Three Parent Babies and Infertility: Public Health and the Worth of Genetic Similarity

Reproductive mitochondrial transplantation (RMT) allows women who are not (typically) infertile but carry heritable diseases of the mitochondria to reproduce by inseminating eggs that contain their own nuclear DNA as well as mitochondrial DNA ‘transplanted’ from the egg of another woman. The British approval of RMT is new, but embryos were made from 1996 and offspring in 2003 (McGee 1998, 2003). The goal articulated by UK regulatory agencies is “the chance of having a healthy child” (HFEA 2013). However a healthychild may be had without RKM; prospective RMK candidates seek to birth a child with the maximum amount of genetic similarity, trading off unknown risk of adding genetic material of a third person in order to avoid known risk of heritable mitochondrial disease.

In the domain of public health, resource allocation for treatment of infertility is seen from a different but useful perspective. Is a societal-level commitment to RKM consistent with best reproductive, maternal, and child health practice and policy? Costs associated with developing, providing and regulating assisted reproductive technologies have skyrocketed, and the decision in the U.K. to allow patients to consume public resources for RKM presents an opportunity to analyze the future of reproductive health. Are parents who are able to have children ‘alone’ only if they pass a known, lethal disease entitled to public resources for ‘infertility’ treatments? I assess the goal of ‘genetic similarity’ in the context of public health principles of healthy reproductive outcomes.