LAUSR

Eighty years after this question was raised in an anonymously penned editorial in the New England Journal of Medicine, largely attributed to the giant Dr. John Rock, we may have an answer. The clustered regularly interspaced short palindromic repeat (CRISPR)-associated system (Cas) geneediting technology now has been applied to gametes and triploid and diploid human embryos. The ease, speed, and low cost of the system have been hailed by many scientists as a tremendous breakthrough. The possibility that this technology, in the not too distant future, could be applied clinically for primary prevention of disease indeed may appeal to doctors and patients alike. Serious concerns remain, however, regarding both the ethics of the technology and technical limitations including its efficiency and fidelity [2–4]. Authors from a prominent gene-editing laboratory stated in a recent manuscript, BSeparately from the debate of the merit and ethics of germline editing in humans, the feasibility of correcting genetic defects via CRISPR technology in human zygotes has not been really tested^ [4]. This view implies that ethics and technical advancement occur independent of one another; it seems vital, however, that the ethics of any disruptive technology be considered together with, if not before, the technical development itself. Unfortunately, history has shown that often technology is developed first, and then society reacts by accepting or rejecting it. Now, more than ever, our field is pressed with questions of where we are headed; should we, as infertility specialists, continue this line of investigation, and if so, under what circumstances is application of this technology clinically, morally, and socially acceptable? If we do not take the lead on this, which specialty will and to what end? A 2017 joint report by the National Academies of Sciences, Engineering, andMedicine entitled BHuman Genome Editing: Science, Ethics and Governance^ seeks to address these questions and others [5]. This 261-page PDF is available for free download online (https://www.nap.edu/catalog/24623/ human-genome-editing-science-ethics-and-governance). There are 22 co-authors on this report, including medical geneticists, stem cell and cancer biologists, pediatricians, internists, lawyers, and bioethicists. Surprisingly, not a single reproductive endocrinology and infertility (REI) physician, arguably the one most likely to counsel patients about this technology if it were ever applied clinically, was involved in drafting this document.