This was interesting. I wrote about this a while back and came to a different conclusion looking at it more from the prenatal care provider perspective. Here's from that essay "The risk of placenta previa is more than six times higher in pregnancies resulting from assisted reproductive technology (ART) than in those conceived spontaneously. This condition is dangerous because it can cause severe bleeding, increase the chance of preterm labor, lead to low birth weight, and necessitates delivery by cesarean section to protect both the mother and the baby.
This increased risk appears to stem from the embryo transfer procedure itself rather than underlying infertility. Supporting this, a Swedish study comparing individuals using preimplantation genetic testing (PGT)—similar to the approach offered by Siddiqui’s company—with other IVF users found similarly high rates of placenta previa in both groups, indicating that the elevated risk is associated with ART rather than fertility issues."
What is the base rate of placenta previa? If it's very uncommon, a 6x increase is still a low probability in absolute terms. Also, who tends to be susceptible?
Here’s a summary per Open Evidence AI “The baseline rate of placenta previa is approximately 4-5 per 1000 pregnancies (0.4-0.5%), though rates vary by geographic region and population characteristics. Prior cesarean delivery is the most consistently identified risk factor for placenta previa, with risk increasing proportionally to the number of prior cesarean deliveries. Other well-established risk factors include advanced maternal age, multiparity, prior abortion (both spontaneous and induced), smoking, and assisted reproductive technology (ART). Assisted reproductive technology substantially increases risk, particularly for singleton pregnancies (RR 3.71, 95% CI: 2.67-5.16).[2]” The study that directly compared preimplantation genetic testing and IVF with spontaneously conceived pregnancies said “Regarding maternal outcomes, the rates of placenta praevia and caesarean delivery were significantly higher after PGT in comparison to spontaneous conception (AOR 6.46, 95% CI 3.38-12.37 and AOR 1.52, 95% CI 1.20-1.92, respectively), whereas no differences were seen comparing pregnancies after PGT and IVF/ICSI.” https://pubmed.ncbi.nlm.nih.gov/36749096/
"I think we have a moral obligation to do what we can to create the healthiest, smartest, and best-looking children possible."
What if they're healthy, smart, beautiful narcissists and psychopaths?
When I look around the world today, it's not quite obvious that super-smart, super-pretty people are having a positive impact on our society. Super-smart people built Instagram, and super-pretty people are making everyone else miserable with it by constructing artificial highlight reels of their lives. Your "elite human capital" invented the technologies and popularized the ideological trends which are wrecking society: https://news.yale.edu/2025/11/13/anxious-generation-author-lays-out-perils-social-media-and-offers-way-more-civil-future
In the same way it's important for supersmart AI to be aligned with human values, it's important for supersmart *people* to be aligned with human values. And in the same way that very little effort is made to ensure that supersmart AI development is actually beneficial to humanity, it seems very little effort is made to ensure that superbaby development is actually beneficial to humanity. Why are we selecting for health, smarts, and beauty without also selecting for benevolence and altruism? Since benevolence and altruism are public goods, maybe governments or nonprofits should subsidize your IVF if you agree to pick an embryo with a sufficiently high benevolence score.
This is how we end up losing sex and only eating at taco bell.
"I've seen the future. Do you know what it is? It's a 47-year-old virgin sitting around in his beige pajamas, drinking a banana-broccoli shake, singing 'I'm an Oscar Mayer Wiener."
He wasnt too far off the mark.
Anyway, im not buying the eugenics bs. Ive seen the results of smart, good looking people interbreeding and it aint always pretty. In fact, some of those kids are fucking ridiculous. Besides, pressure brings out some of humanities finer qualities.
It’s become clear that many of the pregnancy risks associated with ART are disproportionately associated with “artificial” transfers (where medications suppress the normal ovulation process and then supplemental estrogen and progesterone are given) more than “natural” transfers (where normal ovulation occurs, albeit usually supplemented with some medications). The corpus luteum from ovulation is hypothesized to have some good effects on placentation, over and above the progesterone it creates, which is why progesterone supplementation alone isn’t enough.
