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Aspiring Parents Have a New DNA Test to Obsess Over

The Atlantic

www.theatlantic.com › health › archive › 2025 › 01 › polygenic-risk-score-ivf › 681323

The first time Jamie Cassidy was pregnant, the fetus had a genetic mutation so devastating that she and her husband, Brennan, decided to terminate in the second trimester. The next time they tried for a baby, they weren’t taking chances: They would use IVF and screen their embryos’ DNA. They wanted to avoid transferring any embryos with the single-gene mutation that had doomed their first pregnancy. And then they started wondering what other ailments they could save their future son or daughter from.

The Cassidys’ doctor told them about a company, Genomic Prediction, that could assess their potential children’s odds of developing conditions that aren’t tied to a single gene, such as heart disease, diabetes, and schizophrenia. The test wouldn’t be any more invasive than screening for a single gene—all the company needed was an embryo biopsy. The science is still in its early stages, but the Cassidys didn’t mind. Brennan has Type 1 diabetes and didn’t want to pass that condition on, either. “If I can forecast that my baby is going to have less chance to have Type 1 diabetes than I did, I want that,” he told me. “I’d burn all my money to know that.”

Thanks to more sophisticated genetic-testing techniques, IVF—an expensive, invasive treatment originally developed to help people with fertility troubles—is becoming a tool for optimizing health. A handful of companies offer screening for diseases and disorders that range from life-threatening (cancer) to life-altering (celiac disease). In many cases, these conditions’ genetic links are poorly understood or weak, just one factor of many that determine whether a person develops a particular condition. But bringing another human being into the universe can be a terrifying-enough prospect that some parents are turning to extensive genetic testing to help pick their future offspring.

Genetic screening has been a crucial part of IVF—and pregnancy—for decades. Medical guidelines recommend that any aspiring mother should be given the option to test her own DNA and find out whether she risks passing on dangerous genes, a practice known as carrier screening. If both parents carry a particular mutation, doctors will likely suggest IVF and embryo screening. These measures are traditionally limited to conditions linked to single-gene mutations, such as Huntington’s disease, most of which are exceedingly rare and seriously affect a child’s quality of life. During IVF, embryos are also typically screened for chromosomal abnormalities to help avoid miscarriages, and generally nonheritable conditions such as Down syndrome.

[Read: Genetic discrimination is coming for us all]

As the scientific understanding of the genome has progressed, companies including Genomic Prediction and a competitor called Orchid have begun offering a test that promises a more comprehensive investigation of the risks lurking in an embryo's genes, using what’s known as a polygenic risk score. Most common ailments aren’t connected to a single gene; polygenic risk scores aim to predict the lifetime likelihood of conditions, such as diabetes, in which many genes contribute to a person’s risk. Consumer DNA-testing companies such as 23andMe use these scores to tell customers whether they have, say, a slightly above-average likelihood of developing celiac disease, along with a disclaimer that lifestyle and other factors can also influence their chances. These risk scores could theoretically help identify customers who, say, need a colonoscopy earlier in life, or who need to double down on that New Year’s resolution to eat healthier. But the current scientific consensus is that polygenic risk scores can’t yet provide useful insights into a person’s health, if indeed they ever will.  

Analyzing an embryo’s DNA to predict its chances of developing genetically complex conditions such as diabetes is an even thornier issue. The tests, which can run thousands of dollars and are typically not covered by insurance, involve sending a small sample of the embryos to the companies’ labs. In the United States, such tests don’t need to be approved by the FDA. Genomic Prediction even offers customers an assessment of which embryos are “healthiest” overall. But the control these services offer is an illusion, like promising to predict the weather a year in advance, Robert Klitzman, a Columbia University bioethicist and the author of the book Designing Babies, told me. A spokesperson for the American Society for Reproductive Medicine told me there aren’t enough quality data to even take a position on whether such tests are useful. And last year, the American College of Medical Genetics and Genomics published a lengthy position statement concluding that the benefits of screening embryos for polygenic risk were “unproven” and that the tests “should not be offered as a clinical service.” The statement raised the possibility that people might undergo extra, unnecessary rounds of IVF in search of ever healthier embryos.

