Elective IVF gains traction. Doctors have concerns.

In vitro fertilization has exploded across America. The number of babies born through assisted reproductive technologies — most of them via IVF — jumped 45% from 2013 to 2022.A more recent part of the surge is elective IVF — still a small share of overall IVF cycles — in which people who could conceive naturally choose IVF to screen embryos for genetic traits linked to cancer risk, IQ, height and more.Why it matters: It's becoming big business, with screening companies promising "generational health." But doctors warn that the science behind embryo scoring for complex conditions is shaky — and could push would-be parents toward major medical and emotional decisions based on unproven data.Plus, elective IVF is reopening old debates about "designer babies," and the ethics of hand-picking certain traits for future children.Catch up quick: Some types of PGT (preimplantation genetic testing) for embryos used in IVF aren't new — but they've gained popularity in the last few years.PGT-A (for aneuploidy) screens embryos for chromosomal abnormalities, such as those linked to Down syndrome. It's something patients with older eggs and/or a history of miscarriage might consider. These tests can also determine sex.PGT-M (for monogenic) screens for rare single-gene diseases, like Tay-Sachs. It's widely supported by major medical organizations for people who know they're carriers.Now, companies are offering the newest type, PGT-P (for polygenic), which uses DNA databases from adults to estimate an embryo's genetic predisposition to conditions that aren't driven by just a single gene. It's the most controversial of the bunch.Zoom in: The polygenic tests can cost several thousand dollars on top of IVF, which can total tens of thousands more.Companies can assess risk for a number of conditions, including autism, Alzheimer's, Type 2 diabetes, arthritis and schizophrenia.State of play: It's an "emerging consumer phenomenon" for people who don't have fertility issues or known genetic risks to do "elective IVF for the purposes of having a healthier, taller [child], whatever 'best' is to them," says Kian Sadeghi, CEO of genetic testing startup Nucleus Genomics.His company screens not only for cancers and other health concerns, but for traits like height, IQ and male-pattern baldness.He said he'd understand if his own mother had chosen to implant an embryo projected to be taller than he is (he says he's 5 feet, 6 inches) — and compares that decision to opting to have your child take human growth hormone or break their bones to get taller."No needles, no surgeries, no blood, no expensive therapies, no invasiveness. [Instead, with PGT-P,] you can help shape height or cancer risk from the beginning with just software," he tells Axios.Between the lines: The use of adult DNA data to make major decisions about embryo selection with PGT-P makes some doctors and bioethicists uneasy."We just don't have a high enough correlation between genes and disease for me to feel good about offering" PGT-P, says Ruth Lathi, an OB-GYN professor at Stanford University School of Medicine who's studied PGT-P."This test could potentially falsely rank or even discard embryos based on these scores that are not proven in today's environment," she tells Axios.And she worries polygenic testing could strain the IVF system, making it harder to access for those who truly need it.Reality check: IVF itself is an invasive and stressful process that involves weeks of hormone shots, surgeries and long waits. If you're doing that purely to be able to give embryos a polygenic screening test, you're introducing a lot of stress "with no proven benefit," Lathi says."Not ready for prime time" is the way New York fertility doctor Lucky Sekhon would characterize PGT-P technology. Even as someone who did PGT-A testing for her own embryos, she says she wouldn't opt for PGT-P.And she doesn't advise that her fertility preservation patients do the genetic tests on their frozen embryos before trying to get pregnant on their own, because for most people it's "not really giving you an edge or advantage."But genetic counselor Maria Katz of Orchid Health, which offers polygenic health screening for a number of health concerns (but not traits like height and IQ), argues that the tests can still be valuable."The way I counsel patients is: 'If an embryo has an elevated flag, it doesn't mean that it'll go on and develop disease," she says. It just means there's "increased risk."She adds that banning or discouraging the technology entirely starts to "lean into paternalism."Zoom out: The rise of polygenic testing is also raising flags about so-called "designer babies." Beyond the ethical questions and sci-fi-inspired concerns, bioethicist J. Benjamin Hurlbut of Arizona State University thinks the bigger issue is relational.He warns that embryo screening technologies risk redefining how parents relate to their future children — turning what should begin as love and anticipation into evaluation.In his view, the right question isn't, "Is embryo genetic screening good technology?" but, "Is it good for a parent-child relationship to begin this way?"What we're watching: Beyond technology used to select human embryos, scientists are also developing — and debating — ways to edit the genes of human embryos.

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