Global IVF gets many requests about gender selections — where it can be done, what countries restrict it, etc. We know it’s a hotbed topic .. .some calling it devil’s work, others arguing if the science is available than people should be allowed to use it. In the coming months, we will provide even more information on gender selection around the globe… but as a first step, we asked respected Reproductive Endocrinologist, Dr Michael Feinman, to weigh in. He explains the process in simple, easy to understand terms. Gender selection is not a mystery…it’s a science, and currently many qualified clinics in the US are doing it.
Gender Selection 101
For centuries, people have dreamed of ways to select the gender of their offspring.They came up with some pretty interesting methods. Now, through IVF with Pre-implantation Genetic Diagnosis (PGD), this dream has become a reality. As with many advances in reproductive medicine, not all elements of society are comfortable with this reality.
Critics of gender selection are concerned about de-valuing one gender, compared to the other. This concern is understandable, given the recent practice of aborting female pregnancies in India and China. Both of these countries are moving to stop this practice. Others express concern for the advent of “designer babies,” where people can choose other characteristics in their offspring, thus turning them into commodities. Fortunately, we are far away from that reality.
In order to allay these concerns, we use the term, “Family Balancing,” and strive to limit this option to couples who already have a child of the opposite gender.
Pre-implantation Genetic Diagnosis (PGD)
In contrast, IVF with PGD offers virtually 100% accuracy and high pregnancy rates per attempt. Couples undergo IVF in the usual fashion. On day 5, all viable-appearing blastocysts are biopsied by taking a few cells out of the placental region of the early developing embryo. This material can be quickly analyzed to evaluate all 23 chromosome pairs. This allows for the elimination of embryos with abnormal chromosome numbers (aneuploidy), like Down Syndrome. As a side effect, the method also determines the gender of the embryos. Patients can then choose which embryos to transfer to the uterus.
For patients who do not already have a child and are working with egg donors and/or gestational carriers, this technique is proving to be an effective way of selecting embryos for single embryo transfer. In the past, we often transferred 2 embryos, to compensate for the possibility that one might be abnormal. This resulted in a fairly high twin rate. Twins tend to be born pre-maturely and have higher risks of life-long disabilities. Twins can be particularly burdensome in a surrogacy situation. Our experience with modern PGD shows little pregnancy-rate advantage to transferring the second embryo. Thus, some couples are now having “gender preference,” where they use PGD to select the best embryo and freeze the rest for future use. Since the remaining embryos are being frozen, regardless of gender, and the motive for PGD is single embryo transfer, we see this as a different paradigm. Thus far, we see relatively equal numbers of people selecting boys and girls, thus allaying the fears of bias towards boys.
In conclusion, it is now possible to perform accurate gender selection with PGD. Couples seeking a child of the opposite gender to the one(s) they have can enjoy the delights of raising both boys and girls, without risking having more children than they desire. Patients who use PGD to effectively select single embryos, by default, can choose the gender of their first baby, while preserving the other embryos for future use.
Author: Dr. Feinman is active in well-known professional organizations, including Association of Private Assisted Reproductive Technology, the American College of Obstetricians and Gynecologists, the American Society for Reproductive Medicine, as well as the Society of Reproductive Endocrinologists.
Dr. Feinman’s areas of interest include third-party parenting with local and national patients, minimal-stimulation and natural cycle IVF for poor prognosis patients, and strategies for minimizing multiple pregnancies.
Michael Feinman, MD., F.A.C.O.G./HRC Fertility