tokyo

Japan has taken its first step towards introducing preimplantation genetic diagnosis for human eggs that have been fertilized in vitro, with the approval last week by the Japan Society of Obstetrics and Gynaecology of guidelines covering such procedures.

The society's move ends a five-year stand-off between members of the society and an anti-eugenics' patients' advocacy group over the approval of preimplantation genetic diagnosis. The procedure allows couples to ask for eggs used for in vitro fertilization (IVF) to be discarded if certain types of hereditary disorder are detected in the genes.

The society was last year forced to postpone the approval of guidelines for the genetic diagnosis of Duchenne's muscular dystrophy and fragile X syndrome in artificially fertilized eggs after opposition from the patients' advocacy group, which accused it of promoting discrimination against the disabled (see Nature 385 763; 1997).

The new guidelines do not specify which diseases are to be tested for. The health ministry lists numerous hereditary disorders that can be detected by this method, but the guidelines say that each case will be assessed on its merits by a specialist committee of doctors and geneticists.

According to the guidelines, various factors will be assessed before the society gives approval for a genetic test, including the type of targeted disease, the genetic histories of the couple, and the facilities at institutions carrying out the test.

The society's existing ethical guidelines, which will now be modified, were drawn up in 1983 and restrict the use of IVF to treatments for infertility.

Kazuo Sato, president of the society, said in a statement that considerable discussion had been carried out with the public over the years, and that the guidelines, drawn up with special attention to the ethical issues surrounding preimplantation diagnosis, were intended to prevent misuse of the technique.

But members of the anti-eugenics patients' advocacy group, which represents more than 30 women's and disabled people's groups, complain that the society's decision has been rushed. One factor, they argue, was the recent furore over a doctor who successfully impregnated an infertile woman by IVF, using her husband's sperm and eggs donated by her sister. Such a practice is not allowed in Japan, as guidelines restrict IVF treatment to married couples, and prohibit the donation of ova and sperm from third parties.

Critics say the clinical application of reproductive techniques should be regulated by a more powerful body than the society. Members can only be expelled from the society if rules have been broken, and previous incidents have shown that the guidelines lack sufficient power of enforcement to prevent the abuse of techniques.

“The society made its decision rather abruptly, and discussions on the ethical and scientific issues seem to have been carried out in an ivory tower,” complains Norio Fujiki, an emeritus professor of medical genetics at Fukui Medical School. “Discussions of bioethical issues related to medical techniques should not be confined to specialists — it should be debated on a national level.”

Fujiki also says that preimplantation diagnosis should be regulated by law to prevent the risk of it being used for other purposes, such as selecting the sex of the child.

According to the Ministry of Health and Welfare, its council on health science plans to draw up new guidelines on reproductive techniques, including preimplantation diagnosis. But it says the potential social impact of the issue means it will need more time to consult the public.