Dynamics and ethics of reproductive genetics

This chapter on ethical aspects of new genetic diagnostic technologies in reproductive medicine focuses on the use of these technologies in four interconnected contexts, moving from individual patient care to forms of reproductive population screening. In the first half of the chapter we discuss different applications of preimplantation genetic testing (PGT). This includes some new developments in preimplantation genetic diagnosis (PGD), the current debate about aneuploidy screening (PGS-A), and the future prospect of comprehensive genomic embryo screening. In the second half of the chapter we consider proposals for considerably widening the scope of genetic testing in the context of gamete donor screening, with an eye to improving the safety of third-party assisted reproduction. The idea to test all donors (and recipients) for carrier status for a wide array of autosomal recessive disorders directly connects with our next theme: the ethics of offering expanded preconception carrier testing as a form of population screening. From there, we move on to discuss how new genomic technologies have already changed the face of prenatal screening and will continue to do so. In our concluding remarks we briefly reflect on the relation between the dynamics of the field and the ethical debate about new scenarios and challenges.