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Medical and Social Reasons for Gender Selection

February 12, 2013

Gender selection, despite being a controversial topic, can help couples determine the sex of their child for medical or social reasons. Couples looking to reduce the risk of a sex-linked genetic disease in their children or wishing to balance their family can rely on preimplantation genetic diagnosis (PGD) as the only method proven 99.9% effective for predicting the sex of their child.

Andrew Toledo, M.D. of Reproductive Biology Associates in Atlanta, Georgia says gender selection in IVF is a lightning rod topic: “[Gender selection] evokes worry about creating the ‘perfect baby’, but that’s not why it is being done. In the least controversial scenario, gender selection is based on a sex-linked congenital issue that the parents want to avoid passing on to their child.” Some of these genetic diseases include hemophilia, Fragile X, or Autism which can significantly impair the child’s health and life experiences. Parents might consider PGD to choose the sex - male or female- less likely to inherit the disease with fewer ethical strings attached.

Family balancing, according to Dr. Toledo, is a much more heated issue. The most commonly cited problem with gender selection, is a moral issue about creating and discarding embryos. “What happens when you create embryos that could be all of the same sex the sex a couple does not want? You’ve created embryos and put the couple through a medically invasive process. There is a moral and ethical divide.” Toledo says the way around this issue is to first require the couple to have a family history of chromosomal abnormalities which drives a medical need for PGD. Secondary to that, he offers patients the opportunity to choose the sex of their child. “If the couple is healthy, there is no need to do IVF. We don’t do IVF unless there is a medical implication. If you’re going to genetically test an embryo, test and dispose because it is genetically abnormal, not because it is not the ‘right’ sex. If we create embryos that [the couples] don’t use, we require them to donate the remaining embryos anonymously or for scientific research,” he states. Patients are informed in advance of the likelihood that all of the resulting embryos could be of the undesired sex.

Daniel Potter, M.D., of HRC Fertility in Newport Beach, California, acknowledges the controversy surrounding PGD for gender selection, but believes the technology has a lot to offer fertility patients both from a medical and social standpoint. “There are so many benefits to doing PGD. It tells us the risk of genetic diseases like Down Syndrome and Turner Syndrome, among others. If we utilize the 24 chromosome screening, it is more likely for the couple to have a health child than if they were to get pregnant on their own. It also helps a couple that otherwise does not feel their family is complete to have a child of each sex,” he says. Dr. Potter believes the decision to do PGD for gender selection is a very personal decision to be made at the individual level rather than by a third party.

One of the greatest motivators behind gender selection for social reasons is to replicate the relationship a mother or father had with their own parents. Dr. Potter states that 80% of patients interested in gender selection are looking to have a baby girl. "Many women have the strong desire to have a daughter to emulate the relationship they had with their mother," Potter says. A couple who envisions having one boy and one girl, but has two boys may feel a sense of loss and mourning for the daughter they did not have. Gender selection allows couples to take control of their reproductive lives and balance their families if they so desire.

The reality is that gender selection for social or medical reasons is not for everyone. Both fertility doctors believe a couple should do what feels morally and ethically justifiable to them. Currently, The American Society for Reproductive Medicine (ASRM) backs the use of gender selection for eliminating the risk of inherited disease, but is not supportive of gender selection for non-medical reasons. Gender selection accounts for 30-40% of all PGD cases, both medical and social, in the United States. Despite opposing views on the topic, PGD for gender selection has helped the field of reproductive medicine become what it is today.


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