Designing the Next Generation: The Promise and Limits of Embryo Selection and Gene Editing

The ability to reduce the burden of genetic disease is one of the most compelling promises of genomic medicine. But the path forward for embryo selection and gene editing is not purely technical; it demands rigorous evaluation of scientific evidence, sustained ethical reflection, and broad public consensus.

Photo of a scientist holding a multichannel pipette by Thirdman via Pexels.

Earlier this month, entrepreneur Cathy Tie announced the closure of Manhattan Genomics, her controversial startup focused on the use of CRISPR technology for editing human embryos, and its replacement with a new venture, Origin Genomics. The rebrand has renewed public attention to a longstanding question in genomic medicine: “How can disease risk be reduced before a child is even born?” Across a growing number of biotech companies and fertility clinics in North America, researchers and industry leaders are advancing innovations that are revitalizing discussions surrounding the use of genomic information at the embryo stage to help shape future health outcomes. 

Some companies are already offering embryo genomic technologies to prospective parents. Startups like Orchid Health and Genomic Prediction market tests and risk assessment services that allow parents undergoing IVF treatments to rank and select pre-implantation embryos based on predicted genetic risk for conditions like heart disease, neurodevelopmental and psychiatric disorders, hereditary cancers, diabetes, and even obesity or inflammatory bowel disease. This approach, broadly known as Polygenic Embryo Screening (PGT-P), uses genomic information to estimate which IVF embryos will have the lowest risk of developing certain conditions later in life. The use of this technology has already prompted bioethical debate, particularly following reports of the first baby born after polygenic embryo screening. Critics have raised concerns about clinical validity, informed consent, and the broader implications of selecting embryos based on probabilistic genetic information.

At the forefront of a more ambitious vision is Origin Genomics, the successor to Manhattan Genomics, a Silicon Valley startup that aims to directly edit embryos to remove disease-causing or disease-associated genetic mutations. Their vision is about preventative uses of CRISPR-based technologies: if harmful mutations can be corrected before implantation, they argue, some inherited diseases could be circumvented entirely. Notably, however, there is little publicly available information describing how these technologies would be implemented in practice, or whether they are currently being applied beyond early-stage research and conceptual development.

Taken together, the approaches of embryo selection and gene editing signal a broader shift in human reproduction. Reproductive genetics is moving beyond diagnosing disease to actively shaping biological outcomes. While the promise is compelling, it is often presented with a level of certainty that the underlying science does not yet support.

Post by Cathy Tie on X (formerly Twitter), March 19, 2026, discussing the shutdown of Manhattan Genomics.

Two Fundamentally Different Visions for Reproductive Genetics

Although screening embryos for genetic conditions and gene editing embryos to reduce genetic risk are often discussed together, they represent fundamentally different approaches and raise different ethical, legal, and social concerns. 

Polygenic embryo screening (PGT-P) involves analyzing the DNA of embryos created through IVF, at which point scientists estimate each embryo’s genetic predisposition towards a preselected list of traits framed as “undesirable” or “high-risk”. Scores are calculated by combining the effects of thousands of genetic variants, with the end product serving as a probabilistic estimate. In practice, this might look like choosing between two embryos, one with a slightly lower predicted risk of heart disease, and another with a slightly lower risk of schizophrenia, based on statistical differences that may ultimately never manifest. Importantly, this process does not change the embryo itself, it simply ranks viable embryos based on statistical predictions, allowing parents and clinicians to choose which one to implant. A polygenic risk score is not necessarily a prediction of what will happen, but a statistical estimate of what is more or less likely to happen under highly specific assumptions.

By contrast, gene editing involves directly modifying the DNA of an embryo prior to implantation. Using tools derived from CRISPR-based genome editing technologies, the goal is to correct disease-causing mutations at their source. This approach gained global attention following the controversial work of Chinese scientist He Jiankui, who in November 2018 announced the birth of the first gene-edited babies using CRISPR-Cas9 technology. The event sparked widespread condemnation and highlighted the profound risks and ethical challenges of human germline editing. Unlike screening, which works within the limits of existing embryos, editing seeks to permanently modify an embryo’s genome.