Artificial transfers are necessary for infertile and subfertile women who can’t ovulate normally, but among elective IVF patients this is not necessary, further reducing IVF risks.
Interesting topic! I have one case example to share.
My brother and sis-in-law can be included in: "1) High SES couples who can conceive naturally", as they have one toddler, and just lost one pregnancy earlier this year, (at 5 months) due to down-syndrome. They are the 'perfect couple' who want to expand their family, but don't want to go through that kind of emotional duress again. Since they can afford it, and their health insurance covers a large portion too(!), they are currently doing IVF embryo selection with the PGT-A screening. They will pay no more than $15k to have this reassurance.
It looks like ~ 2% of all births in America are results of IVF, and I assume that almost all(?) people partaking in it are higher socioeconomic, higher educated people --so it seems logical to support it.
It's an interesting post. The big questions, in all of this, is whether natural insemination via sperm competition is optimal and IVF somehow inferior through interfering with the natural selection of the most fit spermatozoon to reach the egg.
The unstated assumption is that the quality of the successful spermatozoon is somehow related to the quality of the genetic material inside it.
Intuitively I find it hard to accept, by what mechanism would a particular DNA configuration packed into a sperm's head affect the mechanical efficiency of the flagellum and link to the ATP firepower of the midpiece's mitochondria.
The reality is, as usual, complex and complicated. Correlating the two populations will be informative, but whether enlightening - with the numbers of confounding variables - I'm not sure about. I'd definitely like to know though.
There is some link to physical sperm quality and payload quality. See Pakpahan et al. Essentially oxidative stress from the male environment causes damage to the physical form of the spermatozoa, and that has potential of damaging the DNA payload as well. There is no positive correlation however.
I also find it interesting that the 'best' spermatozoa, as in the most robust, the fastest, will fail to breach the egg. They need to spend time in the female system to chemically prep for egg fusion. The winner ends up being one with a middling profile.
> When you measure against population controls, you get a handful of statistically significant negative health results, and all but one disappear in the comparison to siblings.
Mmm. I mean I'm not really disagreeing with your overall conclusion; but this is mostly because the sibling comparison had (obviously) much smaller sample sizes and thus much larger error bars. It's not so much that you've removed the counfounding, so much as you've decreased the power of the study to the point where it can't detect any difference.
I should've noted this in the article, but this is good evidence any negative effects are small. If you need massive sample sizes to hope to see a difference, there probably isn't much going on.
I agree with some of the other commenters in thinking that sperm competition is likely to not be particularly relevant to the quality of gene assortment the embryo ends up with. Obvious abnormalities may be correlated with damage to the payload or errors in meiosis but the current selection process already screens for that. Intuitively it seems possible, maybe likely, that the portion of the genome relevant to the quality of the "machinery" of the spermatozoa itself is not correlated with any traits we actually care about in the final embryo.
I looked into this for my next child and had the same question in my mind about the importance of sperm competition. I’m glad you did the research!
Have any studies been done on whether Orchid, Genomic Predictions, etc. end up ranking embryos significantly differently from the older way of ranking embryos (i.e eyeballing the cell number, symmetry, fragmentation, etc.)? Anecdotally, a fertility nurse told me that the ranking of embryos by Orchid, Genomic Predictions, etc. were pretty much the same as the older method.
Sperm competition is one of those things that seems obviously nonsensical, I know everything is correlated but obviously there are so many sperms that it's not going to be anything like a complete test of genetic fitness as applicable to an entire human body functioning well. Also the sperm manufacturing process isn't entirely dependent on the one diploid sample of the genome anyway. A super genetically fit spermatozoon could just have a really crappy dysfunctional sertoli cell support it during development or vice versa, by sheer chance. Anyway obviously the answer to the question in the headline is yes, duh, it's the only way I would ever remotely consider having a child. Now they just need to perfect artificial incubators to provide the right mix of stem cells in case the kid gets born prematurely, so they won't be practically guaranteed to end up developmentally disabled due to undercooking... then I might actually feel good about the risk level.
