Nobody's Child, Everybody's Children:

Determinants of Embryo “Health”: Are There Implications for Children?

Recently, there has been an increase in clinical and research focus on determinants of embryo “health”. This development has been partially in response to the imperative to decrease the number of embryos transferred to a woman during in-vitro fertilization (IVF) “treatment” cycles to avoid multiple pregnancies and yet achieve a high pregnancy rate, but also in response to the capacity of preimplantation genetic diagnosis (PGD) to determine particular markers of “health” of interest to prospective parents.

Just as embryo “health” is increasingly subject to genetic and biomedical determinants, it is also subject to social determinants. These social determinants are in many ways analogous to the social determinants of the health of children, such as poverty and related determinants (including nutrition and environment), but are also affected by perceived determinants of what a child’s social health should be, such as desirable cognitive and physical capacity and related social determinants (including high level of education and mobility). Thus, making determinations about embryo health is a multi-dimensional social process that requires location in a political, economic, and social context. 

Further, the concepts of “health,” “disease,” and their social determinants, when applied to embryos, have implications for our understandings of  “health,” “disease,” and their social determinants of children already living, as well as those not yet born. As more genetic and biophysical determinants of “health” become available, a woman may increasingly feel the duty to produce a “healthy” child whenever possible. Thus in determining the criteria through which we assess the “health” of embryos, we must include normative and factual, ethical and legal, as well as scientific lenses.

The final area of our exploration will focus on the lack of sensitivity to the use of the words “health” and “disease,” as well as their social determinants, in relation to the embryo, among scientists, clinicians, and ethicists, and those who write about and use the law. This analysis will include a discussion of how perceptions of these words may be coloured by research interests, financial interests, IVF clinics in pursuit of high pregnancy rates, and the desires of wealthy potential parents to design children of social advantage.