Cross-border preimplantation genetic diagnosis.

To the Editor

Bayefsky's article (2016) reflects upon the different approaches to the regulation of cross-border reprogenetic services (CBRS) and preimplantation genetic diagnosis (PGD) as instituted by more-regulated European countries compared to the laissez-faire approach adopted by the USA. Discussing how the current legal vacuum in the USA attracts couples from countries with more restrictive regulations, Bayefsky thereby makes the issue of reprogenetics policies and CBRS particularly relevant.

Taking into consideration our own article on CBRS (Couture et al. 2015) and also ethnographic fieldwork we have conducted in Canadian fertility clinics, we would like to add four additional arguments to Bayefsky's analyses: (i) ‘Law evasion’ appears not to be the only motivation for CBRS in American PGD laboratories – we also noted cooperation between centres in analyzing specific or rare diseases as another motivation. (ii) Not only do couples cross borders, but, in most cases, clinics from around the world send biopsied samples to the USA for analyses through ‘transport PGD’. This offers patients from regions where PGD testing is not available the opportunity to access high-quality testing. (iii) Bayefsky suggests that the detrimental effect of CBRS is the amplification of the usual risks of PGD. There is also the risk that CBRS may result in sub-optimal genetic counselling. Genetic counselling is necessary to help patients understand the implications of genetic testing in the preimplantation period and to assist in their decision-making process. In the context of CBRS, cultural, scientific and linguistic barriers could weaken a couple's informed consent. Furthermore, the success rate of clinics could be exaggerated to attract foreign consumers and create false hope. (iv) Bayefsky's conclusion is that we could find equilibrium between strict regulations and no regulation. We agree with a balanced approach that would address the contested uses of PGD, such as sex selection (Martin 2014).