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Unrealistic Parental Expectations Encourage Misuse Of New Genetic Technologies In IVF – Dr Alexis Heng Boon Chin

Social pressure may make it difficult for prospective parents to resist using new genetic technologies, says Dr Alexis Heng Boon Chin. This could be further exacerbated by the aggressive sales pitch and sly marketing gimmicks of profit-driven private fertility clinics, resulting in the unnecessary and wanton use of IVF and other clinical assisted reproduction techniques, which were originally developed and intended for the treatment of infertility.

Photo by Mart Production/Pexels.

In recent years, Malaysia has experienced a rapid decline in its fertility rate like most other Asian countries. This hit a 50-year low of 1.6 children per woman in 2022, which has sparked much concern among government policymakers and university academics.

A sense of demographic crisis is in the air. Community health expert Dr Sharifa Ezat Wan Puteh of Universiti Kebangsaan Malaysia (UKM) warned that an insufficient number of young people will have severe repercussions on the labour force in the near future, which would necessitate the recruitment of foreign workers.

Her views were echoed by the chief statistician of Malaysia, Mohd Uzir Mahidin, who predicted that the drastic decline in fertility rates in recent years signalled the potential for a demographic crisis such as a rapidly ageing and declining population with a shrinking workforce, which in turn has dire economic and social implications for the country.

Financial constraints due to inflation and rising costs of living, which were exacerbated by the recent Covid pandemic, together with growing work pressures and increasing expenses of child upbringing and education, have indeed discouraged many families from having more children in recent years.

Increasingly Unrealistic Parental Expectations In An Era Of Low Fertility Rates

In an era of low fertility rates, parents would naturally and instinctively pin all their hopes and expectations on their fewer children, resulting in more money, time and effort being invested per child.

While this certainly has its advantages, the downside is increasingly unrealistic parental expectations and pressure on children to perform and even excel academically, often at a level that may be beyond their innate talents and abilities.

In Malaysia, like most Asian societies, there is a deeply ingrained cultural trait of individuals comparing themselves to their peers, often resulting in much personal dissatisfaction when they see others doing better than themselves.

The same holds true even within the realm of parenting. Probably, the best example is private enrichment and tuition classes.

Many parents are willing to spend large sums of money on these, simply because they are anxious and afraid that their children may fall back academically behind their peers if they are not made to attend such classes.

Indeed parenting anxiety is common in Asian cultures due to parents feeling they are not doing enough in comparison to what other parents are doing in sending their kids to the best schools and enrolling them in the best tuition classes. 

When children bring home their examination results, one of the first things that many parents will often ask after seeing their report book is how well their classmates did. 

Such fixation on how one compares to others makes parenting extremely stressful, which in turn piles up undue pressure on children to compete with their peers rather than focus on holistic learning and self-improvement.

Then, there is also the prevalent concept of “family honour” and “face” in Asian societies such as Malaysia. Children who do badly in school and fail their tests and examinations are deemed to have caused their parents to “lose face” in front of their relatives and friends.

As a result, the phenomenon of “tiger-parenting” is becoming more commonplace in Malaysian society, with parents often pushing their children into the educational rat race at a very young age, typically spending a large proportion of their disposable income on after-school tuition fees.

Hence, it is no surprise that such educational pressures together with the heavy financial burden of expensive private tuition and enrichment classes often deter many families from having more children.

Additionally, many high-income prospective parents often compete to get their children into the best schools even before they are born, through expensive purchases of residential properties near prestigious primary schools.

Such heavy investment in time, money and effort required for child-raising, particularly in large urban areas of Malaysia, would indeed be a daunting prospect for any parent contemplating adding more children to their family.

Hence, there is a vicious cycle of low fertility rates promoting unrealistic parental expectations, which could in turn further depress fertility rates.

Permitting Misuse Of New Genetic Technologies In IVF Could Further Exacerbate Demographic Crisis

Looking to the future, Malaysian government policymakers should be far-sighted and identify new risk factors that could further lower the country’s already dismal fertility rates.

Lurking on the horizon is the misuse of new genetic technologies in fertility treatment, purportedly for health optimisation and genetic enhancement of offspring.

For example, the controversial use of predictive genetic tests to select the “best” IVF embryos for optimal health and intelligence, in what is known as pre-implantation genetic testing with polygenic risk scoring (PGT-P).

Then, there is also gene editing of human embryos to amplify non-disease-related socially-desirable traits such as high IQ, athletic prowess and physical characteristics linked to beauty standards such as height, complexion, eye and hair colour.

Many scientific experts have pointed out that such techniques will not work very well for the selection or genetic engineering of complex traits such as intelligence, height and complexion. Because such traits are determined by the complex interaction of multiple genes with the environment.

Moreover, the usefulness of predictive genetic tests such as PGT-P in selecting such complex traits is severely reduced by the small number and limited genetic variability of IVF embryos produced by the same pair of parents. 

There is a much-reduced number of possible outcomes when selecting specific characteristics within such a small sample size with limited variability, which obviates the usefulness of any such predictive genetic tests.

Additionally, there are also other very obvious technical limitations. For example, the statistical probability of two short parents conceiving a tall child by predictive genetic testing would always remain low, because most of the genes that predispose to tallness are simply absent in those parents. 

The same can be said of two dark-skinned parents attempting to have a fair-skinned baby.

Nevertheless, it is not the real effectiveness that really matters to fertility clinics. Because prospective parents naturally and instinctively want the best for their children, these thus represent particularly lucrative business opportunities for fertility clinics.

Social pressure may make it difficult for prospective parents to resist using such new genetic technologies, if these become a trend and fashion in society, which could be further exacerbated by the aggressive sales pitch and sly marketing gimmicks of profit-driven private fertility clinics. 

A sense of “guilt” might be instilled in prospective parents for not utilising such new technologies to give their offspring the best start in life.

More disturbingly, this could lead to the unnecessary and wanton use of IVF and other clinical assisted reproduction techniques, which were originally developed and intended for the treatment of infertility. 

Healthy and fertile couples might deliberately choose to have a child via IVF, just to utilise such new genetic technologies to optimise the health and intelligence of their offspring.

Not only are such treatments expensive, but they are also highly invasive and risky. Hence, unnecessarily subjecting healthy and fertile patients to such gruelling medical procedures, not to prevent specific genetic diseases but for human enhancement with new genetic technologies, must be considered a form of clinical malpractice.

Because all these will certainly not come cheap, many prospective parents desiring two or more children may eventually settle on having just one “genetically superior” child due to the high costs involved.

Conclusions

In conclusion, Malaysian government policymakers should attempt to initiate a broad shift in societal mindset on the unrealistic and almost unattainable expectations that many parents pin on their children, as part of a comprehensive strategy to boost the country’s low fertility rate.

They should also be particularly wary about the potential misuse of new genetic technologies for optimising the health and genetics of offspring. Furthermore, there could also be psychological and social impacts resulting from the misuse of such technologies.

After spending so much money, parents may even develop more unrealistic expectations of their “genetically enhanced” offspring. Children born through such procedures may have disturbing feelings of being treated like “lab rats,” and that their parents do not love them unconditionally as who they are, regardless of their talents and abilities.

Dr Alexis Heng Boon Chin, originally from Singapore, is an associate professor of biomedical science at Peking University, China.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of Ova.

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