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And thus a rash of centers began to use ICSI as a marketing tool, racing to offer it before their competitors had fully mastered the technique. Financially, the new treatment was a boon: centers typically charged an additional $1,000 to $1,500 to perform the procedures. Technically, ICSI allowed many more couples to achieve pregnancy, especially if they suffered from male infertility. Yet medically, the prospects were uncertain. Because ICSI essentially allowed infertile men to father children, it seemed to destine those (male) children to the same genetic fate. According to several studies, male children born via ICSI lacked the same gene that their fathers did, meaning that they, too, were likely to be infertile. [89] By this point, however, demand for the technique was strong and soaring. Tens of thousands of children were born using ICSI during the 1990s, and thousands of additional parents were increasingly eager to try. [90]
Even more controversial—and potentially lucrative—is preimplantation genetic diagnosis (PGD), a technique that allows doctors to screen eight-cell embryos for genetic traits. In practice, PGD is already being used to select among embryos with a high probability of fatal genetic disorders: parents who carry the gene for cystic fibrosis, for example, or Tay-Sachs disease, can use PGD to identify which of several in vitro embryos are free of these dread defects. In theory, though, PGD can do much, much more. It can screen for defects in embryos produced by older women. It can identify embryos with Down syndrome. And potentially, it can enable parents to select their children’s genetic makeup long before they’re born. The vast possibilities of PGD are described in chapter 4. For now, it suffices to mention that PGD screening currently adds an average of about $3,500 to the total IVF bill. [91]
It is entirely possible—even plausible—to conceive of the reproductive market as a small, profitable enclave of sophisticated science. It is a market, first of all, that remains irrelevant to 85 to 90 percent of the population, those lucky enough to conceive their children the old-fashioned way. Nearly by definition, then, it shouldn’t share the traits that characterize the markets for potato chips or sneakers.
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