Genomic Prediction published a rebuttal to the ACMG that cited, among other research, several studies led by company researchers that concluded that among siblings, those with a lower risk score were significantly less likely to have a given condition. The truth is, though, the effect of screening embryos for polygenic risk won’t be clear until the embryos chosen to develop into fetuses are born, grow up, and either develop diabetes or don’t. Genomic Prediction and Orchid both told me that humanity shouldn’t have to wait that long for the insights their tests provide. Polygenic risk scores are “one of the most valuable pieces of information that you can get,” Orchid’s founder and CEO, Noor Siddiqui, told me. Nathan Treff, Genomic Prediction’s chief science officer, was similarly bullish. “Everybody has some kind of family history of diabetes, cancer, and heart disease. So we really don’t have a situation where there’s no reason for testing,” he told me.

Many of the experts I spoke with about these tests are concerned that people might opt into IVF because they’re chasing certainty that companies can’t really promise. A study last year found both high interest and approval among Americans when it comes to screening embryos for polygenic risk. For now, most of the customers I interviewed used advanced tests that included polygenic risk because they were going through IVF anyway. Many of Genomic Prediction’s customers using the scores are participants in a clinical trial. But Tara Harandi-Zadeh, an investor in Orchid, told me she planned to do IVF even though she and her husband have no fertility issues or history of genetic disease. Harandi-Zadeh is especially worried about de novo mutations—genetic changes that occur spontaneously, without any hereditary link. She wants to screen her embryos to weed out monogenic diseases and plan for the risks of polygenic ones. If I have that information, I can help my child at the stages of life to be able to get treatment or tests or just prepare for it,” she said. Treff told me that people like Harandi-Zadeh make up a small percentage of Genomic Prediction’s customers, but their numbers are growing.

[Emi Nietfeld: America’s IVF failure]

Scientists just don’t understand enough about the genome to confidently predict what any single embryo will be like should it go on to become a person. Most genes influence many facets of our being—our health, our physical traits, our personality—and only a fraction of those interactions have been investigated. “You don’t know the full package,” Klitzman said. “Bipolar disorder is associated with creativity. So if you screen out bipolar disorder, you may also be screening out genes for creativity, for instance.Because no embryo is completely risk-free, future parents might also have to decide whether they think, say, a risk of diabetes or a risk of heart disease sounds worse. A paper out last week put it this way: “The expected reductions in disease risk are modest, at best—even if the clinical, ethical and social concerns are dismissed.”

Those concerns are significant. More and more people are already turning to IVF for reasons other than infertility. Some select their children based on sex. Jeffrey Steinberg, a fertility doctor with clinics in the U.S. and internationally, offers eye color selection and told me he is working on height. Orchid assesses genetic risk for some autism-spectrum disorders, and Genomic Prediction plans to add a similar screening to its catalog. A paper published last week argued that editing embryos—not just testing them—could mitigate genetic risk for a variety of conditions, while also acknowledging it could “deepen health inequalities.” (In the U.S., clinical trials of embryo editing cannot be approved by the FDA, and public funds cannot be used for research in which embryos are edited.) Critics say that even if technology could cut the prevalence of diseases like diabetes, doing so could drive discrimination against those born with such “undesirable” traits. Social services and support for people with those conditions could also erode—similar concerns have been raised, for example, in Iceland, where pregnancy screenings have all but eliminated Down-syndrome births.

[From the December 2020 issue: The last children of Down syndrome]

Even if the science does catch up to the ambitions of companies like Genomic Prediction, genetics will never guarantee a child a healthy life. “Of the 100 things that could go wrong with your baby, 90 percent of them or more are not genetic,” Hank Greely, the director of the Center for Law and the Biosciences at Stanford University, told me. That’s partly why the Cassidys decided to ignore most of their screening results and simply select the embryo that didn’t have the monogenic mutation that Jamie carried, and had the lowest risk of diabetes. “We’re not trying to have a kid that’s 6 foot 2 and blond hair and blue eyes and going to go to Harvard. We just want a healthy baby,” Brennan told me.

