mate, but should not be much higher than prenatal testing on chorionic villi sampling or amniotic material with the same DNA technology. The cost of IVF was a recurrent topic of concern. In the United States it can range from $1,500 to $12,000 a cycle. On average, three or four cycles are performed in the course of treatment. An interesting comparison may emerge between IVF pregnancy rates of parents utilizing preimplantation genetic analysis, who have normal reproductive systems, and rates among the more common IVF parents who have reproductive difficulties.

A persistent question concerning genetic analysis is confidentiality, for example, when an embryo is implanted that is known to be an unaffected carrier of genetic disease. Such concerns exist against a broader background involving a growing number of genes being sequenced and the way in which decisions will, or should, be made—and by whom—regarding access by government or private insurance companies to a patient's genetic profile.3 As one participant pointed out, everyone carries genetic traits potentially detrimental to one's self or one's offspring. As information accrues, the way in which insurance risks are calculated may have to be reconsidered.


For more thorough discussion of these issues, see U.S. Congress, Office of Technology Assessment, Cystic Fibrosis and DNA Tests: Implications of Carrier Screening, OTA-BA-533, U.S. Government Printing Office, Washington D.C., August 1992; Institute of Medicine, Assessing Genetic Risks: Implications for Health and Social Policy, National Academy Press, Washington D.C., 1993; and Institute of Medicine, Social and Ethical Impacts of Advances in Biomedicine, National Academy Press, Washington D.C., 1994 (in press).

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