We Want a Boy: The Ethics of Sex Selection in the Clinic

Controversy is no rarity in the field of reproductive endocrinology and infertility. Since its discovery and early clinical applications, everyone seemed to have (and still has) an opinion about in vitro fertilization (IVF) procedures. Many concerns are religious or political. Others are ethical, medical and genetic. With huge improvements in IVF laboratory techniques that now include preimplantation genetic screening (PGS) when appropriate, IVF patients may ask physicians to select only embryos of one sex or the other. They want to select their child’s sex.

The American Medical Association Journal of Ethics discusses this issue in its October 2014 Virtual Mentor section. Its content is captivating, addressing the question, “Do physicians or professional societies have the right to limit the use of these available techniques?” In some European countries, they do not. The United States has not regulated PGS to prohibit sex screening.

This article covers three techniques that currently can select for sex: prefertilization sperm sorting, PGS, and elective pregnancy termination after prenatal testing. Prefertilization sperm sorting, which is 84% to 92% accurate, is not available in the US. Terminating a pregnancy simply because the child’s sex is “wrong” is unethical.

Risk associated with pre-implantation PGS includes a chance that manipulation of embryos may affect their implantation potential. As this field is new, additional studies are needed to identify other risks. Patients need to know that the additional testing adds costs to an already costly procedure.

The authors discuss various possible situations when patients may ask to select the child’s sex. They may want to balance a family that already has one or more children of one gender. Or, they may simply prefer to have a boy or girl. Making these decisions could cause contribute imbalance of the sexes in the general population.

American Society for Reproductive Medicine Ethics Committee does not encourage use of PGS solely for the purpose of determining sex. At Albert Einstein College of Medicine’s Montefiore Medical Center, all requests to select sex using PGS are referred to the ethics committee. The Society for Assisted Reproductive Technologies is collecting data prospectively for all PGD cases conducted at their affiliated programs. Their plan is to assess the prevalence of PGS for sex selection and develop indications.