This was interesting. I wrote about this a while back and came to a different conclusion looking at it more from the prenatal care provider perspective. Here's from that essay "The risk of placenta previa is more than six times higher in pregnancies resulting from assisted reproductive technology (ART) than in those conceived spontaneously. This condition is dangerous because it can cause severe bleeding, increase the chance of preterm labor, lead to low birth weight, and necessitates delivery by cesarean section to protect both the mother and the baby.
This increased risk appears to stem from the embryo transfer procedure itself rather than underlying infertility. Supporting this, a Swedish study comparing individuals using preimplantation genetic testing (PGT)—similar to the approach offered by Siddiqui’s company—with other IVF users found similarly high rates of placenta previa in both groups, indicating that the elevated risk is associated with ART rather than fertility issues."
Here's my post if you want to link to the study: https://annledbetter.substack.com/p/why-i-dont-fear-an-ivf-takeover
What is the base rate of placenta previa? If it's very uncommon, a 6x increase is still a low probability in absolute terms. Also, who tends to be susceptible?
Here’s a summary per Open Evidence AI “The baseline rate of placenta previa is approximately 4-5 per 1000 pregnancies (0.4-0.5%), though rates vary by geographic region and population characteristics. Prior cesarean delivery is the most consistently identified risk factor for placenta previa, with risk increasing proportionally to the number of prior cesarean deliveries. Other well-established risk factors include advanced maternal age, multiparity, prior abortion (both spontaneous and induced), smoking, and assisted reproductive technology (ART). Assisted reproductive technology substantially increases risk, particularly for singleton pregnancies (RR 3.71, 95% CI: 2.67-5.16).[2]” The study that directly compared preimplantation genetic testing and IVF with spontaneously conceived pregnancies said “Regarding maternal outcomes, the rates of placenta praevia and caesarean delivery were significantly higher after PGT in comparison to spontaneous conception (AOR 6.46, 95% CI 3.38-12.37 and AOR 1.52, 95% CI 1.20-1.92, respectively), whereas no differences were seen comparing pregnancies after PGT and IVF/ICSI.” https://pubmed.ncbi.nlm.nih.gov/36749096/
"I think we have a moral obligation to do what we can to create the healthiest, smartest, and best-looking children possible."
What if they're healthy, smart, beautiful narcissists and psychopaths?
When I look around the world today, it's not quite obvious that super-smart, super-pretty people are having a positive impact on our society. Super-smart people built Instagram, and super-pretty people are making everyone else miserable with it by constructing artificial highlight reels of their lives. Your "elite human capital" invented the technologies and popularized the ideological trends which are wrecking society: https://news.yale.edu/2025/11/13/anxious-generation-author-lays-out-perils-social-media-and-offers-way-more-civil-future
In the same way it's important for supersmart AI to be aligned with human values, it's important for supersmart *people* to be aligned with human values. And in the same way that very little effort is made to ensure that supersmart AI development is actually beneficial to humanity, it seems very little effort is made to ensure that superbaby development is actually beneficial to humanity. Why are we selecting for health, smarts, and beauty without also selecting for benevolence and altruism? Since benevolence and altruism are public goods, maybe governments or nonprofits should subsidize your IVF if you agree to pick an embryo with a sufficiently high benevolence score.
This is how we end up losing sex and only eating at taco bell.
"I've seen the future. Do you know what it is? It's a 47-year-old virgin sitting around in his beige pajamas, drinking a banana-broccoli shake, singing 'I'm an Oscar Mayer Wiener."
He wasnt too far off the mark.
Anyway, im not buying the eugenics bs. Ive seen the results of smart, good looking people interbreeding and it aint always pretty. In fact, some of those kids are fucking ridiculous. Besides, pressure brings out some of humanities finer qualities.
It’s become clear that many of the pregnancy risks associated with ART are disproportionately associated with “artificial” transfers (where medications suppress the normal ovulation process and then supplemental estrogen and progesterone are given) more than “natural” transfers (where normal ovulation occurs, albeit usually supplemented with some medications). The corpus luteum from ovulation is hypothesized to have some good effects on placentation, over and above the progesterone it creates, which is why progesterone supplementation alone isn’t enough.
Artificial transfers are necessary for infertile and subfertile women who can’t ovulate normally, but among elective IVF patients this is not necessary, further reducing IVF risks.
