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Comment by robertlagrant | Hacker News Reader

Based on her in utero sonar scans, and her proportional leg measurements, our youngest, Grace, was flagged to us as perhaps going to be born with Down's Syndrome.

That wasn't the case in the end, but at the time it was presented as an earth-shattering possibility to us. That was tough, but we'd resolved long before to not let info like this affect anything, other than needing to make different life decisions, and to be honest she's so amazing that I can't imagine viewing her differently if she did have it.

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One of the advantages (against the many disadvantages) of IVF is the available genetic and chromosome testing of a few days old blastocyst. It makes the decision of discarding much easier than if the screening is done in utero.

> One of the advantages (against the many disadvantages) of IVF is the available genetic and chromosome testing of a few days old blastocyst.

Could you please expand a bit on that?

They can test an embryo before implantation which means you don't have to abort so it has much less emotional impact.

Ah ok, so the test itself is the same, just one is done before implantation, and the other afterwards. Thanks.

Yeah when the blastocyst is a few days old they can extract a few cells and cryogenically freeze the remaining blastocyst with minimal chance of having ruined it. Those cells are sent to a lab and screened for many chromosome and genetic defects.

In fact, ahead of time the IVF clinic will get blood from mom and dad as well as saliva swabs from their parents to build a model on genetic compatibility. For example, the mom and dad may both be carriers for a rare genetic disorder and this can be explicitly tested against each blastocyst to ensure a baby won’t be created expressing that gene which would lead to defect.

And of course the cells will be tested to ensure each chromosome is normal and blastocysts that are defective are discarded.

This isn’t a perfect science as they are slim chances the cells being tested somehow don’t have the right genetic information (this is called mosaicism) but that’s rare. So overall it gives mom and dad the assurance they are having a normal baby from a biological genetic and chromosome perspective. Because IVF is such a long process fraught with danger it’s something many IVF consumers opt for. Of course, there are ethical and moral concerns regarding this for some people so it’s their choice to not do it or do it and request the blastocysts be preserved and potentially implanted anyways. Now THATS an interesting debate.

> Yeah when the blastocyst is a few days old they can extract a few cells and cryogenically freeze the remaining blastocyst with minimal chance of having ruined it. Those cells are sent to a lab and screened for many chromosome and genetic defects.

Would that part would be different from in utero tests? (short of the freezing of course) It has been 15 years that we did the tests (on amniotic fluid) so the world must have moved forward by now.

> to build a model on genetic compatibility.

I guess that this can also be done for "standard" to-be parents.

> or do it and request the blastocysts be preserved and potentially implanted anyways. Now THATS an interesting debate.

Oh yes - the debate on abort or not abort is already have-a-seat-and-get-popcorn worthy, adding to this a dose of "willingly implant a known defective blastocyst" turns that in to an action movie.

I’m not sure on the first question but I imagine that yes, the same types of tests are conducted.

As for any to-be parents - yes and I’d recommend it. You may find you both carry a relatively rare recessive gene that would give your offspring a 25% of having a certain disorder. This can guide your decision on if you want to go forward with natural fertilization and risk it (and make the choice after testing the cells of the developing baby) or opt for IVF to prevent the disorder (and all others that are testable). In parents that don’t have infertility problems, IVF is pretty successful. Especially if the mother is still in prime form (under 35 great but under 30 is spectacular) and the father doesn’t have poor sperm count and/or quality.

For the last one I err towards it being a personal liberty to decide what life you do and do not bring into the world. But it does get more hairy when you start discussing public support in terms of resources to support the child/family. Then it is everyone’s business imo. But I’d imagine people that can afford IVF don’t rely on government programs to finance their life.

I should add - for men with poor count and/or quality there is a product called ICSI which involves the IVF clinic inspecting sperm cells and finding “the best” one and injecting it into the ovum.

To me it’s spectacular how involved we can be in the natural selection process due to our brains evolving so much. I can’t wait to see how we further this.

> For the last one I err towards it being a personal liberty to decide what life you do and do not bring into the world. But it does get more hairy when you start discussing public support in terms of resources to support the child/family. Then it is everyone’s business imo. But I’d imagine people that can afford IVF don’t rely on government programs to finance their life.

It certainly is a personal liberty. I am French, atheist, and I am very much attached to that freedom.

Having healthy discussion about this is good as it is an eye opener for all the sides involved.

Now, there is the general population part: someone who willingly decides to have a sick child that will cost more to the society must be ready to bear all the costs, including the ones after their death.

On the other hand, this should also apply to people who smoke, are overweight etc. and though this choice are also a burden for the society, financially speaking.

The last part (money) is not an easy one. The first one (morality) is much easier as everyone is an expert in the subject :)

> have a sick child that will cost more to the society

This is easy - you just need a way to measure in advance someone's total utility to society, including any inventions they might make, number of people they make laugh or encourage, how many lives or livelihoods they may save, and then decide whether or not they're worth it.

Get back to me when you have that, would you?

Oh come on - you pay taxes, don't you? Either we get rid of money and we live in some kind of wonderland, or we pay for the society and expect it to be serious.

I am very much for a socialist society, like the one we have in France. I am ready to pay, and do it with pleasure, so that people born disabled, or living in poverty have a chance like my children do.

When someone makes the clear decision to have a child that will be disabled then that person must assume that the world will not be running to help them when they realize they have huge expenses. They wanted these expenses so please do not come crying afterwards, though campaigns.

This is very much different from accidents - we need to be solidar here.

This is very similar to people who smoke or eat to become overweight and then cry when comes the operation that costs a fortune.

Sorry - but I want my money to be spent on things that help the ones who need help and did not expect or predict to be in a bad situation. Not the ones who decided to have a disabled child becaise of some shower vision of theirs.

In the scenario mentioned, no one decided to have a disabled child.

See a few steps up in the thread:

Yeah, I still don't see anyone there deciding to have a child with a disability.

What in "to decide what life you do and do not bring into the world" is not clear?

Someone checks for disabilities with their to-be-born child, learns that they have one and then decides not to abort. This means they conscientiously make the choice to have one.

I do not think this need to be debated further.

> decides not to abort

That's deciding not to do something, not deciding to do something.

This is semantics. Deciding not to do something is a decision one takes. It is not like there is no choice.

Yes, and semantics are important. By your definition I make the decision every day not to end the lives of my children, who could for any number if reasons grow up to be a burden on the state.

Calling inaction deciding to do something is just a way to frame things to try and make action the default.

> or opt for IVF to prevent the disorder (and all others that are testable)

This is a point I never considered (theoretically - I am a parent of teens so the question is over for me). I always assumed that IVF is much more risky (all things taken into account) that natural procreation but I have never actually gave a thought on that.

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