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Assisted Sex Selection
Author: Dr. Anna Kaplan
Using medical techniques to select the sex of a fetus is called assisted sex selection. As you might expect, this is a topic that often starts an ethical debate. Many wonder whether or not a parent-to-be should be allowed to choose a boy or a girl unless there is a medical reason to do so.
There are genetic conditions linked to sex that might make prospective parents think about this question very seriously. These are sex-linked disorders which cannot be identified directly in a fetus. 50% of male children born to a woman with an abnormal gene of this type (a carrier) will have the disorder. If there is no genetic test available to discover whether or not the fetus has the gene, some parents will decide not to continue a pregnancy with a male fetus. As genetic testing advances, more disorders can be identified directly and a decision based only on the fetus’ sex is not necessary. For example, fetal chromosomes can now be checked directly to see if they have the gene for hemophilia.
Women using in vitro fertilization (IVF) can find out the sex of the embryos created. They go through genetic screening before being used. A person or couple could select to transfer embryos only of the desired sex.
Women who have amniocentesis or chorionic villus sampling to screen for congenital problems like Down’s syndrome can learn the sex of the fetus. They could choose to terminate a pregnancy if the sex of the baby was not what they wanted.
The possible medical procedures for sex selection include:
- Before fertilization, used with intrauterine insemination
These techniques have not been proven. There may be ways to separate out the heavier X-bearing sperm, but this is currently still being studied. Theoretically, if the sperm could be selected with 100% accuracy, the sex of the fetus could be assured before conception by only using sperm with the desired chromosome. This would be X if the couple wants a girl and Y if they want a boy. There is active research in this area.
- After fertilization but before the fetus in implanted into the uterus
This is only available to couples using IVF. A couple can choose to use only male or female embryos.
- After pregnancy occurs
This is the only method available for women who get pregnant without any assistance. The sex of the fetus can be determined by amniocentesis or chorionic villus sampling. If the parents do not want a child of the determined sex, the woman would have to terminate her pregnancy. This will prevent having a child of the unwanted sex but in no way guarantees a future pregnancy with a fetus of the desired sex.
The American College of Obstetricians and Gynecologists’ Committee on Ethics has concluded:
“…the committee opposes meeting requests for sex selection for personal and family reasons, including family balancing, because of the concern that such requests may ultimately support sexist practices.”
This group is stating their belief that parents should not chose the sex of their children for personal reasons. Others may say that a baby born to parents that do not want him or her may be in a bad situation.
ACOG does support testing to prevent serious sex-linked genetic diseases. Again, as genetic testing improves, there is less and less reason to terminate a pregnancy on medical grounds just because of the sex of the fetus.
There are places in the world where there is extreme pressure to select a baby’s sex. This is obviously a very personal choice that has to be carefully considered by prospective parents.
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