The Chinese want boys, and the Canadians want girls. If they have enough money, they come to the United States to choose the sex of their babies.
Well-off foreign couples are getting around laws banning sex selection in their home countries by coming to this country, where it's legal, for medical procedures that can give them the boy, or girl, they want.
"Some people spend $50,000 to $70,000 for a BMW car and think nothing of it, but this is a life that's going to be with us forever," said Robert, an Australian who asked that his last name not be used to protect the family's privacy.
He and his wife, Joanna, have two boys. Now they want a girl. Australia allows sex selection of embryos only to avoid an inherited disease.
The United States' lack of regulation means a growing global market for a few fertility clinics. These businesses advertise in airline magazines or post Web sites aimed at luring clients worldwide.
Opponents said this amounts to medical tourism for designer babies and should alarm lawmakers.
But one doctor who offers embryo selection for about $20,000 said he is serving the marketplace and helping nature, not playing God. People will be less alarmed as sex selection becomes more routine, said Dr. Jeffrey Steinberg of the Fertility Institutes of Los Angeles and Las Vegas.
"It's new. It's scary. We understand that," Steinberg said. His Web site features an image of a Chinese flag alongside information about sex selection. "Near 100 percent (99.99 percent) effective gender selection methods to help balance families," the Web site promises.
"We basically want them to know it's available," Steinberg said of the international push. The Web page on sex selection generates 140,000 hits a month from China, he said, and the only country outpacing China's interest is Canada.
In a recent week, his clinics performed the procedure on eight women from abroad and consulted with 12 new foreign patients from China, Germany, Canada, the Czech Republic, Guam, Mexico and New Zealand, he said.
Most couples are affluent, Steinberg said. But some, like Australians Robert and Joanna, have moderate incomes. Robert, 30, works as a construction supervisor and Joanna, 27, is a part-time secretary.
The couple visited Steinberg's Los Angeles clinic in May and, including airfare, will spend half their annual income to have a female embryo implanted in Joanna's uterus.
The procedure determines the genders of a batch of fertilized eggs and implants only embryos of the wanted sex. This process _ preimplantation genetic diagnosis, or PGD _ is more widely used to screen for genetic diseases.
"The Chinese like boys. Canadians like girls. Every country is different," he said, adding that the boy-girl preference balances out at 50-50 when all his clients are added together.
Critics call it "consumer eugenics" and said it opens the door to a future where parents will choose babies' hair color, eye color and potential to grow tall enough to play basketball. U.S. doctors are catering to the same gender bias that has led to female infanticide and the abortion of female fetuses in China and India, opponents said.
"What you're saying is it's better you don't exist than be the wrong gender for my family. And that's a shocking assertion," said Matthew Eppinette, director of research at the Center for Bioethics and Human Dignity, a Christian bioethics group.
PGD can be used to prevent sex-linked inherited diseases. But when it's used solely to select an embryo's sex, the practice is controversial, even among doctors who specialize in reproductive medicine.
"We don't do that. Sex is not a disease," said Yury Verlinsky, director of the Reproductive Genetics Institute in Chicago.
The American Society for Reproductive Medicine says sex selection of embryos is clearly ethical when the method is used to prevent genetic disease. But it discourages its use for choosing one gender over another, saying the practice risks reinforcing sexism and diverts medical resources from real medical needs.
While many countries prohibit sex-selection techniques without a medical purpose, the United States has no such ban.
Some groups are calling for regulation of the practice and its marketing.
"Right now the market is driving practices rather than social and ethical concerns," said Sujatha Jesudason of the Center for Genetics and Society, a nonprofit information and public-affairs organization in Oakland, Calif. "People who have money to pay for it are getting the children of their choice."
The Australians, Robert and Joanna, see gender selection as no different ethically and morally from in vitro fertilization for infertile couples.
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