The quest to identify fetuses carrying potentially fatal genetic
diseases got a powerful tool in the early 1990s, with the development
of Pre-Implantation Genetic Diagnosis. PGD, as it's known, allows
doctors to scan the cells of an embryo fertilized outside the womb for
signs of inherited diseases like cystic fibrosis or sickle-cell anemia,
giving parents the option of not implanting that embryo.
In some fertility clinics, PGD is increasingly being used only to
determine the embryos' sex, and then just boys, or girls, are selected
to develop into babies. Dr. Daniel Potter offers his patients this
controversial service at the Huntington Reproductive Center in Southern
California. In his practice, he finds that immigrant couples are making
different choices for children than American-born couples.
The procedure takes place in the Center's operating room. The patient
is anesthetized, and the reproductive specialist extracts her eggs.
They will be fertilized outside her body, even if the woman is
completely capable of getting pregnant naturally.
Dr. Potter will analyze the chromosomes of her embryos, and select only
the sex she's requested. "Virtually 100% of those pregnancies will be
the desired gender," he says.
Many doctors, medical ethicists and even human rights activists say
Daniel Potter should not be doing this invasive, risky procedure for a
woman and her baby who have no medical need for it. The American
Society of Reproductive Medicine supports PGD when needed to prevent
passing on a genetic disease, but opposes it for gender selection.
Potter, however, says he's just fulfilling his patients' reproductive
rights, explaining, "It's presumptuous of any organization to assert
that a woman should or shouldn't be able to determine the number of
children she wants to have, or the gender of these children."
But ethicist Arthur Caplan doesn't see this as an issue of reproductive
rights. "Medicine has to say what it stands for," he insists. "If it's
all about health and disease, then gender is neither." Dr. Caplan
directs the Center for Bioethics at the University of Pennsylvania,
where he investigates the ethical issues of reproductive technologies.
He's concerned about the expectations parents will have for their
gender-selected children. "If you spent $30,000 to get a boy to
roughhouse and play sports with, and have a boy who is indifferent to
sports, are you going to feel disappointed?" he wonders. "Are you going
to feel shortchanged?"
Other ethicists worry that using PGD to guarantee a boy - or a girl -
reinforces gender stereotypes. Sujatha Jesudason, program director at
the Center for Genetics and Society in Oakland, California, goes even
further. She says sex selection is sex discrimination. "When we say sex
selection is okay, we are saying that it is okay to choose only certain
types of children. When you have a father who says, 'I want a son to
pass on the family business,' he thinks a girl can't do that."
Jesudason, who was born in India, is especially sensitive about her
culture's preference for boys. "There is a whole tone in the culture
that says, girls are just not as desirable."
In an exam room at the Huntington Center, Dr. Potter greets a couple
originally from India, who now live in Canada and have come to his
clinic to have a boy. "When a daughter marries, she joins the other
family. Girls get married and they move out," the woman explains. "With
a boy, they will stay with us and carry on the family." In fact, she
and her husband care for his parents at their home. Her parents are
cared for in her brother's home.
Although they have two daughters, her husband says there'll be no one
to take care of them until they have a son - yet to be born. "The sons
will usually take care of the parents in old age. I think our new
coming generation will do for us, too."
Foreign-born patients make up 25 percent of Potter's gender selection
practice, and of those from India, Korea and China, 90 percent want
boys. That adds up to six boys a month in his clinic alone. Of his
American-born patients, 80 percent ask for girls.
And, Potter says, they tell him why: "It's about the
woman desiring to have the relationship that she had with her mother -
seeing their daughter walk down the aisle, going shopping with them. A
potential daughter occupies a space in their consciousness like a
living, human being. And for them to give up on that, it's like a
Whether parents want a boy or girl because of gender stereotypes,
ethnic traditions, or simply because they have one sex and want the
other - it's the intensity of that desire that's motivated doctors in
many PGD clinics to take it from a procedure designed to detect genetic
defects, to one that detects - and selects - gender.
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