A significant number of women would choose the sex of their child as part of assisted reproduction if they were given the option, says a new survey.1 "To our knowledge, this is the first study to look at the demand and preferences of infertility patients for sex selection," the researchers wrote.
Poll: No Cost Sex Selection is Popular
The poll by two groups of obstetrician/gynecologists at Brigham and Women's Hospital in Boston and the University of Illinois Medical Center in Chicago found that these women would choose infant girls and boys in approximately equal numbers.
"We found that 41 percent of patients surveyed would use preimplantation sex selection if it were offered to them at no cost," said Tarun Jain, MD, the study's lead author at the University of Illinois Medical Center.
Topic of Controversy
Sex selection, particularly for nonmedical reasons, has been controversial in the United States in recent years, Jain told Priority Healthcare in an interview. In fact, it is outlawed in the United Kingdom, based on a survey that found the majority of British citizens favored regulating such a procedure.
Sex selection is currently possible in the United States by use of two procedures: sperm separation and preimplantation genetic diagnosis (PGD). PGD is a technique that can be used during in vitro fertilization procedures to test embryos for genetic disorders before they are transferred to the uterus to begin a pregnancy. This makes it possible for couples with an inherited genetic disorder to lower the risk of having a child who bears the same disorder. But it can also be used to select the sex of an embryo before transfer.2 Sperm separation involves separating the X chromosome-bearing from the Y-bearing sperm before fertilization.3
But these procedures are typically reserved to prevent sex-linked genetic disorders in children. They are not widely used for nonmedical purposes, experts say.
A Seemingly 'Taboo' Topic
"Sex selection is a topic that's almost taboo for physicians to talk about," said Jain, who is an assistant professor of Reproductive Endocrinology and Infertility. "Yet it's important to understand patient interest in nonmedical sex selection, and adequately address the ethical and social implications before the cat is out of the bag."
Up until now, there has not been much of a focus on how patients feel about sex selection as part of ART, Jain pointed out. "As these technologies are growing and become more mainstream, there is no data at all on what the demands may be for such methods," he said. Jain and his colleagues chose fertility patients for their analysis because they have more experience with these types of procedures.
In this study, Jain's team surveyed female patients at a hospital-based fertility clinic to determine the demand and preferences for nonmedical sex selection. They also asked the patients which method they would choose.
Of 561 respondents, 229 said they would want to select the sex of their future child—about 40 percent of those who took part. Among those who said they would choose, 45 percent did not have any children, and 48 percent had children of all the same sex.
Further, of those who said they would choose sex selection if it were offered at no cost also acknowledged that they would pay for a sex selection procedure if they chose to undergo assisted reproduction again in the future.
No Overbearing Preferences Found
Sex selection for nonmedical reasons is not without controversy. Some experts call it "inappropriate" and some religions forbid it.4 Other experts discuss the possibility of sex ratio imbalances that might be created, and the questionable impact on sexism and the status of women.5
"One of the fears is that sex selection will drive patients toward a certain sex," said Jain. "And the presumption is a preference for boys. But our study did not show that. In fact, in patients who did not have children, there was no greater desire for boys over girls."
But the study did find that women with only daughters wanted the opportunity to select a male child, and vice-versa. Non-white groups had a stronger preference for sex selection, the survey also found.
When demographics were analyzed, women who were older, not religious, willing to pay for sex selection, had more living children, had only sons, or had a diagnosis of male infertility were more likely to want a daughter, Jain and his fellow investigators learned.
Guidelines are Contrasting
In conclusion, the researchers suggest that it may be essential for clinics, and perhaps society, to determine what is an acceptable use of nonmedical sex selection.
Among professional medical organizations, views on sex selection contrast. The American College of Obstetricians and Gynecologists (ACOG) and the International Federation of Gynecology and Obstetrics are opposed to the technique. But the American Society for Reproductive Medicine (ASRM) views sex selection as acceptable as long as it provides families with a child of a different sex than an existing child through a concept known as "family-balancing". Despite that, in 2002, ASRM refined its position, saying it discourages the use of PGD for sex selection, though sperm separation may be acceptable.
How do physicians decide whether to offer sex selection to their patients, given these contradictory opinions? "I think it really ends up becoming an individual decision based on their own feelings about this," Jain said.
ASRM's position may be sufficient guidance for some doctors, he explained. "However, it still doesn't address the issue of patients who don't have any kids."
In the end, it will be up to individual physicians, Jain stated. "As the techniques gain more popularity, physicians will have to decide if they will offer the procedure to patients with and without children," he said. "Hopefully, our paper can stimulate more talk in the health policy arena to come up with better guidelines regarding how such issues should be managed."
1. Jain T, Missmer SA, Gupta RS, Hornstein MD. Preimplantation sex selection demand and preferences in an infertility population. Fertil Steril 2005 Mar;83(3):649-58.
2. American Society for Reproductive Medicine (ASRM). Fact Sheet. Preimplantation Genetic Diagnosis. Available at: http://www.asrm.org/Patients/FactSheets/PGD-Fact.pdf. Accessed March 15, 2005.
3. Levin RJ. Current sex pre-selection methods. IPPF Med Bull 1982 Feb;16(1):1-3.
4. Schenker JG. Gender selection: culture and religious perspectives. J Assist Reprod Genet 2002 Sep;19(9):400-10.
5. Robertson JA. Preconception gender selection. Am J Bioeth 2001 Winter;1(1):2-9.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
