Biomedical Engineering Reference
In-Depth Information
4 Gynaecologistsandgeneticists
as storytellers
Disease, choice and normality as
the fabric of narratives on pre-
implantation genetic diagnosis
Kristin Zeiler
Introduction
During the past three decades, several technologies have been developed that allow
medical professionals to assess the physical status of the foetus during a woman's
pregnancy. On the one hand, it has been argued that use of these technologies can
be reassuring for parents who worry that their child may have a certain genetic
disease. They can receive knowledge on which to base decisions of whether to
carry the pregnancy to term. It has also been argued that those who know that
they are at risk of a certain genetic disease and who, therefore, dare not try for
pregnancy may dare to do so thanks to the availability of these technologies. On
the other hand, uses of the technologies have also been criticised for imposing
psychological burdens (Hildt 2002), particularly on women (Lippman 1998).
Today, technologies are not only available for assessment of the prenatal physical
status of the foetus but also for the genetic diagnosis of the embryo.
Pre-implantation genetic diagnosis, hereafter referred to as PGD, implies a
genetic testing of embryos, performed after an ex-corporeal assisted reproductive
technology. Its aim is to identify the presence of genes that will or might result
in a particular genetic disease, and it allows selective transfer and implantation
of embryos into a woman's uterus. PGD can be offered to couples who know
that they are at risk for a certain genetic disease. Furthermore, pre-implantation
genetic
screening
of embryos can be offered to couples who undergo an ex-
corporeal assisted reproductive technology but who are not at risk for a known
genetic disease. The main aim of such genetic screening of embryos is to enhance
the success-rate of the assisted reproductive technology, particularly for women
above a certain age and women who have had previous miscarriages. These
women's embryos may carry chromosomal deviations and such deviations have
been considered a main reason why implantations fail or the women miscarry.
Embryos with chromosomal deviations can be sorted out after genetic screening
(Rubio
et al
. 2003).
The availability and use of assisted reproductive technologies combined with
PGD evoke moral, social and existential questions. When PGD is discussed among
