Pre-implantation Genetic Diagnosis

Pre-implantation genetic diagnosis (PGD) has been successfully performed in animals and humans to detect a variety of heritable diseases in embryos biopsied during an in-vitro fertilization (IVF) program(36-44). More than 40 births of unaffected children have been reported using polymerase chain reaction (PCR) or fluoroscent in -situ hybridization (FISH) technique to analyze the genetics of single cells removed from early cleavage preimplantation stage embryos(45-47).

Following IVF/ICSI preimplantation genetic diagnosis (PGD) became possible by taking a blastomere from the embryo and performing genetic analysis. Fluorescent in situ hybridization (FISH) with sex and autosomal chromosome probe combinations is used to diagnose embryo sex and aneuploidies. Polymerase chain reaction (PCR) has enormous potentials for genetic diagnosis since it amplifies DNA from as few as one or two embryonic cells. A variey of diseases can be identified in few hours. Sensitivity can be improved by using highly sensitive PCR.

Recent advances in preimplantation genetic diagnosis have significantly increased the possibility of genetic selection at a very early stage. It is now possible to detect these genetic defects before the actual occurrence of pregnancy. Consequently, this will save the couples and the treating physicians facing the dilemma of late prenatal genetic diagnosis with the difficult decision to terminate the pregnancy or not. If serious genetic disorder is detected before implantation, the couple may choose to discard transfer of embryos produced in the IVF laboratory. The decision is taken before the occurrence of pregnancy and it would prevent the birth of a severely handicapped child without the need to induce abortion. A model of this preimplantation screening is the detection of Down’s syndrome, Trisomy 13 and 17, cystic fibrosis, haemophilia, Marfan's syndrome, Bloch-sulzemberg Syndrome (incontinentia pigmentosa), or  X-chromosome linked immune deficiency, retinitis pigmentosa and FG Syndrome (mental retardation and hypotonia), muscular dystrophy and Lesch-Nyhan disease.

Is the choice of preimplantation diagnosis in this case an illicit act ? In the western societies discrimination among persons is strongly condemned. If the embryo is a person then we have towards it obligations as strong as we have towards any other person, but if the embryo is not a person or we do not know whether or not it is, then our obligations towards it are much weaker and practically non-existing. Some authors believe that genetic selection ought to be prohibited because its diffusion is going to change in a fundamental and disruptive way the nature of parenthood. Others believe that genetic selection ought to be permitted because it allows parents to have healthier children(48). The decision not to transfer a certain embryo with certain defects reveals a society's values whether it be intelligence (Down's syndrome), lack of suffering, happiness, freedom or survival of the race(32). Some authors would support that governments should provide voluntary testing facilities, extensive dissemination of information concerning genetic diseases and genetic counselling services(49). Confidentiality should be guaranteed to participants in these programs. Diagnostic aids should be provided for people in high risk categories for genetic diseases. Should the embryo be found genetically defective, not to transfer decision should be left up to the individuals after proper counselling by the physician.

An ethical controversy over fetal anomalies and viability is being raised in reference to the role of newborn intensive nurseries who are sustaining the life in severely deformed babies for the purpose of organ donation(50).

Islam has given a great importance to prevention of congenital malformation. Seeking to protect the well-being of children, it advised man to choose his wife with great care. The Prophet (PBUH) said : "Select your spouse carefully in the interest of your offspring because lineage is a crucial issue"(51). He also said : "Do not marry your close relatives because you will beget weak offsprings"(52). Omar Ibn El-Khattab, one of the Prophet's Companions, noting that the Saib tribe intermarried too frequently, told them : "You have weakened your descendants. You should marry strangers". Islam has also determined the rights of the fetus, that the mother should not harm  or expose the fetus to harm(21).

From a Muslim perspective, if the decision not to transfer is performed to protect the mother's life or health or because of a fetal anomaly incompatible with life, it is acceptable(20).