Silicon Valley Wants to Optimize Your Children’s Genes

Summary

Podcast Summary: "Silicon Valley Wants to Optimize Your Children’s Genes"

Podcast Information:

• Title: Interesting Times with Ross Douthat
• Host/Author: New York Times Opinion
• Description: The first draft of our future. Mapping the new world order through interviews and conversations. Every Thursday, from New York Times Opinion.
• Episode: Silicon Valley Wants to Optimize Your Children’s Genes
• Release Date: August 7, 2025

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Introduction

In this compelling episode of Interesting Times, host Ross Douthat engages in an in-depth conversation with Noor Siddiqui, the founder of ORCID—a Silicon Valley startup pioneering advanced genetic testing for embryos. The discussion delves into the controversial and transformative vision of using whole genome sequencing to screen embryos for genetic abnormalities and disease risks, potentially revolutionizing family planning and reproductive choices.

Background on ORCID and Genetic Testing

Ross introduces Noor Siddiqui and discusses ORCID's mission to empower parents with comprehensive genetic information about their future children. The conversation begins by outlining the basic premise of ORCID's technology:

[00:27] Ross Douthat: "One of the most powerful ideas in Silicon Valley is the theory that everything should have some kind of technological solution... My guest today is the founder of a Silicon Valley startup, ORCID, that promises a new level of genetic testing for embryos."

Noor explains how ORCID differentiates itself from traditional IVF centers by providing full genome sequencing of embryos, offering insights into over 1200 monogenic disorders and several polygenic conditions.

Process of Genetic Testing with ORCID

Ross adopts a hypothetical scenario to better understand ORCID's process:

[02:49] Noor Siddiqui: "ORCID completely changes that. We're the first company in the world that allows parents to actually sequence the entire genome of an embryo... sequence 99% of the bases in an embryo's genome."

Noor details the IVF cycle, from egg retrieval to embryo fertilization, explaining how ORCID samples five cells from each embryo on day five, enabling comprehensive genetic analysis.

Monogenic vs. Polygenic Testing

A significant portion of the discussion focuses on the types of genetic conditions ORCID screens for:

[09:20] Noor Siddiqui: "The first layer of testing is chromosomal analysis... The next stage is monogenic analysis, where we're looking for over 1200 monogenic disorders... Then, we assess polygenic conditions, influenced by multiple genes."

Noor emphasizes the distinction between monogenic disorders—caused by mutations in a single gene—and polygenic conditions, which result from the interplay of multiple genetic factors.

Validity and Accuracy Concerns

Ross raises critical questions about the reliability of whole genome amplification and the accuracy of risk assessments:

[24:48] Ross Douthat: "What's your response to the critique that amplification introduces errors, making the genome not identical to the actual embryo's genome?"

Noor counters by asserting that ORCID's amplification method achieves high uniformity of coverage and accuracy comparable to traditional samples like blood or saliva. She mentions additional confirmation layers, such as Sanger sequencing, to enhance reliability.

Further, Noor addresses concerns about polygenic testing reliability:

[29:54] Noor Siddiqui: "The data tells us that reducing risk for one condition often reduces risk for multiple related conditions... the dominant story is actually that you're able to reduce risk for many conditions in the same category simultaneously."

Ethical and Moral Questions

The conversation shifts to the ethical implications of widespread embryo screening and the moral status of embryos:

[47:21] Ross Douthat: "Do you think the embryos that are created in the ORCID process have any kind of moral status whatsoever?"

Noor argues that embryos are precious but compares the natural high discard rate of embryos in traditional conception to the controlled process in IVF. She advocates for parental choice and autonomy, emphasizing that medical interventions should not be morally pressured.

Future Implications and Societal Impact

Ross poses concerns about potential societal hierarchies resulting from genetic optimization:

[56:42] Ross Douthat: "You are essentially advancing towards a future where there will be a caste system in terms of how rich versus poor people are genetically sculpting their offspring. Is your view that you are ushering in that kind of future?"

Noor counters by envisioning a more equitable future where IVF and genetic screening are accessible to all, potentially through insurance coverage. She argues that making these technologies widely available can prevent a genetic divide rather than exacerbate it.

Balancing Technological Advancement and Human Experience

In addressing the possible loss of intimate human experiences tied to natural reproduction, Ross shares a poetic perspective:

[60:07] Ross Douthat: "Do you think anything would actually be lost if... 90% of babies are born through IVF?"

Noor responds by highlighting that sex and reproduction already serve various purposes beyond procreation, stating:

[61:30] Noor Siddiqui: "Sex is already for fun and not for babies 99% of the time. So it's actually not so strange of a concept."

She emphasizes that genetic optimization does not diminish the beauty of sexual relationships but rather adds a layer of responsibility and care in childbearing.

Conclusion

The episode concludes with Noor reiterating her belief in the ethical use of genetic screening to prevent hereditary diseases and improve child health outcomes. She underscores the importance of parental choice and advocates for widespread accessibility to such technologies, envisioning a future where genetic optimization contributes to healthier generations without compromising the fundamental human experiences associated with reproduction.

[64:01] Noor Siddiqui: "Every human life is equally valid. And I think no parent who chooses to take the maximum amount of love and care and information going into that decision should be stigmatized in any way."

Ross thanks Noor for the insightful discussion, highlighting the transformative yet ethically complex nature of ORCID's mission.

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Notable Quotes:

• Noor Siddiqui [02:49]: "We're the first company in the world that allows parents to actually sequence the entire genome of an embryo."

• Noor Siddiqui [09:20]: "We're looking for over 1200 monogenic disorders... These are pediatric cancers, adult-onset cancers, neurodevelopmental disorders."

• Noor Siddiqui [24:48]: "We're able to actually get the entire genome from that really small sample."

• Noor Siddiqui [45:21]: "This really be about parental choice, parental freedom, and parental autonomy."

• Noor Siddiqui [56:42]: "A very sad history, I think, for the last 40 years that Rich people get to have babies and poor people who can't afford IVF don't get to."

• Noor Siddiqui [61:30]: "Sex is already for fun and not for babies 99% of the time."

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Final Thoughts:

This episode of Interesting Times offers a nuanced exploration of the intersection between technology, genetics, and ethics in modern reproductive practices. Noor Siddiqui presents a vision of empowered parenting through advanced genetic screening, while Ross Douthat prompts critical reflections on the societal and moral dimensions of such advancements. The conversation underscores the profound implications of genetic optimization technologies and the necessity of balancing innovation with ethical considerations.

Transcript

[Noor Siddiqui]

Our state has changed a lot in the last 140 years. We know because MultiCare has been here guided by a single making our communities healthier. That comes from making courageous decisions, partnering with local communities to grow programs and services, and expanding healthcare access to those who need it most. Together, we're building a healthier future.

[Ross Douthat]

Learn [e-mail] from New York Times Opinion, I'm Ross Douthad and this is Interesting Times. One of the most powerful ideas in Silicon Valley is the theory that everything should have some kind of technological solution, even the very basic challenge of bringing healthy children into the world. My guest today is the founder of a Silicon Valley startup, orcid, that promises a new level of genetic testing for embryos, screening for the likelihood of common diseases in childhood and adulthood, as well as for genetic abnormalities. The science of this testing is fraught and controversial, but the vision she's offering is sweeping a future where most couples, not just those struggling with infertility, use IVF to screen and select their children in advance, and where the human experience of reproduction is radically transformed. Noor Siddiqui, welcome to Interesting Times.

[Noor Siddiqui]

Thank you so much for having me.

