Podcast Review: Orchid's Noor Siddiqui – Super-babies

Wouldn't you give your children the healthiest and longest life possible? With Orchid Health you can.

This is Noor Siddiqui's promise, as she repeats in the Sunday Times podcast 'Danny in the Valley'. Siddiqui is the energetic founder and CEO of Orchid Health, a startup that aims to revolutionise how we have babies.

How does Orchid deliver healthier babies? First, scientists at Orchid sequence almost the entire genome (over 99 percent) of embryos generated via IVF. Then, they screen for mutations that cause diseases, birth defects, or that are linked with a higher risk of developing over 1200 conditions, including schizophrenia and obesity. Finally, genetic counsellors at Orchid indicate to the aspiring parents which embryos have the healthiest genes – that is, the least likely to get sick during life. The winner of this genetic vetting is transferred to the mother's uterus, ready for the ride of a lifetime (literally).

Currently, IVF and genetic testing are used for medical reasons and only 0.25 percent of the genome is tested. But, in Siddiqui's view, the Orchid's method will become the way we will have babies, while sex will become a recreational activity.

I can hear your outraged and horrified objections. What are the social and moral implications? In her interview, Siddiqui addresses the main concerns.

'Scientists are playing God!': 'Parents already choose their kid with IVF, Orchid isn't any different,' she claims (not strictly true in the UK at least, where several forms of preimplantation genetic testing are tightly regulated or prohibited – see BioNews 1134 and 1135). I, however, suspect this objection needs a stronger rebuttal.

'This borders on eugenics!': 'Orchid focuses exclusively on disease prevention,' she reassures us – even though I agree with her, dystopian futures come into my mind. Society must have an urgent conversation on which traits can or cannot be selected for. But which of the many societies in our world? I wonder.

'It must cost an arm and a leg!': Orchid isn't cheap, indeed. It charges $2500 (£2000) per embryo, on top of the cost for the IVF (£5000 or more in the UK). Siddiqui predicts that technological advances will make it affordable. And, she adds, governments may cover the cost eventually, as making healthier citizens will be cheaper than providing medical treatments. This logic prompts me to worry if in her future we will still pursue cures for diseases with the same urgency.

But does the Orchid's approach work? I believe the podcast should have led with this (spoiler, it doesn't start there). Let's break this question into two:

First: How accurate is Orchid's sequencing? In short, very accurate. In late 2023, the first Orchid baby, Jaffe, was born and her genome was sequenced: the embryo's and baby's DNA matched. This is a great achievement: reconstructing a genome from four cells – this is how many cells Orchid collects – is a huge challenge. I faced similar hurdles myself in my career: my congrats to Orchid.

Second: How accurate are Orchid's predictions? This crucial question is not discussed. The scientific literature, makes you suspect that genetic predictions are a tad overhyped, for now (see Human Reproduction, Nature Reviews Genetics and the BMJ).

Orchid's predictions, and those of the other geneticists, are based on a metric called polygenic risk score (PRS), which is a particular approach to assessing of a person's risk of developing a certain genetic trait or disease. PRSs are developed by combining the small effects of many genetic variants within a person's genome. The methodologies for calculating PRSs are in rapid development, but they are still flawed. The scores don't account for non-genetic factors (lifestyle, environment, but also hereditary elements beyond the DNA). In addition, they are biased towards people of European ancestry, so the predictive power is far lower for individuals of African and Asian heritage (see BioNews 1231). Finally, we don't know yet how well the predictions work, the company has only released information from their first successful birth a few months ago – we will need to wait until further genetically selected babies are born.

In the end, I enjoyed listening to Siddiqui (she has the energy and likability of true leaders) and diving into the technicalities of Orchid's method. My impression is that the technology is not ready to deliver on all its promises yet. But it may be in the coming decades, as more Orchid babies are conceived and grow into adults. As 'Danny in the Valley' warns us, the time is now to prepare for a technology that may put into question the very nature of being human.