Choose Your Child

Fertility specialist Dr. Jeffrey Steinberg has never been one to shy away from controversy. He has weathered accusations that he is “playing God” since the 1970s, when he was part of the team of scientists that brought Louise Brown into the world through the first successful in-vitro fertilization, or IVF. The outcry got louder in the early 2000s when he began offering clients at his Encino-headquartered Fertility Institutes the ability to select the biological sex of their baby, and became louder still when he started promoting eye color selection in 2008. Steinberg’s work has been bashed by ethicists and scientists alike, with critiques ranging from “irresponsible” to suggestions that he is promoting eugenics. He even received a letter from the Vatican in 2009 asking him to stop offering eye color selection. For some business owners, such a response to their service might give them pause. But Steinberg sees things differently. “Controversy, I don’t think, is ever bad – it inspires thought, which inspires advancement and understanding,” he told the Business Journal. It helps that being controversial has been good for business. News coverage of Fertility Institutes’ eye color service helped boost the number of patients for all procedures by as much as 250 percent over five years. Though Steinberg halted the service back in 2009 due to a combination of factors – including backlash from the public and less-than-ideal equipment – he is now taking reservations once again. He expects that he’ll see an increase similar to when he launched sex selection, which spiked from being requested by 5 percent of clients to nearly 90 percent within just a few years. “(Business from eye color selection) is still small, because we’re just now finalizing everything to put this into big commercial volume,” he said. “I’m predicting that in the next 12 months, it’ll jump up to 35 to 40 percent of what we’re doing.” Eye for business Steinberg offers embryo selection at his Encino clinic – located at 16030 Ventura Blvd. – as well as his clinics in New York, Salt Lake City and Guadalajara, Mexico. He gets referrals for gender selection internationally through the company’s office in India, where it is illegal. “Most of our patients are from the U.S., but they come from all over the world,” Steinberg said. The technology behind his services is called preimplantation genetic screening. Developed in the 1990s to look for disorders linked to sex or a single gene, the process involves checking cells from embryos formed through IVF – artificial conception in which a sperm and an egg are combined outside the body in a laboratory – for the presence or absence of certain genes. Though it is unclear exactly how many fertility clinics in the U.S. offer gender selection, it is safe to say that the option to do so is fairly widespread. It is available locally by at least three other centers, including the three-clinic Care Fertility chain, which has an office in Glendale; the Encino branch of HRC Fertility clinics; and Simple IVF Centers in San Luis Obispo. But Fertility Institutes is the world’s busiest clinic for gender selection, according to Steinberg. It is also the only one in the world that offers eye color selection, as he holds a patent pending for the determinaton and analysis of eye color. Fertility Institutes charges $14,880 for in-vitro fertilization along with sex selection and basic screening for sex-linked diseases. Cosmetic eye color selection is another $7,000 and is only available as an add-on to sex selection. While only 5 percent of clients opt for the procedure, it is the focus of about 45 percent of e-mail inquiries, Steinberg said. “We can see the wave coming,” he added. There is still a lot of research to do before the success rate of eye color selection is the same as those for sex. While Fertility Institutes boasts a nearly 100 percent guarantee that the baby will be of the parent’s chosen sex, the nuances of predicting eye color make selecting it far more complex. Both parents must possess the right genetic “building blocks” – including the absence of some genes and the presence of others in a very specific order – for the eye color they want. Even then, the procedure for determining an embryo’s eye color remains challenging, Steinberg explained. “The technology to be able to measure the eye color of a single embryo is here, but only on a very labor-intensive basis,” he said. “That’s not going to work for being able to offer people a choice of eye color.” Steinberg is working to obtain a second patent for a gene chip that will improve precision and efficiency by automatically analyzing the various genes for eye color at once. He has partnered with several private firms for the research process, which includes analyzing the blood of donated embryos for eye color genes, and he expects to secure a patent within the next 12 months. Fertile future In the