Q: What is high-tech sex selection?

A: High-tech sex selection is the use of technologies to choose the sex of a future child, usually in conjunction with in-vitro fertilization (IVF). These techniques have obvious advantages over older, cruder methods such as infanticide and selective abortion, but raise important ethical questions.

Q: What techniques are used for high-tech sex selection?

A: The most significant technique is the use of preimplantation genetic diagnosis (PGD) as part of IVF treatment. One or more embryos of the desired sex is selected, and implanted into the womb of a woman who will carry it to term. Another technique, less accurate and invasive but cheaper, is "sperm sorting," which separates sperm carrying a Y chromosome from those carrying two X chromosomes. The sperm sample with the desired chromosomes is used to fertilize an egg.

Q: What is PGD?

A: PGD is a procedure for testing the genetic makeup of very early embryos created through in vitro fertilization (IVF). At this stage, an embryo has about eight cells, which are typically identical; they have started to multiply but have not yet begun to differentiate. One cell is extracted and analyzed. The remaining cells are capable of developing into a complete fetus. PGD can be used to select embryos that do not have a particular genetic sequence. It can also be used, with very high accuracy, to determine the embryo's sex.

Q: How does using PGD for sex selection differ from "sperm sorting"?

A: Sperm sorting is a pre-conceptive method of sex selection, where clinics sort a sample into sperm bearing an X-chromosome sperm and sperm bearing a Y-chromosome. It relies on the fact that the human X chromosome is about 3% heavier than the Y chromosome. This method is around 75% accurate for identifying males, a little more for females.

Q: In general, why should we be concerned about sex selection?

A: Many people believe that any form of sex selection is inherently sexist because it reinforces the devaluation of one sex in favor of another.

Q: Should parents have a "right" to choose the sex of their children?

A: No. Advocates of sex selection generally base their arguments on parental needs or desires rather than asking what is best for the child as a person. Parental determination of a child's sex could adversely influence the child's interpersonal development, socialization processes, and core identity. There are cases where it may be medically appropriate to avoid certain sex-linked diseases, for the benefit of the child, but that is a very different situation than decisions based on pure preference.

Q: Isn't sex selection a natural extension of reproductive rights?

A: Rights are socially negotiated. A decision about whether and when to bear a child is very different from determining the characteristics of a child.

Q: Are there broader policy concerns?

A: There are several, which deserve extensive public discussion. Private fertility clinics and individual fertility specialists should not be making ad-hoc decisions about potentially lucrative technologies that have profound consequences to the human future. A focus on high-tech sex selection may also be an inappropriate use of medical resources. Devoting limited fertility resources to sex selection would be unfair to couples who need the help of a fertility clinic to have a child at all.

Q: Is sex selection a new phenomenon?

A: No, in one form or another it has existed for many years. Selective infanticide of female babies has been practiced for hundreds of years. More recently, selective abortion (almost always of female fetuses) has become disturbingly common, especially in India and China, where in some regions there are as many as 130 boys for every 100 girls. Legitimizing high-tech sex selection in the West would work to legitimize these practices in developing countries.

Q: What does it mean to use sex selection for "gender balancing"?

A: Sex selection for "gender balancing" or "gender variety" refers to selecting the sex of a child for balancing the sex ratio in a family. It is a new concept created by advocates of high-tech sex selection.

Q: What is the policy of the American Society for Reproductive Medicine (ASRM) on sex selection?

A: In 1999, the ASRM issued a report which concluded, "The initiation of IVF with PGD solely for sex selection holds even greater risk of unwarranted gender bias, social harm and the diversion of medical resources from genuine medical need. It therefore should be discouraged." In May 2001, the ASRM released a report which concluded that physicians should be free to offer pre-conceptive methods of sex selection, if found to be safe and effective, to couples desiring "gender variety" under specified conditions.

Q: Why is the ASRM's position on this matter of significance?

A: In the absence of a regulatory body to govern reproductive technologies, U.S. fertility specialists look to the ASRM for ethical guidance. The ASRM has a special responsibility to be cautious with these and other reproductive technology matters, especially given the self-policing nature of the fertility industry.

Q: Why should we be particularly concerned about PGD for sex selection?

A: The use of PGD for sex selection represents a clear departure from preventive medicine and towards designer babies. PGD is one of a series of technologies that represent a trend towards an unprecedented level of control over the genetic make-up of our offspring. Using PGD to pre-select embryos for sex is especially problematic, because it is a clear example of a non-medical application of this technology. Allowing PGD to be used for this non-medical purpose would open the door to allowing parents to select embryos on the basis of other non-essential genetic traits.

Q: Is sex selection legal in other countries?

A: Article 14 of the Council of Europe's 1997 Convention on Human Rights and Biomedicine states that techniques may not be used to choose a future child's sex, except where serious hereditary sex-related disease is to be avoided. The Convention has been signed by thirty of the Council's forty-one member states and ratified by ten of those thirty. Canada has banned sex selection for non-medical purposes. Using PGD for sex selection for non-medical purposes is prohibited by the HFEA, the United Kingdom's regulatory authority which authorizes clinics to provide IVF procedures.

Last modified June 30, 2006