[Ross Douthat]

I want to start by talking about what it is that your company Orcid, does and promises. And I thought I'd try and do that by presenting myself to you as a prospective client. Now, this will require a little bit of imagination since I'm actually a 45 year old man who has many children. But let's imagine for the sake of this conversation that my wife and I are about 30 years old. We're healthy, not to our knowledge, infertile. We, we want to start a family. But we've read that genetic testing is advancing rapidly. Like most people, we have some medical issues on either side of the family tree and we're interested in doing right by our potential offspring. So we come to you guys, to orcid, for, I guess, a consultation. What do you tell us that you offer?

[Noor Siddiqui]

What ORCID can do is it gives parents the power to protect their children before pregnancy begins. So what happens today in IVF centers is that that they're operating essentially almost blind, right? So this really, really critical decision about which embryo to transfer happens with extremely limited information. So what happens is that the embryo that looks best under the microscope kind of wins this morphology beauty contest is often the one that's selected. Other times there's a very limited genetic test that's offered that looks at a tiny fraction of genetic diseases that could affect a future baby. So Orcid Completely changes that. We're the first company in the world that allows parents to actually sequence the entire genome of an embryo. So sequence 99% of the bases in an embryo's genome, which allows parents to detect risks for some of the most serious conditions. So heart defects, birth defects, pediatric cancers, developmental disorders, things that are, you know, massively change the trajectory of a child's life. And the vast majority of these diseases don't have cures. So what's really exciting about this possibility is that now parents have this ability to protect their children from an entire category of disease that previously we had to just hope for the best and wish that our children wouldn't be affected by them.

[Ross Douthat]

And just since it's going to be important to the larger conversation. One of your views, I think, is that this kind of testing and this kind of process isn't just for people who are older parents or who have super high risk factors or who are struggling to conceive. Right. Your argument is this is potentially for everyone who wants to protect their kids from these kind of conditions. And so that's. Right. Right. That you would say to me as healthy 30 year old male with a healthy wife, like, we should consider doing this. Right.

[Noor Siddiqui]

I think that, you know, no one should ever be pressured into any decision, especially a medical one. So I would say it's the same as, you know, giving women the opportunity to choose an epidural or not to choose a home birth versus a. I think these are incredibly intimate and personal decisions and I do think that it should be part of the menu of choice and everyone should consider it. But obviously no one should be compelled or coerced to do it.

[Ross Douthat]

Right? No, I wouldn't assume that you would be locking us in the room, but you would be presenting it as a reasonable option for someone in our position to consider.

[Noor Siddiqui]

Yeah, yeah, definitely. I think it's something that every parent should consider. Yeah.

[Ross Douthat]

So we're interested. We decide to pursue your process. What happens next? We go through a cycle of IVF and produce some number of embryos, Right?

[Noor Siddiqui]

Yeah, yeah, exactly. So for people who, you know, aren't super familiar with ivf, the way that it works is that you're on medication for 10 to 14 days. What that medication does is it actually synchronizes the follicles in your ovaries. So what IVF does is it captures those eggs. And if you're familiar with egg freezing, egg freezing and IVF are actually identical processes. The question is just when you tab those eg at that retrieval that happens, you Know, typically on day between 12 to 14, what do you do with those eggs? Do you go ahead and freeze them or do you fertilize them with. With your partner's sperm? So once you fertilize them with your partner's sperm, those embryos grow for five days. So on day five, they typically have about 125 cells. And, you know, if you choose to use Orchid, five of those cells get sent to Orchid's lab. So the procedure to actually sample cells from embryos, you can kind of think of it as like a haircut. You know, the embryo has a outer membrane called the trophectoderm. Those are the cells that. And basically what's really powerful about Orcid is that instead of getting that really tiny amount of genetic information, you're able to actually get the entire genome 100 times the data, and then use that to make these really important decisions.

[Ross Douthat]

And this is called whole genome amplification, right?

[Noor Siddiqui]

Yeah, it's called whole genome sequencing. And the first part of whole genome sequencing is amplification. So amplification means you're copying DNA, right? So if you have a bladder saliva sample, there's no need for amplification because the minimum quantity of DNA that you need is already there. You basically lyse those cells, you break open those cel cells, you take the DNA in the nucleus, and you have enough DNA to just throw it on a sequencer. So what we've invented is a new protocol for amplification, a new way to copy DNA so that you get really high uniformity of coverage, so you get really high quality data off of that really small sample size.

[Ross Douthat]

And you're the first company to do this at all, to do it commercially?

[Noor Siddiqui]

Yeah, we're the first company to clinically validate it. So what that means is that we're able to do it on embryos at comparable quality to blood or saliva. And that hasn't been possible before.

[Ross Douthat]

Okay. So we decide to go forward, my spouse and I. So we do the IVF cycle. We have what would be a typical number of embryos then that we're testing.

[Noor Siddiqui]

How old are you and how old is your wife?

[Ross Douthat]

We're 30 in this hypothetical. We're 30.

[Noor Siddiqui]

Yeah. I mean, honestly. So for me, I got 20 eggs and I got 16 embryos, and I was, I think, 28.

[Ross Douthat]

So let's say. Yeah, let's say we have 16 embryos.

[Noor Siddiqui]

So what happens is that of those 16, Embry, you take five cells, at day five, they get sent to Orchid's lab and Then we come back to you in three to four weeks with reports on each of your embryos. So then a genetic counselor, someone who's an expert on genetics, will meet with you and your partner, and then you guys will kind of go through the risks of each embryo and then make a decision between you and your doctor about which one you actually want to go forward with an implant. And then that implantation will hopefully be successful and lead to a pregnancy.

[Ross Douthat]

How many conditions are you doing scores for for each embryo?

[Noor Siddiqui]

Yeah, so it's kind of helpful to kind of go through all the different analysis that happens. The first layer of testing is chromosomal analysis. So chromosomes, you can kind of think of them as like chapters in a book. Right. You know, that's where genetic testing, that's kind of widespread today during IVF stops. That's kind of akin to, you know, if you had a proofreader for your book and the only thing that they're able to tell you is, hey, your book has an extra missing chapter. Right. Like, that's not very good. You'd obviously want to be able. Check for typos. Check for. Are all the sentences capitalized? And do they have a period? Right. So that's kind of the level of resolution that ORCID's able to go. It's able to actually read every single gene. Look for typos that could lead to diseases in each of those genes.

[Ross Douthat]

So that's the first stage. So go on.

[Noor Siddiqui]

Yeah, yeah. So the first stage is chromosomal analysis. Right. So does the embryo have the correct or incorrect number of chromosomes? Right. Then the next stage is monogenic analysis. So that's where we're looking for over 1200 monogenic disorders. So these are things like birth defects, heart defects, skeletal defects. These are pediatric cancers, adult onset cancers. These are neurodevelopmental disorders. These are where, over the last 20 years, geneticists have cataloged, hey, there's this specific gene, a specific variant, and it leads to this disorder.

[Ross Douthat]

So these are monogenetic. Right. So you're talking about, you're looking for problems that are caused pretty clearly by a single gene. How many of these kind of things did you say you're testing for?

[Noor Siddiqui]

It's a little bit over 1200 conditions.

[Ross Douthat]

What about the next level, which is polygenic conditions, which are. And these are conditions that then are influenced by multiple genes. Right. And you're testing for those as well.

[Noor Siddiqui]

Yep. Yeah, exactly. It's just, I think it's just really important not to skip over this monogenic side, because currently you can't test for that large of a set of monogenic diseases during pregnancy. So what's offered today is just something called NIPT. So at, you know, 10 to 12 weeks, you can get down syndrome screening or chromosomal screening. And you know, women are in a really difficult position, right? Because if that test is positive, if down syndrome is detected, the only choice that they have at that moment is either to terminate that pregnancy or to proceed versus being able to give that information at the earliest possible stage before a pregnancy has even started, you know, avoids families having to make that really difficult decision.

