any potentially prejudicial conditions,” explains a genetic counselor to a couple onscreen. “Premature baldness, myopia, alcoholism and addictive susceptibility, propensity for violence, obesity, etcetera.” Those born without the benefit of such interventions become the dregs of society-weaker, sicker, and never quite as successful. This scenario would likely never happen in real life. Except here's the catch-fertility specialists are already selecting embryos against cancers as well as genetic and neurological diseases. They're on the brink of being able to analyze an embryo's whole genome, while the technology that would enable precise manipulation of that same genome not only exists but has worked beautifully in monkeys. Right now, in the United States and the United Kingdom, certain forms of germline modification to human embryos are not only on the regulatory table but looked on with an apparent degree of favor. The day may no longer be so far away when it won't be technology or biology that will hold reproductive medicine back from this sort of future but simply science's stillnascent understanding of genetics. This is forcing a new urgency on long-debated dilemmas in reproductive medicine about who should be born and with what advantages or disadvantages. Indeed, as one panelist said at a 2011 gathering of leading embryo genetics pioneers [1], “As far as I am concerned, Gattaca is here.”