Selecting What? Pre-implantation Genetic Diagnosis and Screening Trajectories in Spain

  • Vincenzo Pavone
  • Sara Lafuente Funes


Based on research conducted in Spain, this chapter follows the narratives of 21 women undergoing in vitro fertilization (IVF) with prenatal genetic diagnosis or screening (PGD/PGS). The analysis shows that there exist relevant differences between the experiences associated with these techniques and their related medicalization process. While the trajectory of women undergoing PGD for chromosome translocations or miscarriages resembles the PGS trajectory, women undergoing PGD in order to have offspring free of a specific genetic condition follow a different trajectory. While selection is always at work, the experience of it may vary significantly.


PGD PGS Spain IVF Miscarriages Chromosome translocation Trajectory 


  1. Adeces. 2015. Técnicas de Reproducción Asistida La necesidad de invertir, 1–50. Madrid: Asociación pro Derechos Civiles, Económicos y Sociales.Google Scholar
  2. Alonso, Marcelo Palacios. 2005. Ley Sobre Técnicas De Reproducción Asistida (35/88): De 1988 a 2005. In Estudios Jurídico-Penales Sobre Genética Y Biomedicina: Libro-Homenaje Al Prof. Dr. D. Ferrando Mantovani, ed. Carlos Aránguez Sánchez and Carlos M. Romeo Casabona, 33–69. Madrid: Dykinson.Google Scholar
  3. Arribas-Ayllon, Michael, Srikant Sarangi, and Angus Clarke. 2013. Genetic Testing: Accounts of Autonomy, Responsibility and Blame. London: Routledge.Google Scholar
  4. Bergmann, Sven. 2014. Fertility Tourism: Circumventive Routes that Enable Access to Reproductive Technologies and Substances. Signs 40 (1): 280–289.Google Scholar
  5. Bumiller, Kristin. 2009. The Geneticization of Autism: From New Reproductive Technologies to the Conception of Genetic Normalcy. Signs: Journal of Women in Culture and Society 34 (4): 875–899.CrossRefGoogle Scholar
  6. Bumiller, Kristin. 2014. The Geneticization of Autism: From New Reproductive Technologies to the Conception of Genetic Normalcy. Signs 40 (1).Google Scholar
  7. Bunton, Robin, and Alan Petersen. 2005. Genetics and Governance. Genetic Governance 18: 1.CrossRefGoogle Scholar
  8. Castiel, Luis David, Maria Cristina Rodrigues Guilam, Paulo Roberto Vasconcellos-Silva, and Javier Sanz-Valero. 2006. Genomic Risk and Personal Responsibility in Health. Revista Panamericana de Salúd Publica 19 (3): 189–197.CrossRefGoogle Scholar
  9. Clarke, Adele E. 2003. Biomedicalization. In The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society.Google Scholar
  10. Clarke, Adele E., Janet K. Shim, Laura Mamo, Jennifer Ruth Fosket, and Jennifer R. Fishman. 2010. Biomedicalization: Technoscientific Transformations of Health, Illness, and US Biomedicine. In Biomedicalization: Technoscience, Health, and Illness in the US, ed. Adele E. Clarke, Janet K. Shim, Laura Mamo, Jennifer Ruth Fosket, and Jennifer R. Fishman, 47–87. Durham: Duke University Press.Google Scholar
  11. ———. 2003. Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine. American Sociological Review 68: 161–194.CrossRefGoogle Scholar
  12. Creswell, J.W. 2013. Educational Research: Planning, Conducting, and Evaluating Quantitative and Qualitative Research. Upper Saddle River, NJ: Pearson Education.Google Scholar
  13. Cussins, Charis. 1996. Ontological Choreography: Agency Through Objectification in Infertility Clinics. Social Studies of Science 26 (3): 575–610.CrossRefGoogle Scholar
  14. Drazba, Kathryn T., Michele A. Kelley, and Patricia E. Hershberger. 2014. A Qualitative Inquiry of the Financial Concerns of Couples Opting to Use Preimplantation Genetic Diagnosis to Prevent the Transmission of Known Genetic Disorders. Journal of Genetic Counseling 23 (2): 202–211.CrossRefGoogle Scholar
  15. Ehrich, Kathryn, and Clare Williams. 2010. A ‘Healthy Baby’: The Double Imperative of Preimplantation Genetic Diagnosis. Health 14 (1): 41–56.CrossRefGoogle Scholar
  16. Ehrich, Kathryn, Clare Williams, Bobbie Farsides, Jane Sandall, and Rosamund Scott. 2007. Choosing Embryos: Ethical Complexity and Relational Autonomy in Staff Accounts of PGD. Sociology of Health and Illness 29 (7): 1091–1106.CrossRefGoogle Scholar
