However, as Read and Donnai discuss, PGD is not an ‘easy option’ given its reliance on IVF technology and associated significant psychological stress and financial cost. Advances

in non-invasive pre-natal diagnosis Selumetinib may soon offer a safer and more acceptable method than amniocentesis or chorionic villous sampling, but only for the detection of mutations of paternal origin or numerical chromosome anomalies. It does not of course avoid difficult decisions about termination of an affected pregnancy. The use of donor gametes, adoption or remaining childless should also be offered to allow a couple to make fully informed reproductive choices. Preconception counselling raises PD0325901 important ethical challenges which are clearly elaborated in the paper by De Wert et al. (2012). The authors distinguish the ethics of 8-Bromo-cAMP price individual preconception counselling from that of population carrier screening. Individual counselling can be viewed as offering couples autonomy and reproductive choice; the alternative ‘prevention view’ of individual

counselling risks placing pressure on couples to make the perceived ‘right choice’ and terminate an affected pregnancy. Preconception carrier screening raises broader ethical concerns about the resurgence of eugenics and the ‘expressivist argument’ that such population screening programmes express a discriminatory view against disability. In this context, it is important therefore to ensure that carrier screening programmes can demonstrate a positive balance of benefits over harms for participants, through and seek to support informed choice not simply high test uptake. The potential psychosocial harms, which are critical to consider in the context of this ethical framework, are further discussed in the paper by Riedijk et al. (2012). Current genetic carrier screening programmes are limited to a few specific genetic conditions. The rapid advances in ‘next generation sequencing’

could significantly change this, as described by Ropers (2012). Examples provided include a diagnostic test panel of approximately 90 genetic defects associated with X-linked intellectual disability and a second panel covering mutations in 500 genes for severe recessive childhood disease. These technological advances raise the important question of how health services can provide adequate counselling for this growing array of genetic tests available to couples contemplating pregnancy. This theme issue of the journal is about preconception care in primary care. As several authors discuss, there are inherent difficulties of delivering preconception care, not least that perhaps up to half of pregnancies are unplanned (Riedijk et al. 2012).