How much would you pay for a smarter baby? Startups claim they can screen embryos for everything from genetic diseases to IQ. Not everyone is convinced   Aug 10th 2026|San Francisco and New York|9 min read   Late last year New Yorkers noticed a series of strange advertisements on the subway. “Have your best baby,” one promised. “IQ is 50% genetic,” noted another. Predictably, they stirred controversy. Yet Kian Sadeghi of Nucleus, the embryo-screening startup behind them, was pleased. “This is a mass-market product. What’s a better way of showing that it’s a mass-market product than the subway?”   Nucleus is one of a growing number of Silicon Valley startups pushing the nascent technology. Noor Siddiqui of Orchid, a competitor, likes to say that “sex is for fun; embryo screening is for babies”. Herasight, another rival, began offering a screening service last year that allows parents to examine an embryo’s risk of various diseases, and also estimates of its height, intelligence and longevity—at a cost of up to $50,000. Nucleus adds hair and eye colour to the mix. The burgeoning industry aspires to reshape the way humans are made.   Not everyone is pleased. In many jurisdictions, including Britain, screening embryos for sex, let alone for polygenic conditions such as hypertension or physical traits such as height, is illegal. Many geneticists and doctors’ groups are sceptical that the technology works. Others say it is unethical. In America, where regulation is looser, religious conservatives and adherents of the “Make America Healthy Again” movement are vehemently opposed.   The startups’ visions may seem otherworldly. But change is coming fast. Cash is pouring into fertility research, leading to potentially rapid advances in genetic testing. Polygenic screening, particularly for common diseases, is popular among Americans, nearly three-quarters of whom say they would use it if they were already undergoing in-vitro fertilisation (IVF). A fight is brewing over the future of these technologies—and the businesses promoting them.   For the moment, only a tiny share of babies are born via IVF, as is necessary for embryo screening. In 2024, the most recent year for which figures are available, 100,000 American babies were created using the process, representing 2.8% of the total. David Sable, an investor and formerly a practising reproductive endocrinologist, says the global fertility market is commonly estimated to be worth just $25-30bn a year.   Yet Silicon Valley’s interest in fertility could expand access to IVF. Several years ago Peter Thiel and Elon Musk began to speak about low birth rates as a threat to America, and started putting money into fertility startups. They were joined by other investors. American venture-capital (VC) investments in fertility enterprises nearly doubled between 2019 and 2022, jumping from $254m to $496m, according to PitchBook, a data provider, even if they have since slowed a bit.   Many of these startups are focused on making IVF cheaper. At present, only 15 American states require the treatment to be included in insurers’ maternity benefits, meaning most Americans pay out of pocket. To reduce costs, a number of startups are selling fertility insurance and payment plans. Nader al-Salim of Gaia, one such firm, says its services save patients an average of $15,000 over the entire fertility process, largely by pooling risk.   