  17. Finkler, Kaja. 2011. Experiencing the New Genetics: Family and Kinship on the Medical Frontier. Philadelphia: University of Pennsylvania Press.Google Scholar
  18. Franklin, S. 2006. The IVF-Stem Cell Interface. International Journal of Surgery (London, England) 4 (2): 86.CrossRefGoogle Scholar
  19. Franklin, Sarah, and Celia Roberts. 2006. Born and Made: An Ethnography of Preimplantation Genetic Diagnosis. Princeton: Princeton University Press.CrossRefGoogle Scholar
  20. Franklin, S., C. Roberts, K. Throsby, P. Braude, J. Shaw, A. Lashwood, and S. Pickering. 2005. Factors Affecting PGD Patients’ Consent to Donate Embryos to Stem Cell Research. Reproductive BioMedicine Online 10: 31.CrossRefGoogle Scholar
  21. Friese, Carrie, Gay Becker, and Robert D. Nachtigall. 2006. Rethinking the Biological Clock: Eleventh-Hour Moms, Miracle Moms and Meanings of Age-Related Infertility. Social Science and Medicine 63 (6): 1550–1560.CrossRefGoogle Scholar
  22. Gammeltoft, Tine M., and Ayo Wahlberg. 2014. Selective Reproductive Technologies. Annual Review of Anthropology 43: 201–216.CrossRefGoogle Scholar
  23. Gianaroli, Luca, Anna Maria Crivello, Ilaria Stanghellini, Anna Pia Ferraretti, Carla Tabanelli, and Maria Cristina Magli. 2014. Reiterative Changes in the Italian Regulation on IVF: The Effect on PGD Patients’ Reproductive Decisions. Reproductive BioMedicine Online 28 (1): 125–132.CrossRefGoogle Scholar
  24. González, Joaquín Jiménez. 2014. ¿ Es necesario un acuerdo internacional en torno al diagnóstico genético preimplantacional (DGP)? Revista internacional de investigación en Bioderecho 1 (1): 88–101.Google Scholar
  25. Hardarson, T., C. Hanson, K. Lundin, T. Hillensjö, L. Nilsson, J. Stevic, E. Reismer, K. Borg, M. Wikland, and C. Bergh. 2008. Preimplantation Genetic Screening in Women of Advanced Maternal Age Caused a Decrease in Clinical Pregnancy Rate: A Randomized Controlled Trial. Human Reproduction 23 (12): 2806–2812.CrossRefGoogle Scholar
  26. Hershberger, Patricia E., Agatha M. Gallo, Karen Kavanaugh, Ellen Olshansky, Alan Schwartz, and Ilan Tur-Kaspa. 2012. The Decision-Making Process of Genetically At-Risk Couples Considering Preimplantation Genetic Diagnosis: Initial Findings from a Grounded Theory Study. Social Science and Medicine 74 (10): 1536–1543.CrossRefGoogle Scholar
  27. Holm, Søren. 2009. The Medicalization of Reproduction—A 30 Year Retrospective. In Reprogen-Ethics and the Future of Gender, ed. Frida Simonstein, 29–36. New York: Springer.CrossRefGoogle Scholar
  28. Järvholm, Stina, Malin Broberg, and Ann Thurin-Kjellberg. 2014. The Choice of Pre-implantation Genetic Diagnosis (PGD), a Qualitative Study Among Men and Women. Journal of Reproductive and Infant Psychology 32 (1): 57–69.CrossRefGoogle Scholar
  29. Kalfoglou, Andrea L., Joan Scott, and Kathy Hudson. 2005. PGD Patients’ and Providers’ Attitudes to the Use and Regulation of Preimplantation Genetic Diagnosis. Reproductive BioMedicine Online 11 (4): 486–496.CrossRefGoogle Scholar
  30. Karatas, J.C., K. Barlow-Stewart, B. Meiser, C. McMahon, K.A. Strong, W. Hill, C. Roberts, and P. Kelly. 2010. Psychological Adjustment, Knowledge and Unmet Information Needs in Women Undergoing Pgd. Human Reproduction 25 (6): 1481–1489.CrossRefGoogle Scholar
  31. Krahn, Timothy, and Sophia Isako Wong. 2009. Preimplantation Genetic Diagnosis and Reproductive Autonomy. Reproductive BioMedicine Online 19: 34–42.CrossRefGoogle Scholar
  32. Kupka, M.S., A.P. Ferraretti, J. de Mouzon, K. Erb, T. D’Hooghe, J.A. Castilla, C. Calhaz-Jorge, C. De Geyter, and V. Goossens. 2014. Assisted Reproductive Technology in Europe, 2010: Results Generated from European Registers by ESHRE. Human Reproduction 29 (10): 2099–2113.CrossRefGoogle Scholar
  33. Lavery, S.A., R. Aurell, C. Turner, C. Castello, Anna Veiga, Pedro N. Barri, and R.M. Winston. 2002. Preimplantation Genetic Diagnosis: Patients’ Experiences and Attitudes. Human Reproduction 17 (9): 2464–2467.CrossRefGoogle Scholar
  34. Marshall, C., and G.B. Rossman. 2011. Designing Qualitative Research. Thousand Oaks, CA: Sage.Google Scholar