[Ross Douthat]

So in, so in these cases, the monogenic conditions, you know, because obviously I have some familiarity with testing during pregnancy and part of what comes with that is a really wide error range, right, where you get lots of false positives. When you're talking about monogenic results, what is your level of confidence in these results?

[Noor Siddiqui]

The testing for chromosomes and monogenic screening is, I would say, very strong, right? You're talking about, you know, 99 plus percent accuracy, sensitive imprecision, kind of in that same ballpark. So you're really, you're getting the same level of performance as you would on blood or saliva. So those are very strong indicators. But at the same time, any embryo testing, any testing on embryos, period, is still a screening test, right? Until that that baby is actually born, you can't give a definitive diagnosis because you don't have an actual human being in front of you. But in terms of the accuracy of the testing, it's very high. We actually also do another layer of confirmation called Sanger sequencing. So basically we use two different technologies to confirm that a variant has been detected before we actually go report it out to parents and their clinical team.

[Ross Douthat]

Okay, and then polygenic testing, what is that?

[Noor Siddiqui]

So we kind of talked about monogenic disease that's very prevalent, but there's a sort of a one to one mapping between, hey, this variant leads to this disease. So for a lot of diseases that, you know, you might be familiar with, things like bipolar disorder, schizophrenia, heart disease, diabetes, they're not driven by, you know, just one genetic typo. They're driven sort of by the cumulative impact of many millions of variants collectively driving risk. So what's really interesting that's happened over the last decade or so is that genetic data sets have gotten very, very large. So we now have both sequence data and medical records from really, really large numbers of people. And what that allows us to do is to build models where we can actually quantify genetic risk or genetic susceptibility to disease. So what that means on a practical level for embryos is that, for example, I'm South Asian. We have, unfortunately, incredibly high rates of heart disease and heart attacks. We're sort of twice as likely to die as other ethnicities. So I don't want my be at high risk for heart disease just because that's, you know, I'm predisposed to that. So what orchidogenic risk scores allow you to do is to quantify genetic susceptibility for each embryo. So what we'll actually tell you in our report is it'll tell you what is the actual percentile of risk. So is this embryo in the 99th percentile of risk? Okay. What does that actually map to? Does that mean that embryo is four times as likely, 15 times as likely to develop the disease, and then what is their absolute risk of the disease?

[Ross Douthat]

But those can be quite different, Right? An embryo could be in the 98th percentile of risk for an extremely rare condition, but the odds would be that it did not have that condition, right?

[Noor Siddiqui]

Oh, yeah, yeah, of course. I mean, basically, you know, that's why we report all three numbers that people can get a really solid grasp of, you know, what the risks looks like. Right. Because it is important to understand at a population level, you know, how high risk is this embryo? Are they 99th percentile or not? But of course, the absolute risk is really critical to understand too. Right. If the baseline risk for that disease is low, people who even have a family history might be less activated or less concerned about it. Right. So we're trying to provide parents sort of the fullest possible picture of, you know, how significant this risk is for their future child.

[Ross Douthat]

And how many conditions are you testing for in the polygenic screening?

[Noor Siddiqui]

I think it's about 12. 12 to 12 to 15. Yeah.

[Ross Douthat]

So in practice, you just, you have an embryo and you say embryo A has an elevated score on these three conditions and a normal score on the others. Embryo B has an elevated score on these two conditions. Embryo C has no elevated scores. And then that's how the parents sort of see the data.

[Noor Siddiqui]

That's the way it's collapsed. But obviously, again, all of that detail in terms of the absolute risk, relative risk, and the percentile is also in there. It's just that, I guess to kind of walk you through it, I mean, I would say people are coming at it from a couple of angles, right? Some people are coming. They have a specific condition that they're affected by, that their partner is affected by, that the parent that they're a caregiver for has been affected by or a child like a first child has been affected by, and they want to mitigate risk and they're coming in with a very specific concern. That's one category. And then there's sort of another category which is people who just want to mitigate the maximum amount of risk. Right. So there's not maybe one specific concern, but they basically see this as, hey, this is sort of the most significant way that I'm going to be able to shape my child's health. So I want to understand everything that's well understood and then just minimize the genetic risk that, that my child will end up with.

[Ross Douthat]

And I know, I think the first baby screened by Orcid was born in 2023, is that right?

[Noor Siddiqui]

I think so, yeah. I think late 2023, yeah.

[Ross Douthat]

Yeah. So how many people have used your service and how many babies, just as a guesstimate have been born at this point?

[Noor Siddiqui]

Yeah, I don't know. It's honestly pretty hard to say because we're kind of like a blood testing company. You know what I mean? People will come to us and get their embryos tested, but they might not, not necessarily come back to us and say, hey, you know, we're pregnant. And you know, sometimes people.

[Ross Douthat]

Then how many people have had their embryos tested with you Ballpark?

[Noor Siddiqui]

We don't really talk about that publicly, but you know, it's in the thousands.

[Ross Douthat]

It's in the thousands, but not the tens of thousands.

[Noor Siddiqui]

We don't talk about it publicly.

[Ross Douthat]

Okay, okay. And your clientele, I know obviously you also don't talk about specific people publicly. So I don't expect you to comment on the reports that Elon Musk and I guess one of his partners used Orchid. But generally what you said before is like you're dealing with a clientele that is partially people who have family histories of serious genetic disorders and partially people who are what sort of cutting edge minded Silicon Valley types. Like, what's the part of the clientele that is sort of coming to you the way that myself as a hypothetical client is coming to you? Who are those people? Make one generalization about those people. Just one.

[Noor Siddiqui]

Yeah, I think that it's. I don't know, I just, I feel like, to be totally honest, I think it's just dishonest to try to flatten the set of people who are using the product. I mean, really, it's an incredibly diverse set of people. I mean, it's people from, you know, incredibly modest means who've had to you know, bury a child due to a genetic disease. It's from people who are very affluent. It's people who are, you know, much younger, people who are much older. It's from, you know, gay couples. It's, you know, single mothers by choice. It's like kind of every type of family has expressed interest in the product. And I think, honestly, that's why I'm excited about building the company and building the product is because it's something that, you know, everyone wants to protect their child. Everyone wants their child to be healthy and to have the maximum amount of opportunity and.

[Ross Douthat]

Okay, that's a. That's a good answer. So a couple personal things. Right. You've already mentioned that you've used this technology yourself. Right. So you have, you said 16 embryos currently with your husband. And how many of those are you planning to implant?

[Noor Siddiqui]

Yeah, we honestly haven't. We haven't really made.

[Ross Douthat]

You haven't ever had a conversation about it? I don't believe you.

[Noor Siddiqui]

We haven't made any decisions yet. Right. So I think I've mentioned that I'd be really excited to be able to have four kids. I know you're already beating my wildest dreams. You already have five of your own, so very impressive. But, yeah, I think, yeah, we're super excited about multiple of those embryos. We wanna have two boys and two girls, so. Yeah.

[Ross Douthat]

So you would select two male and two female embryos. Right? Well, in that case.

[Noor Siddiqui]

In order to get four. Yes.

[Ross Douthat]

Yeah. In order to get. Well, in order to get. No. Right? Yeah. Okay. And how old are you?

[Noor Siddiqui]

I'm 31.

[Ross Douthat]

You're 31, but when do you think you'll have your first kid?

[Noor Siddiqui]

I gotta chat with my husband about that. It's not a one person decision.

