Will Preimplantation Genetic Diagnosis Offer the ?Final Solution? to Homosexuality and Gender Variance?

Originally appeared in Transgender Tapestry #104, Winter 2004.

by Petra De Sutter, M.D., Ph.D.

Preimplantation genetic diagnosis
is a technology that screens embryos, obtained through in vitro fertilization,
to be screened for genetic status; only embryos without abnormalities are transplanted into the uterus. PGD is currently most often performed for genetically inheritable diseases such as cystic fibrosis or chromosomal imbalances in the parents, as an ethically defendable alternative to prenatal diagnosis and interruption of an affected pregnancy. To date, about 1000 children have been born worldwide following PGD, and many pregnancies are ongoing (Tanner, 2002).
Indications for PGD are constantly expanding, and already designer babies have been born?babies whose HLA pattern matches the pattern of a sick sibling, so, after birth, the child can successfully serve as a bone marrow donor to a sibling who is (otherwise fatally) diseased (Verlinsky et al., 2001).
A great deal of controversy has arisen concerning the ethical issues of PGD for non-medical indications, such as gender determination (for family balancing)
or creating designer babies. These non-
medical indications are increasingly being accepted by the medical world (Robertson, 2003).
PGD for intelligence or height is not yet possible, but since the completion of the human genome project and the recent development of more powerful genetic diagnostic methods, it?s not unthinkable that one day PGD will be used to screen for these traits.

Recently a debate article was published in Human Reproduction, a leading reproductive medicine magazine, asserting that parents should be permitted to employ PGD to determine the sexual orientation of their children (Dahl, 2003). Of course, a genetic test for homosexuality still does not exist, but if it did, the author claims there are in fact no ethical arguments against such screening.

The arguments Dahl uses to defend PGD for sexual orientation obviously apply equally to screening for gender identity and variance. If a genetic test became available to diagnose transsexuality in an early cleavage embryo, would it be ethically defendable or even advisable to perform this diagnosis and to prevent a transsexual baby from being born?

The fact that homosexuality (as is transsexuality) is not a disease, is, according to Dahl, not an argument against PGD, since medicine provides a variety of services which have nothing to do with disease?for instance, cosmetic surgery. Dahl also doesn?t consider PGD for
sexual orientation to be a discriminatory act against gay and lesbian people because parents would have a choice to test or not to test.

Dahl also holds that parents have the right not to want a homosexual child (or a transsexual one, for that matter). In his opinion, PGD for sexual orientation in no way would worsen the situation of gays and lesbians; he makes an analogy to disabled people. Support for people with disabilities has increased, although the number of people born with disabilities has decreased.

Finally, Dahl believes some people would PGP to screen for a gay child, instead of the opposite.
Reading Dahl?s arguments in favor of allowing parents to choose the sexual orientation of their child, it?s clear that the issue is not an easy one. A homosexual orientation, in the same way as a gender identity issue, can be considered as pathological or as a simple variation of the norm. It can be seen as undesirable, acceptable, or even desirable. It all depends on the ideology, religion, ethics, and most importantly, education of the person who is talking.

Some would consider homosexuality as a normal variation, but transsexuality as pathological. Who would decide on what is acceptable? Although most parents probably would prefer a child who is straight and has no gender identity issues, does this give them the right to influence these traits? What about the rights of the homosexual or transsexual child to be born (or not to be born)?

Should society accept that some individuals consider homosexuality or transsexuality as conditions that are so adverse that gay or transgendered children should not be born? What would gay or transgendered people feel, themselves?

It?s true that some transsexual people feel they would not want children because of the risk that their condition is inheritable (De Sutter et al., 2002). Would they choose PGD and embryo selection?

The past has shown that eugenic practices are extremely dangerous, and it is therefore disconcerting to notice that some people haven?t drawn lessons from history. Of course, PGD is more elegant than the pink triangle. Some people
may object that prevention is altogether totally different from elimination, but in my view this is a matter of semantics.

Although transsexuality is a condition that certainly is accompanied by many emotional problems and medical issues for the individual affected, wanting to eliminate it through PGD seems to me
as abject as wanting to treat it by psychotherapy or electroshock.
Once parents are able to use these
techniques to screen their embryos, undoubtably, most will wish to eradicate all that is divergent from the norm. In my opinion, and probably contrary to the feeling of many transsexuals themselves, we can only hope that traits such as
sexual orientation or gender identity are not purely genetically determined.
Comments regarding this paper would certainly be appreciated; send them to celiends@hotmail.com.

Petra De Sutter is a gynecologist and
reproductive endocrinologist, head of the
Infertility Center of the Gent University
Hospital, Belgium. She is also a professor
in reproductive medicine at the Gent
University. She is a transsexual woman.