Dr Sable reckons that if IVF does become much more widely available, the embryo-screening market could grow to $400-500bn annually. His estimate assumes the cost will fall to around $15,000 for the entire process; currently, just one cycle of IVF in America costs $15,000-20,000. Dr Sable reckons that prices will drop thanks to technological innovations which may increase success rates, allowing people to go through fewer cycles. Falling labour costs, as a result of automation and economies of scale, as well as greater standardisation should also help.   Some screening is already common among IVF patients. One example is PGT-A, which checks embryos have the right number of chromosomes, and which some studies claim lowers the miscarriage risk (many experts are sceptical). Certain clinics also offer PGT-M, which checks for disorders caused by a single gene, such as cystic fibrosis or Huntington’s. Now startups are adding a third screen: PGT-P, which scores embryos for conditions and traits determined by multiple genes, potentially ranging from certain cancers to eye colour and IQ. Demand for such tests could be substantial. A survey published in 2023 in *Science *found that 43% of all IVF participants would use polygenic screening to increase their child’s chance of getting into an elite university, provided it were safe and free. A third said the same for genetic editing.   Consider Arthur Zey, a software engineer, and his husband Chase Popp, a teacher. Mr Zey says he has always been a “tech nerd” and wanted to apply his skills to the process of having a child. “Most of my professional career I’ve been a product manager in tech, and so in some ways this is just like another product to manage,” he says. Earlier this year the couple had a son using an embryo selected from a group of six on the basis of the results of polygenic screening provided by Herasight. That allowed them to see risk scores for monogenic diseases and more than a dozen polygenic diseases. The startup also gave them predicted ranges for IQ and height.   Messrs Zey and Popp say they hoped to maximise their son’s lifespan, rather than his height or IQ. Yet Mr Zey knows there are advantages to being tall and smart. “All I could do is look at the results for my six embryos and say: ‘Okay, it kind of seems like this one is better.’”   The burden of perfection   For now, Messrs Zey and Popp are unusual. Commercial PGT-P screening is a niche industry. Startups like Herasight cater to a small population of typically very rich people, mostly in America. Even so, that has not stopped them from drawing plenty of criticism.   Some concerns the underlying science. Polygenic risk scores are based on genome-wide association studies (GWAS), which use data from large populations to try to discern associations between genetic variants and specific conditions and traits. Companies that offer screening claim that comparing embryos’ genomes to risk scores derived from these databases, sometimes with adjustments based on ancestry and family history, allows them to come up with individual assessments.   