Their son was born in 2023 and so far has been at the top of the curve for every developmental marker: He’s big and tall; he talked and walked early. It will be years, probably, before they know whether or not he’s diabetic. But it’s hard, they said, not to feel that they picked the right embryo.

The Hipster Grifter Peaked Too Soon

The Atlantic

www.theatlantic.com › books › archive › 2025 › 01 › kari-ferrell-youll-never-believe-me-review › 681317

In the spring of 2009, Vice published a blog post, notorious even by its own standards, titled “Department of Oopsies!—We Hired a Grifter.” An employee had started chatting with the magazine’s new executive assistant, Kari Ferrell; after she reportedly began coming on to him over instant messages, he Googled her, only to find out that she was on the Salt Lake City Police Department’s most-wanted list. Instead of simply firing Ferrell, Vice outed her online, confessing that it probably should have done a cursory search before hiring someone with “less-than-desirable traits, like, say, five outstanding warrants for fraud.” Oopsie! Read it now and you might find the post unrepentantly confessional in a prescient kind of way, anticipating a future in which any sin or failure can be transfigurated as long as it makes for good-enough content.

Which is to say: The fact that only now is Ferrell profiting from her own story illustrates how innocent—easily shocked, even—we once were, and what brazen shamelessness we’ve since come to accept as normal. In 2009, Ferrell’s unfortunate tendency toward pathological lying and light theft made her the internet’s main character for weeks on end. She was fodder for countless Gawker updates and a detailed profile in The Observer titled “The Hipster Grifter” before she ended up serving time in jail and changing her name to evade her past. Conversely, consider Billy McFarland of Fyre Festival fame, sentenced to prison in 2018 for defrauding investors of more than $26 million, who, during the 2024 presidential campaign, served as a conduit between rappers and Donald Trump. Or Anna Delvey, convicted in 2019 for stealing hundreds of thousands of dollars while posing as an art-world heiress, who, since her jail stint, has gained more than 1 million Instagram followers and drew attention for a recent appearance on Dancing With the Stars in which her court-mandated ankle bracelet featured prominently.

[Read: The scams are winning]

You can understand why Ferrell might think it’s well past time for a comeback. Her new memoir, You’ll Never Believe Me, is subtitled A Life of Lies, Second Tries, and Things I Should Only Tell My Therapist, as if to sublimate the unreliability of its narrator into an honest and unfiltered account. And, for the most part, it works. Ferrell is, as she herself confesses, a gifted communicator and manipulator of words, charming and garrulous and breezily intimate. Her story is compelling by any standard. She tells us she still doesn’t know exactly why she did what she did: tricking her closest friends into cashing bad checks, leaving one on the hook for thousands in bail fees; lying about having terminal cancer; seducing easy marks by writing them notes in which she invited them to “throw a hot dog down my hall.” (Her Instagram handle is still “hotdoghandjobs.”) But she is at least willing to consider the question—which these days is perhaps as much as we can ask for.

New York, in the spring of 2009, was still reeling from the financial crisis, which had revealed profiteering and scammery to be essential American traditions. The implosion of the global economy had fostered a kind of hedonistic nihilism among many recent graduates, which Ferrell worked to her (minimal, it turned out) advantage. But there also just wasn’t that much happening online yet—it was the era after Myspace had normalized online connection and before Instagram had turned creative self-branding into a viable career—which helps explain why the exposure of a very small-time Brooklyn grifter with a prominent chest tattoo fascinated people so much. After The Observer’s Doree Shafrir ran a lengthy feature on Ferrell, uncovering her history of conning her friends and lovers, she became an obsession at Gawker, Gothamist, and other New York–area publications. She was an origin story for an enduring generational cliché: the feckless, inked-up Millennial indulging in petty larceny and shameless self-mythologizing for avocado toast and a Viceland email address. (Remember Hannah Horvath on Girls, quietly filching the cash her parents had left for their hotel maid?)

