When embryo testing prompts moral questions: health implications of polygenic screening and eugenics concerns

A recent Vox Future Perfect explainer examined how modern embryo testing sits at the crossroads of medicine, ethics, and everyday parenting, highlighting a growing tension between the desire to give a child the best possible start and the risk of medicalizing every aspect of human variation.

The piece centers on a reader Question from a reader who has several embryos after IVF and faces the choice of which one to implant. The fertility clinic has urged PGT-A testing, which screens for conditions such as Down syndrome and reveals embryo sex. The reader also encounters newer polygenic testing that promises to estimate risk for a wide range of complex traits and diseases, and even hints at enhancements like height or IQ. The columnist notes that the appeal is powerful: if tests could help predict and prevent health problems, wouldn’t parents want to use them to give their child the best possible life? The column also cautions that those promises come with real limitations and ethically fraught implications.

The simpler, longer-standing test, PGT-A, has existed since the 1990s and can screen for certain genetic conditions while revealing the sex of each embryo. The columnist emphasizes that sex determination at the embryo stage does not predict a child’s gender identity, a distinction that matters for parents wrestling with expectations. The newer technology, polygenic testing, looks at thousands of genes to estimate risk for complex conditions—ranging from cancer to mental health issues—and even to forecast traits such as intelligence or height. The piece stresses that these are probabilistic assessments, not guarantees, and that misinterpretation is common among consumers who encounter optimistic marketing.

A central warning comes from statistical geneticist Sasha Gusev, who cautions that absolute risk reductions touted by some companies can be misleading. For example, a claim that a child’s risk of Type 2 diabetes is reduced by 12 percent may be misread as a dramatic decline in lifetime risk. In reality, the change typically shifts a child at higher end of risk into a different category, or merely postpones onset. The same caveat applies to other diseases such as breast cancer. The columnist notes that such estimates rely on statistical assumptions that often overstate benefits and create confusion for parents trying to weigh options in a single pregnancy.

The piece also distinguishes physical diseases from mental health conditions, arguing that polygenic scores perform less reliably for psychiatry. Psychologist Eric Turkheimer is cited as saying that many mental health conditions exist on a spectrum and that the current models treat most forms of distress as variations on normal behavior. The columnist shares a personal anecdote, discussing generalized anxiety and obsessive tendencies and recognizing how traits can coexist with other valued abilities, such as creativity. This leads to a broader scientific point: pleiotropy, the idea that a single gene can influence multiple traits, complicates attempts to “optimize” a child by editing away a negative trait without inadvertently affecting other desirable qualities. If a gene associated with depression also correlates with traits the parent values, the net effect may be unpredictable.

The ethical landscape expands beyond biology to questions of social impact. Polygenic testing can encourage a view of children as objects to be optimized, potentially eroding the psychological foundation of parent–child relationships. Even when a screening tool correctly predicts a risk, the emotional toll on families can be significant if a child is not what parents anticipated. The piece notes that some companies frame their products as enabling parents to “protect” their children from disease, employing language that can feel coercive or fear-based. Abby Lippman, an epidemiologist cited in the column, argues that genetic testing can paradoxically reduce parental choice by pressuring families into certain paths under the guise of autonomy.

Cost and access further complicate the ethics. Polygenic testing is not cheap; the article cites Orchid, a company that charges about $2,500 per screened embryo, potentially creating a widening gap between those who can afford such screening and those who cannot. While technology tends to get cheaper over time, the immediate effect could be a societal tilt toward selective enhancement that privileges wealth and exacerbates inequities. The column suggests that if social systems respond to widespread genetic optimization, a new form of coercion could emerge, where not opting into genetic alteration becomes viewed as a liability rather than a personal choice. In this context, some philosophers have argued that parents have a moral obligation to seek the best possible life for their offspring, a view the column cautions against, noting that it can be misused to pressure families into expensive, high-stakes decisions.

The Vox piece also offers a framework for thinking through these technologies. It introduces the idea of satisficing—choosing options that are “good enough” rather than optimizing along a single metric. In the context of embryos, this could mean prioritizing screenings for conditions that are debilitating or life-limiting, such as Tay-Sachs or certain BRCA-related cancers, where the benefits of screening are clearer, while recognizing that many complex conditions—like some forms of autism or anxiety—often involve a mix of neurological diversity and resilience that can coexist with a meaningful, happy life. The columnist argues that even when screenings can provide benefits, societal and environmental supports can achieve similar improvements without reinforcing a market-driven fantasy of perfect health.

Ultimately, the author refuses to prescribe a universal list of tests to pursue or forego. The key, the piece argues, is recognizing one’s own limits and values: the emotional, social, and financial resources available to a family, the tolerance for uncertainty, and the willingness to confront the possibility that predictive tools may not align with lived outcomes. The columnist urges readers to resist pressure and shaming from profit-driven marketing, insisting that they remain moral agents who weigh the full spectrum of factors before making a decision. As the piece puts it, genetic testing is supposed to expand parental choice, but in practice it often narrows it by amplifying fears and shaping expectations through marketing that equates better health with absolute control over a child’s destiny.

Beyond the clinic and the marketplace, the Vox explainer also situates the debate in a broader cultural context. It cites examples from Silicon Valley’s fascination with IQ enhancement and references a broader literature on prenatal testing, including discussions about Down syndrome’s place in public imagination. The author notes that the entangled mix of science, aspiration, and fear makes this a particularly risky moment for expectant parents, who may be navigating both the excitement of new possibilities and the real consequences of choosing among embryos with imperfect information. The piece closes by underscoring one simple, persistent truth: parents deserve agency, guidance grounded in science, and a framework for making decisions that reflects both health realities and the imperfect nature of predicting human life. The reader is reminded that the goal of medical advances should be to support families and individuals in living healthy, meaningful lives—without compressing the full human story into a single statistical projection.