In the medical field of fertility, genetic evaluation of embryos for sex selection is allowed but controversial.
In the treatment of infertility, the number of chromosomes can be counted using in vitro fertilization (IVF) and the biopsy of embryos. The genetic evaluation of embryos for chromosomal abnormalities, which can result in failed pregnancies and birth defects, also reveals in the embryo the future baby’s gender.
After unhealthy embryos are separated out, parents can also choose their baby’s gender by identifying an embryo(s) of a certain sex to transfer to the uterus through IVF. Virtually no one objects to this selection process, as the information on gender of the embryo is gained for medical purposes.
However, selecting the baby’s gender through the use of IVF in fertile couples for nonmedical reasons is ethically controversial. Sex selection practices, also referred to as gender selection and family balancing, has been addressed by the American Society for Reproductive Medicine (ASRM).
In the United States, infertility clinics develop internal polices on gender selection or family balancing practices, deciding whether or not they will participate in such treatments. Many clinics in this country do not provide these family balancing procedures. Furthermore, the practices are outlawed in a number of other countries.
Our center provides these gender selection services at low cost relative to some of the other centers. We discuss the process of genetic evaluation and the ethical issues involved with our patients.
Ethical concerns about selecting a baby’s gender
Possible destruction of embryos
One concern revolves around what happens to the unused embryos. This is an ethical issue whether genetic testing or gender selection are involved or not. Patients must decide ahead of time regarding the outcome of their frozen embryos anytime they choose IVF.
Many IVF patients keep their extra embryos frozen so that they can use them at a later time to complete their family. The unused embryos may be donated to another couple, donated to research or allowed to thaw, rendering them nonviable.
Our center strongly encourages our patients to donate their embryos to another couple. Couples make the ultimate choice. In some cases, it is appropriate to reimburse a donor couple for some of the IVF-related expenses.
Another societal concern regarding preimplantation genetic screening (PGS) for gender selection relates to the history of gender selection in China and India. In China, due to its previous one child rule enforced for 35 years until 2015, many couples chose abortion of a first pregnancy if it was a girl.
The Chinese population is now skewed. There are not enough women for men to marry. Since selection of the baby’s gender is used sparingly in the U.S., this type of imbalance is not a current concern.
Some raise the concern that selection of the baby’s gender leads to valuing one gender over the other. But according to ASRM, desiring the different rearing experiences that one has with boys and girls does not mean that the parents are sexist or likely to devalue one or the other sex.
Psychologists recognize many differences between male and female children: “It may not be per se sexist to wish to have a child or children of each gender, particularly if one has two or more children of the same sex” (Robertson).
Another set of ethical concerns revolves around the possibility of future abuse of genetic screening of prospective children. The idea is that as science continues to develop, it will become possible to detect certain physical characteristics. This would leave the door open to encourage selection based on these characteristics, which would in turn encourage “designer babies.”
Currently there does not appear to be any technology that would enable such a practice. For instance, there is no identified gene for being tall or having musical ability.
Adult onset diseases
The new uses of preimplantation genetic testing are a rapidly developing science and include research into identifying mutations for susceptibility to cancer and late onset disorders such as Alzheimer’s disease. Our discussion here will not address this topic further.
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- American Society of Reproduction Medicine. 2001.
- Dahle et al. Preconception Sex Selection Demand and Preferences in the United States. Fertile Sterile. 2006; 85: 468-73.
- Ethics Committee of Preconception Gender Selection for Nonmedical Reasons. Fertile Sterile. 2001; 75: 861-864
- Ethics Committee of the American Society for Reproductive Medicine. Fertile Sterile. 2015; 103: 1418-1422.
- Robertson, J.A. Extending Preimplantation Genetic Diagnosis: The Ethical Debate. Human Reproduction, 2003; 18: 465-71.