Ferrell resists this kind of lazy stereotyping. She is, and has only ever been, she insists, entirely her own person. The early chapters of her memoir act as a kind of ABCs of scamming, trying to lightly analyze how she might have been led astray. Adopted from South Korea as a baby, she was raised lovingly by parents who did their best, recalling a home where household goods were often purchased on layaway. When Ferrell was 2, her parents became Mormon converts, packing their family up and moving to Salt Lake City. Ferrell credits Sunday services for providing her with what she describes as “a MasterClass in manipulation,” and a doctor who put her on a diet as a child for unintentionally teaching her to lie (to her parents, about what she’d eaten that day). She writes that, as a teenager, she shoplifted with enthusiasm from big-box stores, as did her friends, but also had a gun drawn on her once for stealing a Sidekick from an acquaintance’s little sister.

With regard to her first con, which she orchestrated in Utah when she was 18, Ferrell writes, “It all sort of happened.” The mark was Charlie, her “brilliant, emotionally mature … caring, and trusting” boyfriend at the time; the scam was to get him to cash a check from her at his bank and pass her the funds (which she didn’t have in her account). That was it. After scoring her first $500 from Charlie, Ferrell repeated the scheme with other friends and acquaintances, sometimes ripping off new people to pay back the old ones when the checks bounced. “I didn’t steal money for drugs,” she writes. “I stole money in hopes that people wouldn’t forget me.” I’m not a therapist, but it’s hard not to psychoanalyze Ferrell’s behavior: the need to feel loved and tended to, coupled with the compulsion to lie and steal, forcing the people closest to her to reject her in ways that would ultimately affirm her worldview. When she was arrested for check fraud, identity fraud, and forgery, she marveled at how flattering her mug shot was and wondered whether she could buy it as a high-res print. She then persuaded another friend to pay her bail, before skipping town when a group of her victims banged on her door demanding their money back.

[Read: Millennial burnout is being televised]

Ferrell fled Utah for New York, where she had dreams of working at Vice or some other idealized cult brand. At first, she wanted to turn over a new leaf. But, she writes somewhat unconvincingly, she “grappled with how to be good in a world that punishes kind people. Mr. Rogers always said to ‘look for the helpers’ in times of turmoil, but whenever I found them they’d be getting kicked in the face by a richer, more ambitious person in power.” Still, she insists, “I didn’t want to blame the world for the way I was.” She’d often laser in on men at parties and concerts, send them sexually aggressive notes, and then pinch whatever she could from them. She’d reportedly love-bomb friends with offers of VIP passes; if they proved resistant, she’d occasionally tell them she had terminal cancer or a psychotic ex-boyfriend who was threatening her, or that she was pregnant. (Not all of this is in the book—I’m relying on other sources.) “I could have gone anywhere to find my marks, but I liked to shit where I ate,” Ferrell writes. This was ultimately her downfall—when her mug shot first appeared online, it wasn’t hard for gossip bloggers to find people who knew her. Some even had Ferrell stories of their own.

A strong personal brand is helpful for a Millennial internet personality; it’s less so for a con artist. You might wonder why people got so caught up with what Ferrell was alleged to have done at the time, given the $1.3 trillion value of subprime loans in 2007, or the $18 billion lost in Bernie Madoff’s Ponzi scheme before his arrest in 2008. But the reality is that money lost to institutions can feel depressingly clinical. The betrayal of being robbed by a friend, or a lover, or a hipster with a pixie cut who likes all the same music you do and signs her notes “Korean Abdul-Jabbar,” is different—more intimate, and much harder to anticipate. Combine this dynamic with revelations about Ferrell trying to scam for things as trivial as Flight of the Conchords DVDs and cab fare, and you have all the absurd, small-scale ingredients for a bona fide internet spectacle.

The title of Ferrell’s memoir is, if you recall, You’ll Never Believe Me, and we probably shouldn’t—there’s enough that she seems to omit, or gloss over, that her account is best taken as an interpretation of events rather than as historical record. But she’s commendable for the ways in which she does try to confess, reflect, self-analyze, adjudicate. Her inability to check her worst impulses seems to have caused her considerable pain, to the point that when she was finally arrested, she writes, she was smiling in the photos—“an expression of pure relief.” Of all the infamous, shameless scammers who emerged after her, none has tried as she has to wrestle with the need to cheat others and the psychology behind the art of the steal. For that, consider You’ll Never Believe Me a job worth waiting for.