HEALTH & MEDICINE :: APRIL/MAY 2007
Sex Selection: Should You Have The Right To Choose The Sex Of Your Child?
The human desire to choose the sex of one’s offspring-to have a son rather than a daughter or a daughter rather than a son -is hardly new. In ancient Greece, it was believed that if men had sex while on their right side a boy would result, and in eighteenth-century France, it was believed that if men tied off their left testicle this would result in a baby boy. In our own time, books that claim to reveal the secret of having a boy or a girl abound. One bestseller recommends the timing of sexual intercourse as the key in addition to other strategies. Indeed, the importance to all of us of a baby’s sex is revealed in the first question we nearly always ask upon news of a newborn (assuming, that is, we have not already found out by sonogram): “Is it a boy or a girl?”
But if the central importance of the baby’s sex and our desire to choose one sex over the other is not new, the techniques for making our desires come true are new. Today, it is possible, at a price, to guarantee the sex of our children. The principal means for doing so are: prenatal diagnosis (either through a sonogram or amniocentesis; preimplantation genetic diagnosis (PGD) followed by selective implantation based on sex; and (less certain technique); prefertilization separation of sperm into X-and Y- bearing ones followed by selective transfer. The first two techniques select post-conception; the last seeks to determine sex at the time of conception.
Scientific Understanding
It has been known for many years that the gender of a pregnancy is determined by the sex chromosome carried by the sperm. Sperm bearing an “X” chromosome, when united with the “X” from the female (females only produce “X”) will result in an “XX” pregnancy that produces a female. If a sperm bearing a “Y” chromosome (men have both “X” and “Y” bearing sperm) unites with the “X” chromosome from the female, an “XY” pregnancy will result that gives rise to a male offspring.
PGD is a relatively new medical technique, introduced about ten years ago for the purpose of screening early IVF embryos for genetic diseases. However, as with other medical technologies, many other uses for PGD were quickly discovered and put into practice, including sex-selection for non-medical purposes. PGD is expensive, costing on average $3,000 for the test.
PGD can only be done with In vitro fertilization. In vitro fertilization (IVF) is one of the methods to treat human infertility. When used by couples with a known family history of genetic disease, IVF has been combined with PGD to screen embryos in vitro (outside the body) in order to avoid uterine transfer of embryos carrying the genetic disease gene or an abnormal chromosome. PGD tests the DNA from cell or cells taken from the embryo to determine whether genes associated with that genetic disease are present or absent. Along with the genetic information comes the de-termination of the sex of the embryo. The embryos remain viable during this procedure and the unaffected embryos are transferred.
Prenatal genetic and chromosomal screening of the unborn has been practiced in the United States for more than thirty years. But thanks to the combination of IVF and PGD technologies, we now have, for the first time in human history, the ability to screen human embryos in the laboratory prior to the initiation of a pregnancy.
What seems to be occurring is “family balancing”. Families with one or four children of the same gender are interested in balancing their family by re-questing sex selection for the gender that is missing from the family dynamics.
Has sex selection produced a reasonable number of successes?
YES! While success rates vary between programs, most programs employing standard sperm separation procedures report success rates in the 70%-90% range. Success with IVF-PGD approaches 100% worldwide. Our program has a chance of achieving the desired gender outcome of a 99-100% assurance with IVF-PGD.
Ethical Issues and Questions Related to the Use of IVF/PGD
Should there be ethical limits on the use of IVF/ PGD to select embryos for uterine transfer that have traits appealing to parents, such as sex, or even other non medical conditions? If so, where should such limits be drawn and by who?
Your comments are welcome.
If you have any other questions about our program, please visit our website at www.healthbanks.com or for information or consultation with one of our infertility counselors, please e-mail us at info@ivf-success.com.
Dr. Jeffrey B. Russell is the Director of the Delaware Institute for Reproductive Medicine, P.A. as well as the Director of the IVF and Embryo Genetics Center P.A. at Drexel University. He has been in practice since 1986 and has helped thousands of couples conceive and start their family.
He is a graduate of the Medical College of Georgia and did his OB/GYN residency at Emory University School of Medicine in Atlanta, Georgia. After completing his residency, Dr. Russell completed a fellowship in Reproductive Endocrinology at Yale University. While at Yale University, Dr. Russell established the GIFT, Embryo Cryopreservation and Ultrasound Guided Retrieval programs as well as serving as the coordinator of the Yale IVF/ ET programs.
Dr. Russell is world renowned for his work in infertility and has appeared on regional and national television programs and in numerous newspapers across the country.
Dr. Russell’s programs produced the first single sperm injection (ICSI) pregnancy in the tri-state area. He also began the first in-vitro fertilization, frozen embryo, GIFT, ZIFT and ICSI programs in the state. His innovative work has resulted in the first immature pregnancy in the United States.
