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Survey Suggests Polygenic Embryo Screening Has Higher Public Acceptance Than Anticipated

NEW YORK – Findings from a recent national survey in the US suggest that preimplantation genetic testing (PGT) that includes polygenic testing for medical or non-medical traits may appeal to some Americans, who found the approach less morally fraught and potentially more usable than germline genome editing.

"Understanding which members of the public are most likely to use a technology can inform predictions about societal impact — for example, the extent to which it is likely to enlarge existing or create new disparities," first author Michelle Meyer, a researcher affiliated with the Geisinger Health System's bioethics and decision sciences department and the Geisinger Commonwealth School of Medicine, and her colleagues explained in a policy forum paper published in Science on Thursday. "Much more should be learned about the public's reflexive as well as considered judgements."

In its paper, the team shared findings from a survey performed in the US in January 2022, which asked more than 6,800 preregistered participants about their views on PGT for polygenic risk (PGT-P). The survey also explored participants' opinions about two related but much different services: germline genome editing and SAT test preparation courses, a non-genetic intervention aimed at bumping up an individual's college admission odds, and thus educational attainment.

In contrast to embryo germline gene editing — so far only reported by one Chinese researcher, who was subsequently jailed for his work — the team noted that embryo screening by PGT-P is already being offered commercially in the US and beyond. Consequently, the researchers set out to understand public perceptions of polygenic testing in the PGT setting relative to genome editing and a non-genetic intervention.

In particular, the investigators used a randomized approach to ask participants about the moral acceptability of each service, including medical and non-medical applications of PGT-P or gene editing. They also surveyed potential willingness to use PGT-P or gene editing services while going through the in vitro fertilization (IVF) process, assuming those services were deemed safe and provided free of charge.

The team also gave participants hypothetical information on the uptake of each service by others to look at whether acceptance of PGT-P, gene editing, or SAT prep was influenced by broader social contexts.

In the first question, for example, participants could classify a service as morally acceptable, morally wrong, not a moral issue, or indicate their uncertainty about the morality of the service in question.

While 41 percent of participants said germline genome editing was not a moral issue or was morally acceptable, that figure jumped to 58 percent for PGT-P. For comparison, just over three-quarters of those surveyed had no moral objection to SAT preparation courses.

Survey respondents also used a scale of zero to 100 percent to indicate their likelihood of using PGT-P, gene editing, or SAT prep to increase their child's chances of attending a highly rated college by 2 percent.

There, participants said, on average, that they would be 43 percent likely to use PGT-P. On the other hand, they put the likelihood of using gene editing at 34 percent, and said there was a 69 percent likelihood that they would turn to an SAT prep service for their child.

However, individuals appeared more likely to accept or use each service when they were told that 90 percent of other individuals were using the services, too. In contrast, participants said they were less likely to take advantage of the services when use by other was just 10 percent.

"In the US, there appears to be both greater moral acceptance of, and greater willingness under certain circumstances to use, PGT-P versus gene editing — and the more people used PGT-P, the more likely others say they would, too," the authors reported, though they cautioned that the current data "do not measure willingness to use PGT-P or gene editing among those who would not otherwise already be using IVF."

In their secondary analyses, meanwhile, the researchers found that moral acceptance and likely use of all three services — PGT-P, gene editing, and SAT prep — were somewhat higher in younger survey participants or in individuals with at least a bachelor's degree.

Even so, the authors cautioned, the fact "[t]hat those who themselves have higher educational attainment are more interested in using PGT-P for this phenotype raises the risk that PGT-P will exacerbate existing inequalities."