Is It Permissible to Perform IVF To Return Only Healthy Eggs (PGD)?

Question:

Hello Tzohar Ethics, My husband and I recently learned that we are carriers of the BRCA gene, which causes an increased risk of getting sick from a number of different types of cancer. We were offered the possibility of doing preimplantation genetic diagnosis (PGD). In other words, performing IVF and returning to the uterus only the fetuses that do not carry the impaired gene.
As of today, we are not aware of any other fertility issues, chas veshalom. We already know that this is a complex topic, because we are dealing with an invasive, lengthy, and expensive procedure with ethical significance (what if the fetus could be entirely healthy despite the BRCA gene? And what if the fetuses are completely healthy but there are too many of them) and this is despite the chance of disease not being definitive (the gene increases the risk but does not cause the disease). It also occurs in adulthood and there could very well be easier treatments in the future. Of course that are other factors such as the psychological stress that comes with knowing you are a carrier as well as other things.
I am (painfully) aware of both sides but I haven’t been able to find a clear position of halacha and Judaism for the topic. Even if this is permissible halachically and ethically (and it seems to me that this is the case), I would love to understand the reasoning behind this a little bit more in depth and understand what Judaism has to say on the aforementioned dilemma. The argument for the procedure is clear – bringing a healthy child into the world. But to contrast this I have additional questions:
- What is the justification to intervene in these cases at all?
-Why not let God decide?
-How is PGD different than abortion? The fertilized egg can be a future person, perhaps even an entirely healthy one. In other words, there could be fetuses that are “thrown in the garbage”.
-As of today, there is research showing that IVF and PGD are entirely safe. Alongside this, and primarily with everything that PGD involves, there is a lack of long-term studies. In other words, perhaps there are side effects or complications of the treatment and we are not aware of them yet. How can we consider something unknown in the decision?
-Is it right to make different decisions for different children? For example, PGD for the first child and not the others, or the other way around? Or from a moral perspective it is more proper for the decision to be uniform?

Thank you, I am eagerly waiting for your response.

Hello,

The world of genetic research has truly placed realities in front of us where we are exposed to statistical risks when we want to bring a child into this world, and fulfill the mitzvah as well as form the deep connection between parents and children.

PGD is a wonderful technology that brings great blessing to the world.

It is possible that you presented the caution from this at a very high intensity. Granted, we are dealing with an invasive procedure, however extracting the ova are done nowadays as a standard of care, and it is not too long nor as expensive as it used to be; there are no real ethical issues with it because of the fact that we are not dealing with ‘fetuses’ but ‘fertilized eggs’, which according to halachic authorities are considered ‘general innards’ and one should not refer to them as fetuses; etc. Even the IVF process is not defined as spilling seed.

Therefore, the accepted opinion amongst authorities is that using PGD in cases of a genetic mutation is permissible (there is resistance to using this technology to choose the sex of the fetus for non-medical reasons), and it brings much blessing into the world, less psychological stress, etc; In all realms of medicine, if not all, we have received permission from the Master of World to act, and this is true for business (where we do not let “God decide” but do as much as we can, and of course pray for it) all the way to medicine.

As stated earlier, a fertilized egg is not considered a person in halacha, and therefore not using it is not considered an abortion of any fashion.

Regarding the risks: there is no medical procedure without risk. The most practical example is the concern around the COVID vaccine. Despite this, we make an infinite number of decisions in cases of doubt without knowing beforehand. The most prominent example… marriage. When we assess the risk to have children with high probability of breast cancer vs. using PGD – we then can make a fair decision regarding using this technology.

Therefore, the side permitting using this technology in cases where two parents are genetic carriers is very strong, from a halachic, ethical, and medical perspective.

All the best and may you have much joy,

Rabbi Yuval Cherlow

Head of the Tzohar Ethics Center

For additional reading:

Choosing the Sex of the Baby Using PGD From a Public, Ethical, and Halachic Standpoint
Funding PGD
What is Halacha and Mussar’s Approach to Surrogacy?
The Risk that We Don’t Talk About in Emergencies: Neglecting the Ethics of Medical Experimentation