基因技术在生殖领域日益成熟，以Genomic Prediction和Orchid Health为代表的公司已能进行多基因选择，通过基因检测优化胚胎，降低患病风险。Genomic Prediction最初专注于预测糖尿病、精神分裂症等疾病的发生概率，而Orchid Health则提供全基因组测序，能检测更多与自闭症、发育障碍相关的基因变异。尽管这些技术目前仍局限于降低疾病风险，但其发展已引发“设计婴儿”的讨论，因为将选择范围扩展到身高、智商、肤色等性状仅是时间问题。近期，Nucleus公司已率先将胚胎选择推向性状层面，标志着基因技术在人类增强领域的重大突破。

🧬 **基因选择技术已从早期基于外观判断胚胎健康，发展到通过基因检测预测疾病风险。** Genomic Prediction公司在2021年推出了首个多基因选择婴儿，通过对多个胚胎进行基因分型，选择出整体基因最优的胚胎进行植入，以期降低后代患上糖尿病、精神分裂症等疾病的风险。例如，普通人患II型糖尿病的几率为30%，而通过多基因选择，风险可降至20%。

🌐 **全基因组测序技术为胚胎选择提供了更广泛的检测范围。** Orchid Health公司在2023年进入该领域，其提供的全基因组测序能够检测包括自闭症、发育障碍等在内的多种遗传疾病相关的基因变异，甚至包括新生突变，相较于Genomic Prediction仅关注重要基因变异，其检测能力更为全面。

⚖️ **胚胎选择的边界正在模糊，从疾病预防向人类增强迈进。** 尽管Genomic Prediction和Orchid Health声称不提供身高、智商、肤色等性状的选择，但业内普遍认为，将技术扩展到这些“有争议”的性状只是时间问题。最近，Nucleus公司已率先进行性状选择，将胚胎选择的应用范围从疾病风险降低扩展到了人类性状的优化，引发了行业内的广泛关注和讨论。

⚠️ **“设计婴儿”的担忧伴随基因选择技术发展，伦理边界需审慎考量。** 尽管目前的公司声称仅为降低疾病风险，但性状选择的出现使得“设计婴儿”的说法更具现实意义。这种技术的发展不仅涉及科学的进步，更触及深刻的伦理和社会议题，如何在追求健康后代与避免基因歧视、维护人类多样性之间取得平衡，是亟待解决的问题。

[see footnote 4 for conflicts of interest]

In 2021, Genomic Prediction announced the first polygenically selected baby.

When a couple uses IVF, they may get as many as ten embryos. If they only want one child, which one do they implant? In the early days, doctors would just eyeball them and choose whichever looked healthiest. Later, they started testing for some of the most severe and easiest-to-detect genetic disorders like Down Syndrome and cystic fibrosis1. The final step was polygenic selection - genotyping each embryo and implanting the one with the best genes overall.

Best in what sense? Genomic Prediction claimed the ability to forecast health outcomes from diabetes to schizophrenia. For example, although the average person has a 30% chance of getting type II diabetes, if you genetically test five embryos and select the one with the lowest predicted risk, they’ll only have a 20% chance2. Since you’re taking the healthiest of many embryos, you should expect a child conceived via this method to be significantly healthier than one born naturally. Polygenic selection straddles the line between disease prevention and human enhancement.

In 2023, Orchid Health entered the field. Unlike Genomic Prediction, which tested only the most important genetic variants, Orchid offers whole genome sequencing, which can detect the de novo3 mutations involved in autism, developmental disorders, and certain other genetic diseases.

Critics accused GP and Orchid of offering “designer babies”, but this was only true in the weakest sense - customers couldn’t “design” a baby for anything other than slightly lower risk of genetic disease. These companies refused to offer selection on “traits” - the industry term for the really controversial stuff like height, IQ, or eye color. Still, these were trivial extensions of their technology, and everybody knew it was just a matter of time before someone took the plunge.

Last month, a startup called Nucleus took the plunge.

https://www.astralcodexten.com/p/suddenly-trait-based-embryo-selection