The risk of genetic defects is not emphasized enough in fertility treatment. NF1 occurs in 1 of 3000 live births. NF1 is characterized by Dr. Kaleb Yohay at NYU as “a common autosomal dominant neurocutaneous disorder with a predisposition to the development of benign and malignant tumors. Mutations in the NF1 gene result in loss of function of neurofibromin 1, a guanosine triphosphatase-activating protein that helps maintain the proto-oncogene Ras in its inactive form. Loss of neurofibromin results in increased proliferation and tumorigenesis.”
Older childless couples seeking fertility treatment may be childless because they are producing a lot of embryos that fail to thrive in the womb because of various genetic defects. There is a technical word (besides “natural selection”) for this biological process of culling (besides “culling”) that happens in the womb. Older parents can overcome this obstacle to conception with IVF, but this can also risk bringing to term children with significant chromosomal breakages who would otherwise not have survived gestation.
Precision medicine doctors should explore the benefits of preimplanation genetic diagnosis using whole genome sequencing, for NF1 and the many other genetic disorders. Whole genome PGD would be a reasonable additional cost of IVF for older parents.