“Choice over Chance” - the Discursive Construction of Polygenic Embryo Screening As a Risk Management Technology
Genomic Prediction offers a novel form of susceptibility testing during IVF, known as Preimplantation Genetic Testing for Polygenic Disorders (PGT-P). This technology generates a risk profile for each embryo, estimating the likelihood of developing complex conditions such as schizophrenia, cancer, or cardiovascular diseases, with the goal of helping parents select the 'best' embryo for implantation.
The paper explores how webinar participants describe, justify, and defend PGT-P. Drawing on Science and Technology Studies and governmentality studies, three key discourses emerge: risk, ranking, and choice. These discourses shape and give meaning to various bodies of knowledge—genetics, statistics, bioethics, and medicine—and are tied to different forms of power: the authority of somatic experts and clinicians, the diffuse power of neoliberal governmentality, and the enabling and constraining power of genetic testing technologies.
Genomic Prediction’s key innovation is the "Embryo Health Score", a single metric that estimates each embryo's overall health. This score, along with the use of a bell curve to visually represent risk, introduces a new way of measuring, ranking, and communicating risk. By ranking embryos, the technology echoes historical eugenic practices and influences parental choices by highlighting one outlier—the 'healthiest' embryo. In this sense, parental decision-making is "delegated" to the technology of PGT-P.
In conclusion, the discourses surrounding PGT-P shift reproductive decision-making toward a focus on probability and risk. These discourses position reproductive technologies within a framework where all levels of risk are to be intervened on and viewed as controllable, reinforcing what Finkler (2003) calls an "illusion of control."