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By Sameera Khan
It is now possible in Mumbai to diagnose a genetically
abnormal baby within 72 hours of fertilisation, thanks to the rapid
worldwide progress in molecular genetics and advanced laboratory
technology.
Two preimplantation diagnosis techniques are
currently available. Both the Polymerase Chain Reaction (PCR) and
the Fluorescent In Situ Hybridisation (FISH) are not new. They are
already used in prenatal testing.
Dr. Pai, who plans to offer the FISH procedure
to his IVF patients in a few weeks, said when observed under a special
microscope, it was possible to detect the abnormal and defective
chromosomes.
Significantly, it is also possible to detect,
the sex of the embryo with FISH, which is bound to throw up questions
of ethics. In fact, the first case in the city where FISH was used
for preimplantation diagnosis was a case involving determining the
sex of the baby. At the Malpani infertility clinic in Colaba, a
couple who came in for assisted reproduction paid an extra lakh
of rupees to have only male embryos transferred back into the woman's
uterus.
"I didn't see a problem with it since
the couple already had a girl child," says Dr Malpani.
"It's very unlikely that preimplantation genetic diagnosis
can be misused for sex determination. There are so many safeguards
in the form of financial barriers. How many can afford it?"
he asks.
Add Dr Pai, "It's easier to misuse amniocentesis,
which is cheaper (Rs 4,500 to Rs 6,000) and easier to do, but since
this is a high-end, highly skilled technique, its role as a sex
determination test is limited."
But Dr Parikh of Jaslok remains unconvinced.
"If used correctly, preimplantation genetic testing can be
a boon for older women, for those suffering recurrent miscarriages
or having a family history of genetic disorders," she says.
"But if it is not correctly supervised and handled with care,
it can be misused for sex determination by some and we should be
constantly aware of that danger."
With several more fertility clinics springing
up every day all across the country and increased competition in
the business of making babies in the lab, what is feared is that
medical ethics may somewhere be compromised. Just as the use of
amniocentesis for sex determination was banned by the Prenatal Diagnostic
Techniques (Regulation and Prevention of Misuse) Act, 1994, health
activists say that the newer diagnostic methods will also have to
be regulated and monitored.
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