[Ross Douthat]

Well, we can have you both. Second personal question. So you've mentioned in a number of interviews that you are inspired to get into this field and focus on it because of your mother's experience. Can you talk a little bit about that?

[Noor Siddiqui]

Yeah. So growing up, you know, my mom got a pretty, pretty devastating diagnosis. She. She started by losing her night vision, then she lost her peripheral vision, and then slowly she started losing her central vision. So she ended up getting diagnosed with a condition called retinitis pigmentosa. So what that means is that you sort of progressively go blind, and it was a pretty long odyssey to actually get that diagnosis. And then there was a lot of fear around. Okay. Is that going to affect her siblings, my aunts and uncles? Is it going to affect us or children? And you Know, really kind of what. I was obviously very young when a lot of this was happening.

[Ross Douthat]

How old. How old was she when this sort of manifested itself?

[Noor Siddiqui]

So I think the first symptoms that I think she had admitted to, at least. Least my dad, were probably in her early 30s. And then I think maybe in her mid-30s is when he pushed her enough to be like, hey, I think this is something that you should really be looking into. And I think that really what sat with me and what I fell through, that experience was just this sort of profound unfairness, right? This idea that there's this genetic lottery that's unfolding and some people win and some people lose and through no fault of their own. Someone who I love bitterly isn't going to be able to enjoy the things like being able to see her grandkids and just things that I think you and I take for granted that, hey, we're going to be able to see into old age. And as I got older, I try.

[Ross Douthat]

Not to take that entirely for granted. But, yes, I take granted.

[Noor Siddiqui]

Well, you're a better person than me.

[Ross Douthat]

Is this one of the conditions that you. Is your mother's condition, one of the conditions that you test for right now with orchid?

[Noor Siddiqui]

Oh, yeah, yeah, absolutely. Yeah.

[Ross Douthat]

We have an entire category, monogenic or polygenic.

[Noor Siddiqui]

It's a little complex, like the entire disorder. But the set of conditions that we test for are the monogenic forms of retinitis pigmentosa. So we also screen for monogenic forms of blindness, deafness, a lot of congenital anomalies that are known. But the important thing I think, to understand is for cancer, for example, as a category, we test for monogenic forms of cancer, but not all of cancer is monogenic, if that makes sense to me. It seemed like the most important thing for me as a future parent was that I wanted to be able to minimize the chance that my child was going to be affected by what affected my mom and what affects, unfortunately, millions of people today. Right. So right now, it's like this really horrible situation where these people who have these genetic diseases, each of them are individually so rare that pharma companies have no incentive to design a cure. The market is literally too small. So that's why I was so activated by this idea.

[Ross Douthat]

Right. So embryo screening is faster, more certain, more comprehensive than waiting for a cure and more affordable.

[Noor Siddiqui]

It's much more affordable. Right. You're talking about the price of consumer electronics to be able to mitigate risk for thousands of some of the most devastating diseases.

[Ross Douthat]

Which reminds me, I failed to ask one client's question, which is, what does the procedure cost for one set of embryos?

[Noor Siddiqui]

Yeah. So it's 2,500 per embryo. So just multiply that by the number of embryos that you and your partner end up creating. Hi, I'm Juliet. I'm Joelle.

[Ross Douthat]

We're from the New York Times games.

[Noor Siddiqui]

Team, and we're here talking to fans about our games.

[Ross Douthat]

What's your vibe when you're playing one of our games?

[Noor Siddiqui]

It makes me feel like I'm procrastinating in a really productive way. It just scratches an itch in my brain. We have a routine. I'm doing long distance with my boyfriend. We'll call every night and share our screen. We do connections, the mini, and then strands, always in that order.

[Ross Douthat]

Aw.

[Noor Siddiqui]

Do you have a favorite? The mini. We try and get it under 30 seconds. We rarely get it under 30, but that's always the goal.

[Ross Douthat]

Folks will really time themselves. But with spelling bee, I give myself all day.

[Noor Siddiqui]

I play it when my kids are going to bed. Do you guys play together? My daughter plays. She likes playing wordle. If you ever miss a day, there's also archives. That's so great to know. And you have it for connections as well. Lord help me. I'm just gonna be doing that all day, every day. New York Times games subscribers get full access to all our games and features.

[Ross Douthat]

Subscribe [e-mail] games for a special offer. Let's talk about the science for a minute. So there's a lot of scientific controversy about the work you're doing. There's a lot of criticism and a lot of skepticism, not about the basic idea of genetic screening, but about both the specific way you're doing it and some of the promised results. So I want to ask you some of the questions that seem to come up in that area. And the first has to do with just the process that we've talked about already of amplification, where you are essentially copying a full genome from a smaller sample. And something that you hear frequently is that this process itself introduces errors, that the genome that is amplified is not going to be identical to the actual genome of the embryo. And so you are inevitably, in doing that kind of process, going to introduce essentially potential error levels and. And its own form of sort of dice rolling and Russian roulette into the test results that you get back. What's your response to that critique?

[Noor Siddiqui]

So it is true that older amplification methods suffered from those issues. So kind of the technical terms for these are allele, dropout, and Lack of uniformity of coverage. But basically what does that actually mean? It means that you're not getting a representative sample of the genome that you want. Right, but that is sort of the core technical problem, one of the core technical problems that ORCID solved. And the reason, reason how the way that we know that we've solved it is that we take the exact same standards that are used on blood and saliva and we've exceeded those standards. Right. And we've actually gone, you know, a step further than that where we've actually sequenced babies that have been born. So we've actually can compare the embryo sample to the cord blood and the DNA of the baby at birth. And we've shown that all of those results agree and that we can reliably read the entire genome from that really small sample example.

[Ross Douthat]

To what extent are these results publicly available as opposed to reflecting sort of proprietary corporate technological findings? Like can I as a journalist see those results and take them to a geneticist who's skeptical of you and sort of have them read it? Like, is that out there?

[Noor Siddiqui]

Of course, yeah, that would be your right. So yeah, all of these validations are public. They've been peer reviewed. We've also had state and federal level inspections come into the lab to also review all of these documents. That last piece around the outcome data is still in sort of a pre print phase. So that means that it's just going to be available publicly in a few months, before the end of the year.

[Ross Douthat]

But yeah, so what is proprietary?

[Noor Siddiqui]

Yeah, so the amplification protocol as well as the computational methods that we use in order to basically call variants and build these genetic risk score models. So basically the.

[Ross Douthat]

So it's the risk score that is essentially a trade secret. You can't tell me how you generate the risk score because a potential competitor would come along and steal that method.

[Noor Siddiqui]

Well, what I'm saying is that both the chemistry and the computational side is proprietary. They're all sort of new methods that we've invented. So for the chemistry side we have a provisional patent that we filed. And for the computational side, that's kind of more in the trade secret category.

[Ross Douthat]

Okay, so let's talk about then, questions about polygenic testing and diseases that are caused or influenced by multiple genes. My understanding is that the state of our actual knowledge of how the genome works and influences things like diseases is limited in all kinds of ways. And that there are sort of two sets of open questions about this kind of polygenic screening. First, just to what extent is it basically reliable? And second, to what extent do we just not know what other things a set of genes might be doing doing? So you can imagine a world where you look at an embryo and you say, ah, it has this set of genes that make it somewhat more likely to have heart disease or Parkinson's. We don't want to use that embryo. But then it turns out that something in that set of genes also codes for resistance to disease or something like that. Right. I think this concept is called pleiotropy, the idea that a set of genes can have different effects, Right, in the same person. So how does your testing deal with both of those realities? Like one, just sort of basic uncertainty about how genes interact with each other. And two, the idea that you might be, you know, testing for one condition and failing to capture some other set of effects that would be themselves lifelong and powerful.

