IVF and Sex Selection

In vitro fertilization (IVF) has opened a whole new world of information for family building. A crucial step in IVF treatments is screening both eggs and sperm for viability and vitality. During this process, diseases or conditions that can be passed down through the DNA are detected. This allows potential parents to give their child a chance at a normal and healthy life, right from the embryo stage.

The process of screening both eggs and sperm for disease is called preimplantation genetic testing (PGT). In this screening process, it is also possible to determine the sex of an embryo. Since sex detection is possible, there are parents who choose to select the sex of their child before implantation. Although there may be medical precedence for pre-selecting the sex of a child, there are legal and emotional implications. Let us dig in further into PTG.

Sex vs. Gender

Previously, ‘gender’ and ‘sex’ were considered synonymous. However these terms have evolved as society has changed. One study described the terms as such; ‘gender’ is not a singular identity, but a spectrum which comprises behavior, lifestyle as well as life experiences, and lifestyle, while ‘sex’ refers to the biological characteristics of a person.  

In today’s world where inclusivity matters, the terms gender and sex are no longer synonymous. It has been observed that the sex a person is born with could change in their lifetime. As the world works through the reality that sex could change, the current terminology in use to describe sex is ‘assigned sex at birth’ (ASAB). This is used to describe the reproductive organs, as well as the hormonal and chromosomal at the time they are born.

The facts are that potential parents may be in a position to select the sex of their child at the embryo state. However, there is no way to tell if the child born will assume the same gender characteristics as the sex they are born.

Sex Selection Legality

In Canada, China and India, as well as many European countries, sex selection is illegal. Although, if there is a medical precedence for sex selection, such as preventing the passing on of a hereditary disease or condition, PGT is permitted. Legally, this would require proof supporting the medical precedence.  

Sex selection has been controversial in the US because it is optional. The ethics about pre-selecting the sex of a child is under much scrutiny. The American Society of Reproductive Medicine (ARSM) acknowledges the genuine concern of pre-selecting sex, and has expressed concern over how ethical the practice is, but the organization has not pushed for the practise to be outlawed.

IVF and Sex Selection

Since the advent of IVF in the late 1900s, it has been possible to determine the sex of an embryo. However, the use of the PGT opportunity to pre-select the sex of children has become popular in more recent years. This however, has not been as straightforward for potential parents as it may seem. 

Reasons for Choosing Sex

Hereditary diseases and conditions sometimes affect one sex more than the other. Sex selection is therefore used to prevent sex-linked diseases from being passed on. Some diseases that are connected to a person’s sex include duchenne muscular dystrophy, hemophilia, certain forms of high blood pressure, as well red-green color blindness.

The study of genetics has revealed that there are some sicknesses that are carried on the X chromosome, affecting males significantly more than females. This is because males have only one X chromosome and females have two X chromosomes. Consequently, females have a better shot at healthier outcomes, because such a disease would potentially leave the second X chromosome unaffected. 

Out of necessity thus, sex selection has provided the opportunity to reduce or eliminate the potential passing down of hereditary disease. Parents using pre-selection as a mitigative measure against disease are less likely to undergo legal scrutiny. Preselecting out of personal preference is controversial, but parents also do it in situations where they desire to have an equal number of children of both sexes, or desire to have only one child of a specific sex. 

How Sex Selection Works

There is a window during the IVF process where the sex of a child can be definitively identified. After fertilization, the newly formed embryo is allowed to develop independently for about five to seven days before it is implanted into the uterus. It is during this phase that a small biopsy can be taken for genetic testing, and sex identification. There are two main types of PGT testing for disease. Below is a brief explanation of each.

Preimplantation Testing for a Monogenic Disorder

This test is used to identify single-gene disorders. It is called a PGT-M - or PGD - test and can effectively identify conditions such as sickle cell anemia, Tay-Sachs disease and cystic fibrosis.

Additionally, if any anomalies exist in the chromosomal count of the embryo’s DNA, the PGD test can identify this with accuracy. Chromosomal anomalies are largely responsible for a majority of early miscarriages, and the PGD test reveals the viability of an embryo ahead of time.

Preimplantation Testing for Aneuploidy

Also referred to as a PGT-A test it is also used to identify chromosomal count anomalies. Disorders affecting chromosomes such as Down syndrome can be detected using this test. However, it is not as thorough in the spectrum of disorders it identifies compared to the PGT-M tests.

In Summary

The course of IVF treatment allows for potential parents to identify and prevent the passing on of sex-linked hereditary conditions and chromosomal diseases. However, in recent years, using this opportunity to select the sex of offspring has raised many ethical questions which remain unanswered.  

As a result, fertility clinics, in recognition of this ‘grey area’, have policies that regulate the use of PGT to select the sex of an embryo simply as a matter of preference. Additionally, countries that have outlawed sex selection for non-medical reasons have driven medical organizations to advising healthcare providers to exercise “ethical caution” when using PGT protocols.

If you have any further questions about the option of sex selection as part of your IVF treatment, the team of fertility experts at Los Angeles Reproductive Center are ready to advise you on our PGT guidelines at any of our locations countrywide. 

Frequently Asked Questions (FAQs)

How much does it cost to choose the sex of an embryo?

Choosing the sex of an embryo using PGT tests typically incurs a cost ranging between $1,000 and  $4,000. This additional sum is not a part of the overall cost of IVF treatment, therefore consulting with your insurance provider ahead of treatments is crucial. 

What sex are most IVF pregnancies?

Most IVF pregnancies are male. PGT testing ironically has resulted in male embryos being implanted one and a half times more than female embryos, even with the advantage that female chromosomes have with regard to hereditary diseases and conditions.