That is disputed, however. Although selecting on the basis of polygenic risk scores works across many offspring, as in animal breeding, it is less sure to have the desired result for a single child, notes Kevin Mitchell of Trinity College Dublin. For example, an embryo’s genome may have a single rare variant that has a large effect on its likelihood of developing a certain condition, but which would be unlikely to surface in population-level correlations.   Herasight attempts to deal with this issue by validating its risk scores using sibling data from GWAS datasets to ensure its models retain predictive value within a single family. It claims that, if it tests ten embryos for a couple where both parents have type-2 diabetes, it can reduce their child’s absolute risk of developing the condition by 12-20 percentage points, from a baseline of 40-60%. Herasight has been critical of competitors, particularly Nucleus, for not providing more detailed public information about their methodology. (Nucleus, for its part, says it is working constantly to ensure its scores are accurate.)   Some also argue that the magnitude of the benefits from embryo screening are overstated. If parents picked from ten viable embryos, the median boost to their child’s height would be 2.9cm, according to a paper in *Cell *in 2019, based on technology at the time. If they selected for IQ, the gain would be three points—unlikely to be life-changing. Moreover, for those picking among fewer than five embryos, the expected gains drop precipitously. Although the average number of viable embryos depends on the patient’s age, in many cases it is closer to two or three from each IVF cycle. Dagan Wells of the University of Oxford adds that, for many conditions, genes are less important than environmental factors such as diet. Selecting against some traits could also have unintended consequences. Genetic material can have different effects in different parts of the body, a phenomenon called pleiotropy. If parents select an embryo intending to lower their child’s risk of a certain disease, they may be neglecting or exacerbating problems for which providers do not (or cannot) offer a score.   Yet many of the technical issues, not least the lack of training data among certain populations, should improve with time. The *Cell *paper estimated that increasing the sample size of the underlying databases could double the median gain in IQ points from polygenic scoring. Or consider the effects of rare genetic variants. As databases grow, artificial-intelligence models may be better able to account for the effects of individual variants. With pleiotropy, some studies suggest that most genetic correlations between pairs of polygenic diseases are either positive—meaning cutting the chance of one decreases the chance of others—or insignificant. At present, the technology is “kind of a promissory note”, says Trinity’s Dr Mitchell. “They say, ‘Trust us, this is a bit shit right now, but it’ll be good soon’.”   