[Noor Siddiqui]

Yeah, yeah, yeah, let's definitely get into both of those concerns. I think what people are really asking when they talk about pleiotropy is this idea of genetic trade offs, right? So if you lower risk for schizophrenia, are you actually unknowingly increasing risk for another condition? And one thing that I love about genetic genetics is that it's become a incredibly quantitative science. So researchers, not just at ORCID but around the world, have actually looked into this exact question. So what they do is they build something called a confusion matrix. So what that does is it's testing pairwise correlations between schizophrenia or any disease of interest and thousands of other diseases. Right? And the dominant pattern in that data is that diseases actually, actually that are of a similar category correlate with each other. So basically, schizophrenia risk actually correlates with risk for bipolar disorder and other mental health conditions. So what that means is this idea of genetic trade offs isn't the dominant story. The data tells. The dominant story the data tells is actually that when you want to reduce risk for mental health disorders, you actually reduce risk for multiple diseases simultaneously. Right? So heart disease is, is, you know, has the most correlation with things like atrial fibrillation and other cardiac conditions. So it's not the case that there's these massive genetic trade offs that we know of. And then it is the case that it happens in a small number of specific situations. You know, those correlations have been found. But the dominant story is actually that you're able to reduce risk for many conditions in the same category at once. And I think that that's something that is a really exciting discovery because I think, think that, you know, I totally agree. It's like, it's a fear that people have is that, you know, am I unknowingly increasing risk for another condition?

[Ross Douthat]

Right. And you're effectively saying it could happen, but it's not the most likely scenario.

[Noor Siddiqui]

Yes. However, I would say that, you know, the other kind of boogeyman argument of like, unknown unknowns, I just don't find it very compelling. Because if our standard for any medical intervention was that, you know, we'd have to clear the bar for unknown unknowns, we would never do anything, right? Like, so when we. When we run a clinical trial for a drug and, you know, we find that it's effective, we don't say, okay, but what about in 50 years if this person, like, you know, self destructs or, like, falls down dead? Right? Like, there's a certain standard that we've accepted is a reasonable standard. And what that standard is is that, hey, in what. What genetic risk scores do is they actually exceed the standard in all of. In all of medicine, right? You're talking about. Okay, but that, but that gets you just one second. The thing is, is that genetic risk score scores exceed the standard for any drug that's currently on the market, right? You have hundreds of thousands of people that these scores have been validated in. You've validated these scores not just in a single country, but across multiple countries, multiple populations. So I think it's very difficult to argue from a quantitative perspective that we cannot measure the genetic predisposition to disease we have seen over and over again in many different populations across time. Now that, you know, we can quantify the genetic susceptibility to disease, we can see individuals who are 4 times, 3 times, 15 times, 30 times the likelihood, depending on which genetics risk score that you're looking at. And I think that that's a much stronger evidence set than we have for blockbuster drugs.

[Ross Douthat]

But that gets to my next question, right? You mentioned the idea. Well, you can't. The idea that, you know, at age 50, someone drops down dead is not necessarily. Has to be central to the calculation of any given intervention. How do you know that your interventions in some of these areas are working given that some of the conditions you're testing for don't manifest themselves for years or decades, right? So, yes, you have a set of tests where if a set of children are born through Orchid's work and they all turn out to have severe abnormalities, you could say, okay, this isn't working. Right? But when it comes to, let's say, schizophrenia, right, like, setting aside all the difficult questions about what actually actually causes schizophrenia. Schizophrenia tends to manifest itself often in late teenage years in people's twenties. Right. Like, from our point of view, an orchid baby born today, who you're trying to offer a polygenic risk score for on schizophrenia might not manifest schizophrenia until the year, you know, 2046. So isn't it going to be decades before you will actually have data to be able to say definitively our risk assessments for these longer term conditions are working?

[Noor Siddiqui]

No. So what's amazing is that we actually already have this data today. The way that we know that it's working is that we already have data from people who are alive today who have schizophrenia. We have data from their families. And what you can do is you can run the model and see how often are you able to identify that risk in individuals, and you can actually go a step further and actually look at, at data within families. So what that means is that you look at siblings, you look at data sets where you have multiple siblings, one is affected by a disease, the other one isn't affected by a disease, and then you can actually see, okay, how often is that risk score? Correct? How often are you able to reliably see that, okay, you know, this embryo is at this, you know, individual developed the disease, and they also had a very high risk score. And what that data shows you again and again and again, this data isn't just orcid alone. This is like the entire, entire genetics community has published these results. Is that what these genetic risk scores can do, how powerful they are, is that they can identify individuals that are anywhere from three to six to 30 times, depending on which disease it is that you're looking at. And that's the exact same framework that we use again for clinical trials for drugs, right? You look at cases and you look at controls, people who are treated with a drug and people who weren't. How often is the outcome that you're measuring mitigated? Right. If you're trying to mitigate heart attacks, how different is the rate of heart attacks in people who took the drug versus who didn't? Similarly, in the context of genetic risk for people who are quantified at high genetic risk versus people who are at low genetic risk, how much more often do the people at high genetic risk get the disease? And what you see again, over and over again across populations is that that happens. So basically, it would be ridiculous to tell people, you know, that, hey, we're going to stop offering any drug because we have to wait 50 years to see if it continues to work, if it works. In the population that you studied. Studied, you offer it because it's clear that it works based on a reasonable standard.

[Ross Douthat]

But what you are promising, right, is that you have, again, a proprietary algorithm that is not publicly available that assesses these risk levels. And tell me if I'm wrong. What you're saying to me is that you are validating this algorithm retrospectively by saying, look, we've based it on tests of people and families that have schizophrenic already. We know when it manifests, and based on that, we are able to project forward and say this should work for the next set of populations down the line. I completely accept that that's possible. But again, the claim of a proprietary algorithm is that you're doing something special that not everyone else could do, and you are making a prospective bet on the effectiveness of that algorithm. You can't prove it to me by saying, you know, look, people who didn't go through this testing, we promise you, we've matched the algorithm onto them. Right? In the end, it will be a while before the algorithm itself is vindicated, right?

[Noor Siddiqui]

No, that's not how any medical test is evaluated. Any medical test is evaluated on existing data, and you proceed assuming that existing data is valid. Right? So, for example, a drug company doesn't go and tell you, hey, this is exactly the molecule, and this is, you know, the proprietary. I mean, of. Of course they patent it, they show you the results, and we publish the results too. For every single risk score that's offered, we'll tell you exactly what you're doing.

[Ross Douthat]

Forgive me if I'm confused, but what I'm saying is when a drug company tests a drug, they're testing it on people, they're treating a cancer, and they give the drug to people with cancer. And some of the people with cancer get better and some of them don't. And they can say, we gave these people this test. These people, over the course of our process, manifested these results with an algorithm that's being applied to embryos. You don't get those results until the person actually develops or doesn't develop schizophrenia. That's all I'm saying. Right. If you're comparing the way a drug is tested, it's not just looking back at people in the past who have had cancer. You are actually giving it to people and seeing what happens happens. Right? And you are running a test on embryos and claiming and making a set of predictions about where the embryos go. And I completely buy that you're trying to make those predictions based on existing data and that it might be possible to make those predictions. All I'm saying is you won't have the equivalent of clinical trial data for some of these conditions for a long time. That's all I'm saying. Is that wrong?

[Noor Siddiqui]

I think it's a bit misleading, right, because the difference is that, you know, we're not giving embryos drugs, right? What is it? What are we evaluating about embryos? We're evaluating their DNA. So the DNA of existing people is a perfectly legitimate way to evaluate whether or not a risk score works. And if you think, right, you're not.