Interesting topic! I have one case example to share.
My brother and sis-in-law can be included in: "1) High SES couples who can conceive naturally", as they have one toddler, and just lost one pregnancy earlier this year, (at 5 months) due to down-syndrome. They are the 'perfect couple' who want to expand their family, but don't want to go through that kind of emotional duress again. Since they can afford it, and their health insurance covers a large portion too(!), they are currently doing IVF embryo selection with the PGT-A screening. They will pay no more than $15k to have this reassurance.
It looks like ~ 2% of all births in America are results of IVF, and I assume that almost all(?) people partaking in it are higher socioeconomic, higher educated people --so it seems logical to support it.
It's an interesting post. The big questions, in all of this, is whether natural insemination via sperm competition is optimal and IVF somehow inferior through interfering with the natural selection of the most fit spermatozoon to reach the egg.
The unstated assumption is that the quality of the successful spermatozoon is somehow related to the quality of the genetic material inside it.
Intuitively I find it hard to accept, by what mechanism would a particular DNA configuration packed into a sperm's head affect the mechanical efficiency of the flagellum and link to the ATP firepower of the midpiece's mitochondria.
The reality is, as usual, complex and complicated. Correlating the two populations will be informative, but whether enlightening - with the numbers of confounding variables - I'm not sure about. I'd definitely like to know though.
There is some link to physical sperm quality and payload quality. See Pakpahan et al. Essentially oxidative stress from the male environment causes damage to the physical form of the spermatozoa, and that has potential of damaging the DNA payload as well. There is no positive correlation however.
https://scholar.unair.ac.id/en/publications/meta-correlation-of-sperm-morphology-and-dna-fragmentation-index/?hl=en-US
I also find it interesting that the 'best' spermatozoa, as in the most robust, the fastest, will fail to breach the egg. They need to spend time in the female system to chemically prep for egg fusion. The winner ends up being one with a middling profile.
> When you measure against population controls, you get a handful of statistically significant negative health results, and all but one disappear in the comparison to siblings.
Mmm. I mean I'm not really disagreeing with your overall conclusion; but this is mostly because the sibling comparison had (obviously) much smaller sample sizes and thus much larger error bars. It's not so much that you've removed the counfounding, so much as you've decreased the power of the study to the point where it can't detect any difference.
I should've noted this in the article, but this is good evidence any negative effects are small. If you need massive sample sizes to hope to see a difference, there probably isn't much going on.
I agree with some of the other commenters in thinking that sperm competition is likely to not be particularly relevant to the quality of gene assortment the embryo ends up with. Obvious abnormalities may be correlated with damage to the payload or errors in meiosis but the current selection process already screens for that. Intuitively it seems possible, maybe likely, that the portion of the genome relevant to the quality of the "machinery" of the spermatozoa itself is not correlated with any traits we actually care about in the final embryo.
I looked into this for my next child and had the same question in my mind about the importance of sperm competition. I’m glad you did the research!
Have any studies been done on whether Orchid, Genomic Predictions, etc. end up ranking embryos significantly differently from the older way of ranking embryos (i.e eyeballing the cell number, symmetry, fragmentation, etc.)? Anecdotally, a fertility nurse told me that the ranking of embryos by Orchid, Genomic Predictions, etc. were pretty much the same as the older method.
Sperm competition is one of those things that seems obviously nonsensical, I know everything is correlated but obviously there are so many sperms that it's not going to be anything like a complete test of genetic fitness as applicable to an entire human body functioning well. Also the sperm manufacturing process isn't entirely dependent on the one diploid sample of the genome anyway. A super genetically fit spermatozoon could just have a really crappy dysfunctional sertoli cell support it during development or vice versa, by sheer chance. Anyway obviously the answer to the question in the headline is yes, duh, it's the only way I would ever remotely consider having a child. Now they just need to perfect artificial incubators to provide the right mix of stem cells in case the kid gets born prematurely, so they won't be practically guaranteed to end up developmentally disabled due to undercooking... then I might actually feel good about the risk level.
I meant haploid whoops