If technological problems are resolved, ethical ones will only grow. Disability-rights groups are already wary of PGT-M, worrying it suggests lives with certain genetic conditions are not worth living. The rise in use of PGT-P widens that debate to many more traits. Then there are opponents who are concerned that screening startups are promoting a friendlier version of eugenics. Some worry that embryo editing—on which America has applied a de-facto ban since 2016—could come next.   Industry insiders reject the fretting, sometimes bluntly. Risk scores may not be perfect, but they are “best in class”, says Delian Asparouhov of Founders Fund, a VC firm co-founded by Mr Thiel, which has invested in various fertility startups. “What I hate about some of the traditional health-care industry and genetic counsellors is they’re like, ‘You need to have a Harvard clinical-grade license’” to interpret genetic data. “Fuck that,” he continues. “I just want whatever the best statistical models are. I don’t need a PhD to read this stuff.” (Herasight, Nucleus and Orchid all have genetic counsellors to walk clients through their results.) As for ethics, Mr Asparouhov argues that all parents-to-be engage in a form of genetic selection when they choose a partner. “If this is eugenics, then so is Hinge,” he argues.   Most of the companies offering PGT-P are more circumspect. They say their customers are mainly looking for ways to ensure their children are healthy, rather than to create “super-babies”. Yet their decision to offer scores for intelligence and aesthetic traits suggests they recognise there is a market for the latter.   Arguments over the future of a small cohort of startups may seem like a niche concern. But if IVF gets cheaper and genetic data more abundant, as looks likely, the business of embryo screening will only grow—along with the ferocity of the debate. The nearly 50-year history of the fertility industry is full of technologies that were once contentious, including IVF. Startups like Nucleus, Orchid and Herasight are, in that sense at least, nothing new. ■   為了更聰明的寶寶，你願意付出多少代價？   新創公司聲稱他們可以對胚胎進行篩檢，範圍涵蓋從遺傳疾病到智商的一切。但並非所有人對此深信不疑 2026年8月10日 | 舊金山與紐約 | 閱讀時間 9 分鐘   去年底，紐約人注意到地鐵上出現了一系列奇怪的廣告。「擁有你最好的寶寶，」其中一張承諾道。「智商有 50% 取決於遺傳，」另一張寫著。不出所料，這些廣告引發了爭議。然而，背後這家胚胎篩檢新創公司 Nucleus 的基安·薩德吉（Kian Sadeghi）卻對此感到高興。「這是一個大眾市場產品。有什麼比地鐵更能展示它是一個大眾市場產品的方式呢？」 Nucleus 是越來越多推動這項新興技術的矽谷新創公司之一。競爭對手 Orchid 的努爾·西迪基（Noor Siddiqui）喜歡說：「性愛是為了樂趣；胚胎篩檢是為了寶寶。」另一家對手公司 Herasight 於去年開始提供一項篩檢服務，讓父母能夠檢查胚胎患有各種疾病的風險，並且還能預估其身高、智力與壽命——費用高達 50,000 美元。Nucleus 甚至將髮色和瞳孔顏色也納入考量。這個蓬勃發展的產業渴望重塑人類的誕生方式。   並非所有人都為此感到高興。在許多管轄區（包括英國），篩檢胚胎的性別，更不用說篩檢高血壓等多基因疾病或身高這種身體特徵，都是違法的。許多基因學家和醫生團體對這項技術是否有效持懷疑態度。其他人則表示這不符合倫理。在法規較為鬆散的美國，宗教保守派以及「讓美國再次健康」（Make America Healthy Again）運動的支持者皆對此強烈反對。 這些新創公司的願景可能看起來恍如隔世。但改變正在迅速降臨。資金正源源不絕地湧入生育研究，引領著基因檢測領域潛在的飛速進展。多基因篩檢，特別是用於常見疾病的篩檢，在美國人當中相當受歡迎，如果已經在接受體外受精（IVF，即試管嬰兒），近四分之三的人表示他們會使用它。一場關於這些技術的未來——以及推廣它們的企業——的爭霸戰正在醞釀中。   目前，只有極小比例的嬰兒是透過試管嬰兒出生，而這是進行胚胎篩檢所必需的。在有數據可查的最新年份 2024 年，有 100,000 名美國嬰兒是透過這種方式孕育的，占總數的 2.8%。大衛·塞博（David Sable）是一位投資人，過去曾是執業的生殖內分泌學家，他表示，全球生育市場的年價值普遍估計僅為 250 億至 300 億美元。   然而，矽谷對生育領域的興趣可能會擴大使用試管嬰兒的途徑。幾年前，彼得·提爾（Peter Thiel）和伊隆·馬斯克（Elon Musk）開始將低出生率視為對美國的威脅，並開始將資金投入生育新創公司。其他投資人也加入他們的行列。根據數據提供商 PitchBook 的資料，美國風險投資（VC）對生育企業的投資在 2019 年至 2022 年間幾乎翻倍，從 2.54 億美元躍升至 4.96 億美元，即使此後稍微有所放緩。   