  35. Mastenbroek, Sebastiaan, Moniek Twisk, Jannie van Echten-Arends, Birgit Sikkema-Raddatz, Johanna C. Korevaar, Harold R. Verhoeve, Niels E.A. Vogel, Eus G.J.M. Arts, Jan W.A. De Vries, and Patrick M. Bossuyt. 2007. In Vitro Fertilization with Preimplantation Genetic Screening. New England Journal of Medicine 357 (1): 9–17.Google Scholar
  36. McClaren, Anne. 1987. Can We Diagnose Genetic Disease in Pre-Embryos? New Scientist 116 (1590): 42–47.Google Scholar
  37. Muñoz, Francisco Javier Jiménez. 2012. La reproducción asistida y su régimen jurídico. Madrid: Editorial Reus.Google Scholar
  38. Ormondroyd, Elizabeth, Louise Donnelly, Clare Moynihan, Cornelie Savona, Elizabeth Bancroft, D. Gareth Evans, Rosalind Eeles, Stuart Lavery, and Maggie Watson. 2012. Attitudes to Reproductive Genetic Testing in Women Who had a Positive BRCA Test Before Having Children: A Qualitative Analysis. European Journal of Human Genetics 20 (1): 4–10.Google Scholar
  39. Overall, Christine. 2012. Ethics and Human Reproduction: A Feminist Analysis. Abingdon: Routledge.Google Scholar
  40. Pavone, V., and F. Arias. 2012. Beyond the Geneticization Thesis: The Political Economy of PGD/PGS in Spain. Science, Technology and Human Values 37 (3): 235–261.CrossRefGoogle Scholar
  41. Pehlivan, Tugce, C. Rubio, L. Rodrigo, J. Romero, J. Remohi, C. Simon, and A. Pellicer. 2003. Impact of Preimplantation Genetic Diagnosis on IVF Outcome in Implantation Failure Patients. Reproductive BioMedicine Online 6 (2): 232–237.CrossRefGoogle Scholar
  42. Pennings, Guido. 2002. Reproductive Tourism as Moral Pluralism in Motion. Journal of Medical Ethics 28 (6): 337–341.CrossRefGoogle Scholar
  43. Potter, J. 1997. Discourse Analysis as a Way of Interpreting Naturally-Occurring Talk. In Qualitative Research: Theory, Method and Practice, ed. D. Silverman, 144–160. London: Sage.Google Scholar
  44. Pownall, Holly. 2013. Neoliberalism, Austerity and the Health and Social Care Act 2012: The Coalition Government’s Programme for the NHS and its Implications for the Public Sector Workforce. Industrial Law Journal 42 (4): dwt016.CrossRefGoogle Scholar
  45. Roberts, Celia, and Sarah Franklin. 2004. Experiencing New Forms of Genetic Choice: Findings from an Ethnographic Study of Preimplantation Genetic Diagnosis. Human Fertility 7 (4): 285–293.CrossRefGoogle Scholar
  46. Rothman, Barbara Katz. 2001. The Book of Life: A Personal and Ethical Guide to Race, Normality, and the Implications of the Human Genome Project. Boston: Beacon Press.Google Scholar
  47. Ruckert, Arne, Ronald Labonté, and Rylan H. Parker. 2015. Global Healthcare Policy and the Austerity Agenda. In The Palgrave International Handbook of Healthcare Policy and Governance, ed. E. Kuhlmann, R.H. Blank, I.L. Bourgeault, and C. Wendt, 37. London: Palgrave Macmillan.CrossRefGoogle Scholar
  48. Salama, M. 2014. Cross Border Reproductive Care (CBRC): A Global Perspective. Obstetrics and Gynecology International Journal 1 (2): 00008.CrossRefGoogle Scholar
  49. SEF. 2013. Registro de la Sociedad Española de Fertilidad: Técnicas de reproducción asistida (IA y FIV/ICSI), 1–41. Madrid: Sociedad Española de Fertilidad.Google Scholar
  50. Svendsen, M.N., and L. Koch. 2008. Unpacking the ‘Spare Embryo’. Social Studies of Science 38 (1): 93–110.CrossRefGoogle Scholar
  51. van Rij, Maartje C., Marij Gielen, Rutger Lulofs, Johannes L.H. Evers, Liesbeth van Osch, Nienke Muntjewerff, Joep P.M. Geraedts, and Christine E.M. de Die-Smulders. 2011. Profiles and Motives for PGD: A Prospective Cohort Study of Couples Referred for PGD in the Netherlands. Human Reproduction 26 (7): 1826–1835.Google Scholar
  52. Wahlberg, Ayo. 2016. The Birth and Routinisation of IVF in China. Reproductive Biomedicine and Society Online 2: 97–107.CrossRefGoogle Scholar
  53. Zeiler, Kristin. 2004. Reproductive Autonomous Choice—A Cherished Illusion? Reproductive Autonomy Examined in the Context of Preimplantation Genetic Diagnosis. Medicine, Health Care and Philosophy 7 (2): 175–183.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Vincenzo Pavone
    • 1
  • Sara Lafuente Funes
    • 1
  1. 1.Institute of Public Goods and Policies (IPP), Consejo Superior Investigaciones Científicas (CSIC)MadridSpain

Personalised recommendations