[Ross Douthat]

Giving the embryos drugs, you're just discarding the ones that you. I mean, in a way, you're doing something more extreme to them, right? You're saying you're discarding them.

[Noor Siddiqui]

No, we're not discarding an embryo. I mean, Orcid has absolutely zero to do with discard. We provide genetic reports and parents make their own decisions about which embryo they want to implant and whether they want to discard it or it actually advises against discarding any embryo for any reason. So, yeah, we have absolutely nothing to do with discard.

[Ross Douthat]

Okay, that's a good bridge to some moral questions I have. But before we cross that bridge, I just want to ask you about IVF itself. Because right now, IVF for a lot of women is painful. It's difficult, it's expensive, and it's something that people, people only really seek out in many cases when they're facing serious fertility challenges. You're imagining a future where IVF becomes, if not the normal, at least a normal way to have kids. So does IVF itself need to change in some way for that future to be possible?

[Noor Siddiqui]

No, I actually don't think so. I think that, well, from my personal experience, I had zero side effects. I took zero days off work in was. I mean, it was like a non event, to be totally honest. I mean, I think that, you know, some people have, you know, really heavy periods and it like, you know, ruins their, their whole day or week. IVF itself, I think was, it's, it's pretty simple, right? I mean, you're, you're taking medication for 10 days. The results were amazing. And I think that if you think about what people already do for trivial reasons, I mean, people get Botox, people get plastic surgery. People do much more, more invasive things that are more expensive for really trivial gain, right? This is talking about, is your child going to suffer for a lifetime from a disease that you could have prevented? Are you going to spend two weeks to make sure. That that doesn't happen. I think that a lot of parents would choose that. Right. So this question has actually already been asked nationally to Americans and 70% of Americans are in support of using these types of genetic risk scores to actually understand risk before pregnancy. And actually 30% of Americans would consider IVF in order to mitigate risk. And if you think about the costs, I mean, the costs are just like artificially inflated in the U.S. right? I mean, in Europe you can get IVF plus the medication for less than $5,000.

[Ross Douthat]

I think one should be skeptical of applying the answer to a poll question to the way people actually make choices about these things in real life. And I think one should be skeptical about applying your experience, and I'm glad that it was as easy as it was for you to the experiences of the wider range of women, because I would say just from sort of personal knowledge, there are a lot of different experiences with ivf. I would also just note, you know, you haven't actually had a child. Right. So you're describing sort of part of the IVF process as having been incredibly simple for you, but there's another part which is trying to actually get pregnant through it.

[Noor Siddiqui]

Sure. But data shows that if you have three chromosomally normal embryos, you have a 95% chance of a successful pregnancy. And that's from data on thousands and thousands of cycles. And I think that, yes, I don't want to diminish that. People have really rough and difficult IVF experiences. But I think there's a difference between what is the practicalities of what needs to be done. You need to take shots for 10 days and do a 10 minute procedure to extract your eggs. And then battling with infertility. Battling infertility is equivalent to battling canc. I don't want to diminish that. That's a very difficult thing that people have to go through.

[Ross Douthat]

Right. For the healthy, the healthy back to the client, the healthy 30 year old who isn't infertile as far as we know. Right. You're saying that a certain amount of modest pain and challenge is worth it for the benefits that you describe.

[Noor Siddiqui]

For me personally and for people who choose this, it's not, you know, again, no one should be compelled to do something that they personally find, you know, the wrong decision for their family. But if you look at the history of medical innovation in pregnancy, I mean, you see this over and over, Right. So when epidural was first introduced, there was this massive moral panic. People were, were told that, hey, you know, women have to endure pain during pregnancy. You know, we shouldn't remove it, we shouldn't over medicalize it. And now, you know, it's completely standard. I mean, 70% of women choose an epidural when they deliver their baby. Right. If you think, if you think about hospital birth versus home birth, right. It used to be that everyone gave birth at home. Now 98% of Americans choose to give birth in a hospital. Why did they do that? Right. When you're hemorrhaging, you have an intervention that you're able to do that's life saving in the hospital that you don't have access to at home. Right? So I think for the same reasons, people are going to vote with their feet where they think the better outcomes are. And I think that there's this huge knowledge gap where people think that, you know, genetic disease maybe won't affect them or isn't as prevalent as it actually is. And if people really understood, hey, you know, developmental delay, intellectual disability, autism, pediatric cancer, birth defects, all these really horrible things, actually we now understand the molecular basis of it. I think people are going to vote with it, feed and say, hey, yeah, you know, two weeks of injections, yeah, it's annoying. You know, that's something I, that is a hurdle that I would rather go across. But people don't, the payoff is worth it.

[Ross Douthat]

But people don't just vote with their feet in terms of how medical processes work. Right. Like, so the United States has a very, very high rate of cesarean sections, for instance, which are not necessarily medically indicated, but have become sort of a source of convenience and pressure from doctors and so on. Right. That has, I think in certain ways warp the experience of childbearing in the U.S. right. And I think it becomes easy to see a scenario where, you know, you, you get a certain kind of medical pressures and expectations that push people towards doing the kind of interventions you're describing because of, you know, again, I agree, no one is going to be locked in a room and told they have to do this. Right? But you can end up with certain kind of medical systems creating pressures for things that, that aren't necessarily just people making free choices and voting with their feet. Both things can happen. People make choices, but the system imposes certain expectations. Right. And I think it's very likely in a future where the orcid process becomes a kind of norm that you would then get a whole set of medical pressures like what are you, a bad parent? You're not going to, you know, you're not going to test Your kids and so on. Right. Like you could imagine a couple kind of tipping point or a cascade where you go from this is sort of a choice that a certain number of parents do to this is the expectation that the medical system imposes on expectant parents. Which is why I think it's important to think about some of the moral questions and cultural questions. Right. Associated with this kind of change.

[Noor Siddiqui]

I just want to maybe like agree with you and push back on that. I think that maybe it's sort of a universal opinion that there's two models much, you know, finger wagging at women. I think that women are attacked if they choose to breastfeed. I think they're attacked if they choose not to breastfeed. I think that they're attacked if they, you know, want to have a lot of kids. I think they're attacked if they don't want to have kids. And I think that all of that societal pressure, whether it's, you know, cultural or whether it's from the medical establishment needs to stop. Honestly, I think that, you know, this really be about parental choice, parental freedom and parental autonomy. So I think that, you know, I totally agree with you. I think that for any intervention or for any procedure, procedure that's touching something so intimate and so personal, it should be about, you know, just making an informed decision where people are just told honestly, hey, this is what is possible. These are the, you know, risks and benefits and then they make a decision that's right for their family. So totally agree with you there that like, there shouldn't be pressure from the medical establishment one way or the other.

[Ross Douthat]

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[Noor Siddiqui]

This stuff that you may not have seen.

[Ross Douthat]

The way the tabs are at the top with all of the different sections, I can immediately navigate to something that matches what I'm feeling.

[Noor Siddiqui]

I go to games always doing the.

[Ross Douthat]

Mini, doing the wordle. I loved how much content it exposed me to things that I never would have thought to turn to a news app for. This app is essential. The New York Times app, all of the times, all in one place.

[Noor Siddiqui]

Download it [e-mail] apparently.

[Ross Douthat]

Let's talk about some of the moral and societal questions that I think this tech raises. Start with a basic one. Orchid technology relative to having babies by having sex involves creating substantial numbers of embryos. Many of those embryos will not be used. They'll be kept on ice. They'll eventually be discarded. This is something Americans are comfortable with under the existing IVF system, but they're comfortable with it in a context where most of the people who are doing this are struggling with infertility and are in a kind of crisis environment. What you're talking about is, you know, doing this at a much, much larger scale. So I just have to ask, do you think the embryos that are created in the orchid process have any kind of moral status whatsoever?

