Gender Selection: Can You Choose Gender With IVF?

Gender selection can be achieved through genetic testing of embryos created during an IVF cycle. The process allows the parent to select an embryo of a specific sex before implantation. Other terms for gender selection include sex selection, family balancing, gender preference, or sex-specific embryo selection. While there are many names for it, they all mean the same thing. To understand the process, you must first understand what an IVF cycle entails.

In vitro fertilization (IVF) is an assisted reproductive technology (ART) that helps individuals and couples struggling with infertility achieve their dream of expanding their families. It involves fertilizing an egg with sperm in a laboratory setting, bypassing certain challenges in natural conception.

During the IVF process, some intended parents choose to undergo preimplantation genetic testing (PGT) for aneuploidy screening or monogenic/single-gene diseases (formerly PGD) to screen embryos for abnormalities or genetic conditions. Preimplantation genetic testing (PGT) can also reveal the sex of each embryo.

PGT provides critical genetic information and is capable of facilitating sex selection. This aspect, particularly when used for non-medical reasons, is part of an ongoing and nuanced dialogue in reproductive medicine.

This article provides an overview of PGT and how it can be used to determine the sex of an embryo.

Understanding Sex Selection in IVF

Sex selection, or choosing the sex of a baby, is possible through PGT. This section provides an overview of common methods used for sex selection during IVF, starting with an explanation of PGT.

Preimplantation Genetic Testing (PGT)

Preimplantation genetic testing involves screening embryos for genetic abnormalities before embryo transfer. This includes PGT-A for aneuploidy (extra or missing chromosomes), PGT-M (formerly PGD) for specific monogenic or single-gene diseases, and PGT-SR for structural rearrangements of chromosomes.

PGT may be beneficial for individuals or couples who:

While PGT can also reveal the embryo’s sex (XX for female or XY for male), it’s important to note that it’s not the primary purpose of PGT.

Common Methods Used for Gender Selection (Family Balancing)

There are two common methods used for sex selection in IVF:

Sperm Sorting

Sperm sorting using Micrsort was a common method in the past. However, in 2011, the FDA ordered Microsort to stop their clinical trials and to stop implanting embryos produced with sperm cells sorted using the Microsort process. Because Microsort is not FDA-approved, it is not available for clinical use anywhere in the United States.

Genetic Screening

Some individuals or couples may choose to undergo genetic screening with PGT-A during IVF. This test involves taking a small sample of cells (embryo biopsy) from each embryo to check for chromosomal abnormalities that could lead to health issues.

PGT-A doesn’t guarantee an embryo will result in a baby without genetic abnormalities from single gene disorders; however, some studies show that PGT-A may benefit patients at an advanced maternal age.

Examining these cells helps identify potential problems and reveals the embryo’s sex (XX for female, XY for male).

Legal and Ethical Considerations

The legality of sex selection via PGT through IVF varies by country. Some countries explicitly prohibit it, while others allow it with some restrictions.

According to a 2020 report published by Cold Spring Harbor Perspectives in Medicine, non-medical sex selection is legislatively prohibited in the following countries:

• Australia
• Austria
• Belgium
• Canada
• France
• Germany
• India
• Italy
• Netherlands
• South Korea
• Switzerland
• United Kingdom

China, Brazil, Japan, and Singapore allow sex selection for non-medical purposes but with certain regulations and restrictions.

The only countries that explicitly allow non-medical sex selection (without restrictions or guidelines) are the United States and Mexico.

In addition to legal considerations, there are also ethical concerns surrounding sex selection through IVF, including:

• The potential for discrimination and reinforcing stereotypes. Widespread sex selection could lead to societal pressures and potential discrimination against specific sexes, particularly against females in societies with strong gender biases.
• The commodification of children. The ability to select the sex of offspring through IVF raises ethical concerns about viewing children as commodities that can be customized based on personal preferences.
• The potential for a skewed human sex ratio in the population. IVF with sex selection could potentially disrupt the natural balance of male and female births in a population, leading to an imbalance in the future.
• The religious and cultural implications. Opinions about sex selection can vary greatly based on individual beliefs, cultural norms, and religious perspectives. What might be considered acceptable in one culture could be unethical in another.

Factors Influencing Gender Selection

An individual or couple may choose to use IVF for sex selection for a variety of reasons, including:

Medical Reasons

Sex chromosomes aren’t determining factors for just sex alone. They can also carry certain genetic disorders specific to one sex or the other.

Through preimplantation genetic diagnosis, IVF can be used to select embryos with or without certain genetic disorders, including those that are sex-linked.

X-linked disorders include:

• Red-green color blindness
• Hemophilia A
• Duchene muscular dystrophy
• X-linked agammaglobulinemia
• Alport syndrome
• Charcot-Marie-Tooth disease
• Fabry disease

Y-linked disorders include:

• Hypertrichosis of the ears
• Webbed toes
• Swyer syndrome (some cases)
• Y chromosome infertility

Family Balancing

Intended parents who already have one child (or multiple children) of a certain sex may choose to use IVF with PGT-A for sex selection to “balance” the existing family.

Cultural and Societal Factors

When considering IVF, many couples focus on medical reasons like preventing genetic disorders or family balancing. However, cultural and societal influences can also play a role in some decisions, including sex selection.

Different cultures have unique traditions and expectations surrounding family structure and gender roles. In some cultures, having children of a specific sex might hold significant meaning:

• Family lineage: Certain traditions may emphasize the importance of carrying on the family name or inheriting property, which can lead to a preference for male embryos.
• Social roles and expectations: Cultural norms and expectations surrounding what it means to be male or female can influence the desire for a child of a specific sex.

It’s important to acknowledge that using PGT-A for sex selection based on cultural or societal reasons raises ethical concerns.

Process of Sex Selection

While RMA Network prioritizes medical necessity in using PGT with IVF, we understand that some families may consider sex selection as part of their family-building journey. We strive to provide accurate information and support to individuals and couples considering this option.

Here’s an overview of the process involved:

Success Rates and Outcomes

Success rates and outcomes vary depending on multiple factors, including the IVF clinic’s expertise, the age of the intended parent, and the specific circumstances of each individual or couple.

In a 2015 study, researchers examined medical records and interviewed 218 couples who underwent PGD for sex selection. The study found that all the couples were able to successfully achieve their desired sex selection.

Takeaway

Preimplantation genetic testing is a valuable tool for individuals and couples undergoing IVF. It helps identify and prevent the transmission of genetic conditions and informs decisions about embryo selection for implantation. Additionally, it allows for the selection of embryos with a specific desired sex.

A Word From RMA

At RMA, we prioritize the well-being of our patients and are dedicated to providing personalized care while following ethical guidelines and legal regulations.

If you’re interested in learning more about sex selection through IVF or PGT, we encourage you to schedule a consultation with one of our experienced fertility specialists. You can also call us directly at one of our convenient locations to discuss your options and address any questions or concerns you may have.