‘This topic isn’t black and white’

Kreenjala Pyakurel ’22 was drawn to Clark University for two reasons. The University’s small size helped ease her transition from Nepal to the U.S. But Pyakurel was especially attracted to Clark’s role in creating the birth control pill.

Gregory Pincus, a professor of biology, continued reproductive research at Clark that he’d begun at Harvard — work that would eventually culminate in the creation of the birth control pill. The pill was developed and released in 1960 by the Worcester Foundation of Experimental Biology, which Pincus co-founded after leaving Clark. As someone passionate about reproductive and sexual health, that connection made Clark, and Worcester, feel like a clear choice for Pyakurel. “I could see myself here,” she says.

Pyakurel, a biology major and economics minor who is graduating in December, took her first step toward a career in public and reproductive health this summer. She worked as a bioethics and health policy intern with Stacey Pereira at the Center for Medical Ethics and Health Policy at Baylor College of Medicine as part of an ongoing research project. Her focus was on a new technology called polygenic embryo screening, which can be used by parents who use In vitro fertilization. The screening can provide information on the likelihood of an embryo developing certain conditions or traits, everything from common health conditions like diabetes to complex traits like intelligence. It’s a step further than the genetic screening for monogenic disorders, like cystic fibrosis and Huntington’s disease, which has been used for years.

Pyakurel, who worked remotely, helped analyze interviews the team at Baylor College of Medicine conducted with physicians, as well as parents who could be eligible for polygenic embryo screening, on topics such as the ethics of screening embryos for traits like hair color or cognitive abilities. Pyakurel organized the responses into overarching themes.

“If you have a history of diabetes or heart disease in your family, some parents may want to screen for those conditions,” Pyakurel says. “Every day was fascinating. Some of the interview responses really varied and seeing people’s ideas gave me a picture of what my future working in reproductive health could look like.”

Pyakurel discovered that advanced embryo screening produces accompanying cultural and political concerns. For instance, screening for intelligence raises questions about eugenics and the pursuit of so-called “designer babies.” And while screening for polygenic diseases like hypertension, coronary heart disease, and diabetes could be helpful for families with a medical history of those conditions, there are issues of accessibility. Polygenic embryo screening is expensive and still not widely offered.

The lack of research on ethical concerns and stakeholder perspectives is part of the reason Pyakurel sought out her internship.

“It was an eye-opener to see that this topic isn’t black and white. I like how interdisciplinary this work was. It’s social, cultural, political, biological, and psychological,” she says.

Pyakurel’s adviser, biology Professor Javier Tabima Restrepo, supported her through the internship, sharing his expertise in genomics.

Pyakurel was in the middle of her internship, exploring how new technologies can inform women’s reproductive choices, when the Supreme Court overturned Roe v. Wade.

“It drove me to realize that this field is where I belong and is what I’m meant to do,” she says. “I’m passionate about empowering women around their health and autonomy.”