There are currently 1,075 clinics and 563 laboratories that can test for 944 diseases worldwide. In February and March of 2003 alone, tests for 11 new diseases were added to a web site that tracks genetic testing. Surprisingly, there are very few laws regulating embryo screening (or pre-implantation genetic diagnosis, PGD). Only a few states have laws that address PGD, and a federal court ruled in the Lifchez case that procedures designed to assist in making reproductive decisions are legal.

In 2000, an American couple decided to have a second child and used prenatal genetic diagnosis to select an embryo that was not only free of a defective gene but could also serve as a bone marrow donor for their first child. This second child was to donate bone marrow to the couple's six-year-old daughter, Molly, who suffered from Fanconi anemia, a disease that leads to bone marrow failure. For the donation to be successful, the couple chose to perform PGD to see which of the embryos they had created would be free of the affected gene and could provide a tissue match for Molly. In the end, Molly received cells from her brother Adam, who was conceived using PGD and IVF. As of 2001, Molly was recovering from her illness better than doctors had expected.

Critics of unregulated prenatal testing and selection worry that prenatal selection is the beginning of a dangerous path. There are a number of issues: the potential for a consumer approach to childbearing (evident in requests by couples undergoing IVF for a child of a certain sex to "balance the family"); the unrealistic and potentially undermining expectations brought to the life of a carefully "selected" child; and the specter of a private eugenics in which some will have the ability and incentive to select certain kinds of children, while others will not.

PGD, IVF and other reproductive technologies significantly extend reproductive choice, both in the creation of children and the selection of traits within those children, potentially setting the stage for eugenic practices as well as economic inequalities. At the same time, people who conceive without the help of technology are at liberty to have babies for whatever reason they want, including to "catch" a man, fill the void created by the death of a child or to act as caregivers when the parents reach old age. Is this fair? Perhaps more than ever before we are confronted with the questions: What kind of children should there be and who should be allowed to have them? Can you decide?