[Noor Siddiqui]

I think that embryos are extremely precious. I mean, they're the most miraculous and like magical cells that we've, I think, ever discovered. Right? I mean, they somehow differentiate, you know, into the trillions of cells that make, you know, you and I. Unfortunately, I think a lot of people don't understand biology. So what happens the old fashioned way, right, when you know, you know, you and your partner have sex at home is a lot of embryos are discarded through that process. Nature is extremely brutal, right? So a lot of people don't know that. You know, even people in their 20s, they have about a 20% chance of getting pregnant every month. So, yes, an egg can fertilize, right? Great. Now you have an embryo. But that doesn't mean that embryo is going to implant. So at the natural process at home, there's been multiple, really large scale studies on this. Lots of embryos are discarded at home. It's just that IVF makes that process visible that is currently invisible to people. That's happening at home.

[Ross Douthat]

But that's not true. So the term discard implies agency.

[Noor Siddiqui]

If it applies.

[Ross Douthat]

Agency, spouse, if you. Okay, fine, fine. The difference, the obvious difference between embryos that fail to implant when a husband and a wife have sex and embryos that are discarded in a laboratory is that in the first case, the embryo dies with no human being deciding that it's going to die. And in the second case, the embryo dies because the laboratory decided it should die. In the same way all human beings die over a long enough time horizon, everyone's survival rate is zero. But if you had a system that was set up that required discarding hundreds of thousands of adult human beings, we wouldn't say, oh, everybody dies. Mother Nature is much more cruel. Right? Like in order for your argument to work, you just have to say the embryo doesn't have any moral status that we're obliged to respect and therefore it's okay to discard it. All of this talk about mother Nature, I think is a distraction from that issue.

[Noor Siddiqui]

I think that your framing is dishonest and I want to tell you why it's dishonest. You can take embryos that have been created through I IVF and you can transfer them back into the mom if you really want to make it not a human choice whether or not those embryos become babies or not. And then it is exactly equivalent and many people choose to transfer those embryos into mom. It's called compassionate transfer. And they don't take the IVF meds. And there's a very low chance that that's going to become a pregnancy. Just like when you and your partner at home do it the old fashioned way that there's plenty of times of the month that it's not going to lead to a pregnancy.

[Ross Douthat]

I actually completely agree with you. I think that it is quite different to transfer embryos into a woman's body when they have a really low chance of survival than it is to discard or permanently freeze and then forget about existing embryos. Right. Which do you think is most likely to happen at scale in a world where orchid technology takes off the compassionate method you describe, which does have some chance of leading to pregnancy or, or millions upon millions of embryos just being discarded, isn't it? Clearly, clearly it's the latter. Right.

[Noor Siddiqui]

So what I would say is that it's overly simplistic to say that everyone is gonna make the same decision. Maybe a lot of people really wanna do compassionate transfer. Maybe that becomes the default way that, you know, embryos are handled. It really depends on people's personal decisions. I think what the bottom line is, is like we shouldn't be shoving our moral beliefs on other people. If you believe that you want your embryos to be frozen indefinitely because you believe, believe in this future where sci fi is going to be able to provide gene therapy on those embryos, more power to you. If you feel very strongly that every embryo is a human life and you want to do compassionate transfer, then you should have full right to do that.

[Ross Douthat]

Okay.

[Noor Siddiqui]

But I don't think we should be making assumptions about what choices people will make. Because when you stand in that position, then when people are actually in that decision in that moment, they'll make a potentially decision that would surprise you.

[Ross Douthat]

Okay. But you are promoting a technology that has profoundly, potentially transformative effects on society. Clearly you're arguing for it because it has beneficial effects. And you are essentially saying you don't know what's going to happen to all the extra embryos. Who can possibly say? It's just up to people. We know in practice what is likely to happen. Happen, right?

[Noor Siddiqui]

I don't think that's true.

[Ross Douthat]

I feel like I'd like to know what you think about the moral status of the embryo. Isn't that something I should be able to know? Like just to go back to the example you talked about, right. With your mother and her illness. In the world you're describing, your mother would exist as an embryo, right? Not your mother as an adult human being. Your mother is an embryo. And someone running an orchid style program would look at that embryo and say, we're not going to implant that embryo. Does that bother you at all? Would you say, oh, I'd like to have my mother have a chance at life through some kind of low probability compassionate injection. Are you comfortable with that embryo being frozen or discarded? What's your actual view?

[Noor Siddiqui]

Look, that question has, again, extremely dishonest framing and dichotomous reasoning. So let me just walk you through my grandma's life situation. So do you support women or girls getting the chance to finish high school? Do you support girls getting the chance to choose who they marry and when they marry? Right. Well, my grandma wasn't.

[Ross Douthat]

I think somebody, somebody's doing some dishonest framing here, but I don't think it's me.

[Noor Siddiqui]

No, no, I don't think it's dishonest framing. And I think that that's, that is the actual situation that my grandmother was in. She was married at 16 and had my mom at 17. Right. Now we've progressed as a society and we give girls the choice to finish high school. We give women the choice to choose when they mar. Marry and who they marry. And all of those decisions have profound consequences on who gets born. Different people are getting born because girls are finishing high school. Different people are getting born every time a woman rejects a man on a first date.

[Ross Douthat]

I'm not asking about the set of choices that bring embryos into being. I'm asking about the embryos themselves. You're running a business and you're saying it would be good to live in a society where the embryo that became came, my mother was assessed and ruled out of bounds. And I'm just asking you what the actual status of that embryo Is. Does it matter? Is it, you know, like, if I took the trays of embryos that contain you and your husband's embryonic children and I threw them in the river, what kind of crime have I committed? Have I committed a property crime? Like, should I pay a fine? Like, what have I done?

[Noor Siddiqui]

So are you saying that you want to criminal. Criminalize IVF and that you should ban ivf? Is that your stance?

[Ross Douthat]

I have convictions on abortion and IVF that are generally out of step with the mainstream of America. And I completely own that. I would say, no, I don't want to. No, I don't want to ban ivf, but I think there should be limits on the number of embryos created. Absolutely. And I would favor, at least at a level of sort of moral suasion, encouraging the kind of compassionate. What's the term you use? Compassion?

[Noor Siddiqui]

Compassionate transfers.

[Ross Douthat]

I've heard compassionate transfer. I would support that. So if I've answered your question.

[Noor Siddiqui]

Sure.

[Ross Douthat]

Now I'd like you to tell me, does the embryo have any moral status? That's all I'm asking.

[Noor Siddiqui]

Sure. I think that the question of, okay, an embryo that is going to get adult onset blindness. What do I think about that embryo? My mom doesn't want to be blind. She doesn't want me to be blind. She doesn't want her grandkids to be blind. So I think that it is a positive moral choice. It is the responsible decision as a parent to detect that risk at the earliest possible stage and to transfer the embryo that has the best probability of a healthy life. I don't think that there's any moral question there. I think almost the opposite. I think that creating stigma or creating some sort of taboo around the idea that parents would want to proactively get that information is a dangerous idea to propagate. For me, personally, I do think every single embryo is precious. I think it's an absolutely amazing thing that we're able to make this process work outside of the body. And it would be amazing if we had cures for all of these genetic diseases so we didn't have to make these difficult decisions. But unfortunately, medicine is just not very good. We do not have cures for these diseases. My mom has no options for being able to reverse the vision loss.