這些新創公司中有許多正專注於讓試管嬰兒變得更便宜。目前，僅有 15 個美國州要求將此治療納入保險公司的生育福利中，這意味著大多數美國人需要自費。為了降低成本，許多新創公司正在銷售生育保險和付款計劃。其中一家公司 Gaia 的納德·薩利姆（Nader al-Salim）表示，他們的服務主要透過分散風險，在整個生育過程中平均為患者節省 15,000 美元。 塞博醫師估計，如果試管嬰兒真的變得更加普及，胚胎篩檢市場可能會成長到每年 4000 億至 5000 億美元。他的估算假設整個過程的費用將降至 15,000 美元左右；目前，在美國僅一個試管嬰兒週期就需要花費 15,000 至 20,000 美元。塞博醫師認為，由於技術創新可能會提高成功率，從而使人們能經歷更少的週期，價格將會下降。自動化和規模經濟帶來的勞動力成本下降，以及更高度的標準化，應該也會有所幫助。   某些篩檢在試管嬰兒患者中已經相當普遍。一個例子是 PGT-A，它能檢查胚胎是否擁有正確數量的染色體，且有些研究聲稱這能降低流產風險（許多專家對此持懷疑態度）。某些診所還提供 PGT-M，用於檢查由單一基因引起的疾病，如囊腫性纖維化或亨廷頓氏舞蹈症。   現在，新創公司正在添加第三種篩檢：PGT-P，它能對由多個基因決定的狀況和特徵進行評分，潛在範圍從某些癌症到瞳孔顏色和智商。對此類檢測的需求可能相當龐大。2023 年發表在《科學》（Science）雜誌上的一項調查發現，如果有安全且免費的前提，所有試管嬰兒參與者中有 43% 會使用多基因篩檢來增加孩子進入精英大學的機會。三分之一的人對基因編輯也持相同態度。   想想軟體工程師亞瑟·澤伊（Arthur Zey）和他的丈夫，身為教師的蔡斯·普普（Chase Popp）。澤伊先生說他一直是一個「科技宅」，並希望將自己的技能應用到生育孩子的過程中。「在我的職業生涯的大部分時間裡，我都是科技領域的產品經理，因此在某些方面，這就像是另一個需要管理的產品，」他說。今年早些時候，這對伴侶利用 Herasight 提供多基因篩檢結果，從六個胚胎中挑選出一個，並誕生了一個兒子。這讓他們能夠看到單基因疾病和十幾種多基因疾病的風險評分。這家新創公司還向他們提供了智商和身高的預測範圍。 澤伊先生和普普先生表示，他們希望能最大化兒子的壽命，而不是他的身高或智商。然而，澤伊先生知道身材高大和聰明是有優勢的。「我能做的就是看看我那六個胚胎的結果，然後說：『好吧，看起來這個好像比較好。』」   完美的負擔   目前而言，澤伊先生和普普先生屬於少數。商業化的 PGT-P 篩檢是一個小眾產業。像 Herasight 這樣的新創公司服務於一小群通常非常富有的人群，主要在美國。即便如此，這並沒有阻止他們遭受大量的批評。   有些疑慮關乎背後的基礎科學。多基因風險評分是基於全基因組關聯研究（GWAS），該研究使用來自龐大人群的數據，試圖辨識基因變異與特定狀況和特徵之間的關聯。提供篩檢的公司聲稱，將胚胎的基因組與來自這些資料庫的風險評分進行比較（有時根據祖先和家族史進行調整），可以讓他們得出個體評估結果。   然而，這一點存在爭議。都柏林聖三一學院的凱文·米切爾（Kevin Mitchell）指出，雖然根據多基因風險評分進行選擇在許多後代中有效（如動物育種），但對於單一孩子來說，是否能產生預期結果就不那麼確定了。例如，一個胚胎的基因組可能有一個單一的罕見變異，這對其罹患某種狀況的可能性有很大影響，但這種變異不太可能出現在人口層面的相關性中。   Herasight 試圖透過使用來自 GWAS 資料庫的手足數據驗證其風險評分來解決這個問題，以確保其模型在單一家庭內仍保留預測價值。它聲稱，如果它為一對雙親均患有 2 型糖尿病的夫婦測試十個胚胎，它可以將他們的孩子患該疾病的絕對風險從 40-60% 的基準降低 12-20 個百分點。Herasight 一直對競爭對手（特別是 Nucleus）持批評態度，因為後者沒有就其方法論提供更詳細的公開資訊。（Nucleus 方面則表示，它正不斷努力確保其評分的準確性。）   有些人還認為，胚胎篩檢帶來的好處被誇大了。根據 2019 年發表在《細胞》（Cell）雜誌上的一篇基於當時技術的論文，如果父母從十個可用的胚胎中挑選，對孩子身高的中位數提升將是 2.9 公分。如果他們針對智商進行選擇，獲益將是三點——不太可能改變人生。此外，對於那些在少於五個胚胎中進行選擇的人來說，預期好處會急劇下降。雖然可用胚胎的平均數量取決於患者的年齡，但在許多情況下，每個試管嬰兒週期更接近兩到三個。牛津大學的大衛·威爾斯（Dagan Wells）補充說，對於許多狀況而言，基因的重要性不如飲食等環境因素。   淘汰某些特徵也可能帶來意想不到的後果。基因物質可以在身體的不同部位產生不同的影響，這種現象被稱為「多效性」（pleiotropy）。如果父母選擇一個胚胎是為了降低孩子罹患某種疾病的風險，他們可能會忽視或加重提供者沒有（或無法）提供評分的潛在問題。   然而，許多技術問題（尤其是某些人群中缺乏訓練數據的問題）應該會隨著時間的推移而得到改善。《細胞》雜誌的那篇論文估計，增加基礎資料庫的樣本量，可以使多基因評分帶來的智商點數中位數增益翻倍。或者考慮罕見基因變異的影響。隨著資料庫的擴大，人工智慧模型可能能夠更好地解釋單一變異的影響。對於多效性，一些研究表明，多基因疾病對之間的絕大多數基因相關性要麼是正相關的——意味著降低一種疾病的幾率會降低其他疾病的幾率——要麼是不顯著的。目前，這項技術「有點像一張承諾紙條」，聖三一學院的米切爾醫師說。「他們說，『相信我們，這東西現在有點爛，但很快就會變好了』。」   如果技術問題得到解決，倫理問題只會與日俱增。殘疾權益團體已經對 PGT-M 保持警惕，擔心這意味著患有某些遺傳狀況的生命不值得活下去。PGT-P 使用率的上升將這場爭論擴大到了更多的特徵上。還有一些反對者擔心，篩檢新創公司正在推廣一種更友善版本的優生學。有些人擔心胚胎編輯——美國自 2016 年以來已實施事實上的禁令——可能會是下一步。 產業內部人士拒絕這種擔憂，有時甚至相當直白。風險評分可能不完美，但它們是「同類最佳的」， Founders Fund（由提爾先生共同創立、已投資多家生育新創公司的風險投資公司）的德里安·阿斯帕魯霍夫（Delian Asparouhov）說。「我討厭某些傳統醫療保健產業和基因諮詢師的地方在於，他們會說，『你需要擁有哈佛臨床級許可證』」才能解讀基因數據。「去他的，」他繼續道。「我只要最好的統計模型。我不需要博士學位來讀這些東西。」（Herasight、Nucleus 和 Orchid 都設有基因諮詢師來引導客戶了解他們的結果。）至於倫理，阿斯帕魯霍夫先生認為，所有準父母在選擇伴侶時都在進行某種形式的基因選擇。「如果這是優生學，那麼 Hinge（交友軟體）也是了，」他爭辯道。   大多數提供 PGT-P 的公司都較為謹慎。他們表示，他們的客戶主要是尋求確保孩子健康的方法，而不是為了創造「超級寶寶」。然而，他們決定提供智力和審美特徵評分的事實表明，他們意識到後者存在市場。   關於一小群新創公司未來的爭論看似是一個小眾關注點。但是，如果試管嬰兒變得更便宜，基因數據變得更豐富（這看起來很有可能），胚胎篩檢業務只會成長——隨之而來的還有討論熱度。生育產業近 50 年的歷史充斥著曾經備受爭議的技術，包括試管嬰兒本身。像 Nucleus、Orchid 和 Herasight 這樣的新創公司，至少在這個意義上，並非什麼新鮮事。 --Hosting provided by SoundOn