not-so-far-off future, eye color will be but one item on the menu for Fertility Institutes clients. Steinberg foresees hair color and height on the list soon. “Once we know where the genes are, we can work with them,” Steinberg explained. For Steinberg, aesthetics are less exciting than the prospect of being able to analyze embryos for genes that are linked to debilitating health conditions, such as autism. Along with eye color, Fertility Institutes hopes to include a screen for the genes linked to the disorder on its forthcoming chip. The next big thing for fertility is CRISPR/Cas9, a type of technology that uses a sequence of DNA to edit genes. The process and outcomes are very different from the services Fertility Institutes offers, Steinberg explained. “We’ve been doing genetic analysis,” he said. “CRISPR is genetic engineering.” CRISPR allows certain genes to be altered or cut out of the genome, making its potential utility virtually boundless in terms of treating disease. Steinberg imagines a time when devastating mutations, such as those linked to hard-to-treat cancers, can be clipped out. The genetic code for certain types of anemias, Tay Sachs disease and others will be removed before the baby is conceived. “Things you’d be absolutely guaranteed to get, you aren’t going to get,” Steinberg said. Though the technology is currently used on embryos in the U.S. in research settings, it is not yet legal to do so commercially. Steinberg imagines that once CRISPR is deemed safe, it will not be long before the government gives a greenlight to use it in a clinical setting. “It’s on the launching pad,” he said. “Once they say go ahead, each project will be closely monitored, but it’s not that far away.” Ethical dilemmas The concept of genetic modification has been a hot topic among doctors, scientists and ethicists, mainly because of the prospect of those who can afford the technology will gain even greater advantages over those who cannot. But while some futurists envision a world where even intelligence can be engineered, Steinberg thinks science is a long way from being able to pull off something so complex. “Intelligence is multi-genetic,” he said. “We don’t have a clue about what’s going on with someone who’s very intelligent versus someone who’s not.” But for some, embryo selection alone still raises significant ethical issues. Choosing an embryo at the cost of discarding others conflicts with theological ideas that maintain that human life begins at conception, explained Biola University professor Dr. Scott Rae, who previously served as a consultant to the ethics committee at Providence St. Joseph Medical Center in Burbank and Providence Holy Cross Medical Center in Mission Hills. “This is where we have a really fundamental, foundational difference,” Rae said. “Embryos … aren’t just clumps of cells or akin to a bag of marbles.” Those that are donated for research are ultimately discarded, he noted, which constitutes a disregard for human life. He also feels that having the option to choose embryos with certain traits contributes to inequality in similar ways as genetic modification. “You end up exacerbating the divide between the medical haves and have-nots,” Rae said. “(That cements) a socioeconomic advantage in place through genetics and biotechnology.” He does see a place for such advancements in preventing disease, however, as does Dr. Rivka Weinberg, a philosophy professor at Scripps College in Claremont who has a specialty in bioethics. She also shares Rae’s concerns about the potential societal impact of genetic selection – and about how it could impact children who grow up under the expectation that the genes their parents chose for them will manifest in special talents. “You don’t need to be anything special to live a good life – that’s not the right way to enter parenthood,” Weinberg said. “For this kind of technology to be used for anything other than to avoid or resolve a medical condition leads, in my opinion, to sets of problems with parental attitudes.” Steinberg does have prospective clients who are interested in choosing genes that would make their child musically or athletically gifted, he said. Those couples or individuals are sometimes referred for counseling before being admitted to the clinic’s programs – and occasionally they are rejected. “People want to know if we can make good tennis players, or good dancers or singers,” Steinberg said. “That brings up a little bit of concern on my part. … Unrealistic expectations is the biggest reason we reject.” Yet he sees no harm in giving parents a little more choice in the aesthetic traits of their future child. And while he understands the concerns, he is confident that opinions will change as the technology is more widely adopted. “Everything that starts off new is scary and people are wary of it, and maybe that’s the way it should be,” Steinberg said. “But with time, people get used to it.”