[Ross Douthat]

All right, I've badgered you on this point enough. Two last questions. The first is, is about the kind of sci fi dystopian future that a lot of people see hanging around this issue. And it relates to the fact that I think most people's expectation is that if you can figure out what polygenic scores mean for diseases, you're going to be able to figure out what polygenic scores mean for athleticism, intelligence, to say nothing of a whole host of superficial traits. So in which case, if you have a set of genetic technologies that cost a certain amount of money. 2,500 per embryo, right? 2,500 per embryo. If this technology works as well as you say it does, then you are essentially advancing towards a future where there will be a caste system. In terms of how rich people versus poor people are genetically sculpting their offspring. Is your view that you are ushering in that kind of. Of future?

[Noor Siddiqui]

No, I don't think so. And I think that society fundamentally rejects that idea because it is fundamentally so disgusting. Right. I think that we're moving toward a world where IVF itself is something that is going to hopefully be covered for everyone. It's a really sad history, I think, for the last 40 years that Rich people get to have babies and poor people who can't afford IVF don't get to. That's sort of a fundamental human right that I think was violated. And I think it's nice that we're finally seeing steps toward that being corrected where everyone will be able to have access to ivf. And I think in addition to that, hopefully we'll be able to get access to screening technologies like orcid. I think that because it spurs such moral outrage, this idea that something that would create such an advantage, such a vastly different outcomes, I don't think that's something that Americans will choose to only leave to the few that can afford it. I think it's something that in the very near future, hopefully we'll be able to mobilize enough excitement around so that it's something that's going to be covered for everyone.

[Ross Douthat]

So essentially, you need a kind of socialism to avoid the sort of genetic hierarchy eugenic dystopian. No, I. Right. I mean, that's.

[Noor Siddiqui]

I think it's just insurance coverage. I mean, it's insurance coverage for a very nominal amount. Right. We're currently covering, you know, in the last, you know, year of your life or the last two weeks of your life, extremely expensive life support machines and medical procedures that are extending your life by a few days. And I think that even today, with the money that we have today, if we spent it more appropriately, if we spent it more in line with what people's actual preferences are, we could already afford this for everyone in America today.

[Ross Douthat]

Okay.

[Noor Siddiqui]

It's just a question Of Will. Right. That's why I'm so excited to talk to you. Because Will.

[Ross Douthat]

Will. And budget. And budget deficits. But. But yes. All right, last. A last question. You are excited about a world in which lots and lots more babies. Babies than is the case right now, are born from laboratory fertilization. And I'm just curious if you think allowing that this might be desirable in certain cases if a world where this became the norm would be losing something that is very fundamental to human beings and human families and human relationships. And that's the relationship between sex and procreation, between you and your husband having sex. Apologies. And the future generations that come into being. And I'm gonna take the podcaster's privilege. I apologize for this. But I'm gonna read you a piece of a poem. It's by a poet named Galway Kinnell. And the poem is called After Making Love, we hear footsteps. And the idea is sort of contained in the title, that the husband and wife make love and it wakes up their child and the child comes, comes and gets in bed with them. And Cannell writes, in the half darkness we look at each other and smile and touch arms across this little startlingly muscled body. This one whom habit of memory propels to the ground of his making sleeper. Only the mortal sounds can sing awake this blessing love gives again into our arms. Sorry. Do you want worry about removing or diminishing from human experience that aspect of being a husband and a wife in a relationship with a child?

[Noor Siddiqui]

What do you mean?

[Ross Douthat]

I mean in your future. The feeling in a future where orchid technology becomes a norm, the feeling that that poet is expressing where a man and a woman make love. And by making love, they bring a new life into the world that they haven't sculpted or engineered in any way that is given to them out of the self giving from each other that. That forms this profound connection between sex, the way you love your partner and the family that you brought into being. And again, allowing that we're in a world where people have genetic disorders and there are all kinds of reasons that people would consider other ways of having children. You're imagining a future where that just sort of goes away. And I'm wondering if you think anything would actually be lost if that goes away. If 90% of babies are born through IVF and having sex and having a baby out of that becomes this weird thing that the Amish do. Aren't you pushing some really intimate and important aspect of human experience out of human experience?

[Noor Siddiqui]

Yeah, I think people will, you know, obviously continue to have sex. I mean, it's. It's a profound source of connection. I think it's just that people will. I mean, it's actually funny. I mean, this quote that I've. That I've said of, you know, sex is for fun, orchid and embryo screening is for babies. It's actually kind of.

[Ross Douthat]

Yes. I didn't want to quote that to you because I thought it was so ridiculous, but go on.

[Noor Siddiqui]

I actually don't. I think it's already true. I mean, already people are having sex much more often than they're having babies. Sex is already for fun and not for babies 99% of the time. So it's actually not so strange of a concept. Right. So it's a.

[Ross Douthat]

But then sometimes it is. But wait, wait. But when you get a baby, most people get it from having sex. And so it's. Yes, there's plenty of people who have sex without having babies, but most people who get a baby, it is linked inextricably to having sex with your spouse.

[Noor Siddiqui]

Yeah. Today. And I think.

[Ross Douthat]

And you're saying it's time to sever that for the sake, I concede, of potential medical benefits. I'm just saying I think pretty clearly something that, like, poets write about would go away.

[Noor Siddiqui]

Yeah. I think that sex is a beautiful thing. And I think that if you have, you know, enormous genetic privilege and for you to roll the dice and to get a, you know, outcome that isn't going to lead to diseases is in the cards for you, then of course, you know, go ahead and. And, you know, roll the dice. It's just that I think that the vast majority of parents in the future are not going to want to. To roll the dice with their child's health. They're going to see it as, you know, taking the maximum amount of care, the maximum amount of love, in the same way that they plan their nursery, plan their home, plan their preschool. All of these decisions are actually extremely insignificant in terms of the difference between is your child going to live with pediatric cancer with a heart defect that we can't surgically fix, born without a skull and never going to be able to make it to their first birthday. I think when people think about it really concretely in terms of what are they giving up? What are the risks that could potentially affect this child? I think that then it becomes about stewardship. It becomes about how do I make a responsible choice for my family? How do I make sure that, you know, my child doesn't have to suffer in the same way that I do in the same way that my sibling does in the same way that my parent that I'm a caregiver for does. So I mean, I think sex is obviously a very beautiful thing. It's a very profound part of the human experience. But I think that it's, yeah, I think it's denigrating and dismissive to IVF parents and to IVF babies to say that somehow science babies are inferior to babies that are made the old fashioned way. I mean, every human life is equally valid. And I think no parent who chooses to take the maximum amount of love and care and information going into that decision should be stigmatized in any way. I think it's their personal choice and I think freedom and choice is what makes America a great place to live and to be.

[Ross Douthat]

Noor Siddiqui, thank you so much for joining me.

[Noor Siddiqui]

Thank you so much for having me. It was an awesome discussion.

[Ross Douthat]

As always. Thank you so much for listening. One last thing for today. You might not know that you can find Interesting Times in the New York Times app. Download the app and tap Listen at the bottom of the screen to find us and all the other New York Times shows and narrated articles. Interesting Times is produced by Sophie Sophia Alvarez Boyd, Andrea Batanzos, Raina Raskin and Victoria Chamberlain. It's edited by Jordana Hochman. Our fact check team is Kate Sinclair, Mary Marge Locker and Michelle Harris. Original music by Isaac Jones, Sonia Herrero, Aman Sahota and Pat McCusker. Mixing by Pat McCusker audience strategy by Shannon Basta and Christina Sarah Samuelski. And our director of Opinion Audio is Annie Rose Strasser.