These two approaches reflect fundamentally different ways of thinking about reproduction and responsibility: one selects among different embryos, the other attempts to actively redesign them.

Example of polygenic embryo risk reporting from LifeView (Genomic Prediction).

Selection Versus Eradication: Two Ethical Frameworks

Beyond the technical differences, these approaches also reflect distinct ethical frameworks. Polygenic embryo screening aligns with what can be described as an “ethic of selection.” It does not alter embryos, but instead allows parents to choose among them based on predicted traits. From this perspective, the technology is an extension of existing reproductive choices, in which embryos are screened for defects and discarded or deprioritized based on an array of genetic and non-genetic criteria. 

By contrast, gene editing represents more of an interventionist approach, and is described by King’s College London professor Dusko Ilic as an “ethic of eradication.” Rather than choosing among embryos, it seeks to eliminate genetic risk entirely by altering the underlying biology in one or more embryos. This raises new ethical questions about the scope of parental responsibility: "Is it enough to avoid potential harm caused by chaotic and complex biological and evolutionary systems, or is there a stronger moral imperative to actively intervene into the embryo's genome to improve outcomes where possible?"

While editing may appear more effective for disease prevention, it also introduces greater uncertainty. For starters, the irreversibility of such changes means that mistakes are not confined to a single individual and can be passed on to further generations. At the same time, both approaches raise questions about how we define health, normalcy, and desirable traits.

Who Gets Access to a “Better” Start?

In either the case of embryo selection or editing, equity and access are among the most immediate concerns. IVF treatments are already expensive, with most Canadian provinces and insurers covering only one IVF cycle of the 2-3 cycles needed for pregnancy on average. Adding genomic technologies to this process increases the cost further. As a result, access is limited, raising the possibility that genomic optimization, though modest, could become a privilege biased towards those with higher incomes.

These technologies also force questions about how we define “health.” While reducing the risk of serious disease is widely seen as ethically and morally justified, the same tools can be used to select for non-medical and aesthetic traits. The boundary between therapy, enhancement, and eugenics is not always clear, and societal consensus on where to draw that line remains unsettled.

There is also a growing regulatory gap, whereby embryo gene editing is effectively prohibited in Canada and the United States, while polygenic embryo screening exists in a more ambiguous space, often proceeding without clear clinical guidelines. In this context, private companies are playing a significant role in shaping how these technologies develop and are utilized in the clinical practice.

Finally, there is the issue of public understanding. Genomic technologies are often accompanied by optimistic narratives about eliminating disease or engineering better outcomes. While these visions can be compelling, they risk oversimplifying the underlying science and creating expectations that current technologies cannot meet. 

Microscope image of the IVF process. Photo by Dr. Kontogianni via Pixabay.

When Innovation Outpaces Deliberation

The emergence of companies like Origin Genomics, alongside the expanding market for polygenic embryo screening, underscores the rapid pace of change in reproductive genomics. These developments signal a shift in how clinicians and companies think about reproduction, risk, and responsibility. While polygenic screening is already being offered in some clinical settings, approaches such as those proposed by Origin Genomics remain largely conceptual and unproven.

The prospect of reducing the burden of genetic disease is a compelling and widely shared goal, consistent with the broader trajectory of modern medicine. Yet the path forward is not purely technical. It calls for careful evaluation of scientific evidence, sustained ethical reflection, and meaningful public engagement.

At present, both embryo screening and gene editing remain limited in their capabilities and uncertain in their long-term consequences. As these technologies continue to develop, the most important question may not be what they can do, but how, and whether, we choose to use them.

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Daniel Kiss is a Research Associate at Genomics4S, where he supports research projects in science policy and genomics and contributes to public outreach initiatives. 

Recommended citation:

Kiss, D. (2026). Designing the Next Generation: The Promise and Limits of Embryo Selection and Gene Editing. Zenodo. Canadian Institute for Genomics and Society (Blog). April 6, 2026. https://doi.org/10.5281/zenodo.19444406