Most expectant couples are happy to let nature make the decision for them. But for some people, choosing the sex of their baby represents the opportunity to make a long-cherished dream—the birth of a daughter or a son—come true.

The technology currently is in place for determined parents to choose boy or girl. Their reasons for doing so range from the tragic—the death of a child or the threat of gender-based genetic disease, to the sentimental—a perceived dearth of girls in the family over several generations, to the “popular”—an attempt to achieve gender balance in families.

Research suggests that almost 90 per cent of those seeking to influence the sex of their children don’t simply “prefer” one sex over the other, but are mainly interested in substantially influencing their odds of having at least one of each.

Gender selection methods take two divergent paths. There are preconception techniques, which are generally less provocative than post-conception techniques.

“For centuries attempts have been made to choose the gender of offspring. The argument for permitting preconception gender selection is that it serves the desires of couples who have strong preferences about the gender of their offspring, some of whom might use abortion or embryo selection, both examples of post-conception gender selection—to realize their goal or be unhappy with children of the undesired gender,” says Dr. Laurence Jacobs, a Chicago-area reproductive endocrinologist and one of the leading fertility experts in the country. A teaching professional, he is in private practice at the Fertility Centers of Illinois, (fcionline.com).

Just because science makes it available, is it right for parents to customize their progeny as if children were a consumer product? Ethical questions and the looming specter of eugenics, make sex selection a complex field—one that’s being debated in countries around the globe.

“Sex selection simply for balancing a family is controversial and brings to the table many ethical issues, for example, what do we do with the embryos of the ‘wrong sex’? Do we simply discard them? Are we playing God too much? What if a couple wants a girl and the treatment results in a boy? Ultimately the technology is available and can be used appropriately but, it can also be abused,” says Dr. Sam Najmabadi, director of Center for Reproductive Health and Gynecology in Beverly Hills, (www.reproductive.org).

Currently prohibited in some European countries, sex selection is legal in the United States.

“At FCI we believe that ethics, law and social practice, while not regarding procreative liberty as absolutely unlimited, ordinarily accord couples and individuals wide choice in reproductive practice. Couples should, in many cases, be permitted to act on preferences for children of a particular gender. We offer preconception gender selection to couples that have an interest in it,” says Dr. Jacobs.



Among the most reliable sex-selection methods are:

• Shettles Method: Developed by Dr. Landrum Shettles in 1989. Based on the idea that Y-bearing sperm, which produces boys, are lighter faster swimmers that X-bearing or girl-producing sperm, which are also hardier. Difficult conditions favor the latter, according to this theory, which makes it critical to know exactly when ovulation occurs so you can time your efforts to favor the sex of your choice. Simply put, peak ovulation favors boys; two to four days in advance of ovulation favors girls. Dr. Shettles claimed a 75 per cent success rate for girls and an 80 per cent success rate for boys—many dispute the success rates alleged for this method.
• Ericcson Method: Dr. Ronald Ericsson’s method is employed by many fertility centers in the US. X and Y sperm are filtered and separated —the enriched sample is used during ovulation to influence gender. “Out of 18 couples wanting boys, 14 delivered boys, which helped give an 83 per cent success rate for the method. The Ericcson method may enhance the odds for a male child for reasons that are unclear,” says Dr. Jacobs.
• MicroSort Method: Costly, patented and high-tech. Developed by Dr. Lawrence Johnson who first used the technique in animals. Uses a technique called flow cytometry to separate sperm and increase the X and Y factor in each sample; in the case of X upping the DNA content from 50 per cent X to 88 per cent; in the case of Y to 73 per cent. Success ratios equal: 88 per cent for girls, 73 per cent for boys
• In-Vitro-Fertilization with Preimplantation Genetic Diagnosis (IVF-PGD): The most controversial and expensive of the procedures. (Costs for IVF average $8,000-$12,000 and PGD $3,500 for those without insurance coverage.) On the third day following egg retrieval a developing embryo is evaluated outside the womb for sex determination to essentially 100 per cent accuracy. Only the preferred-sex embryos are then transferred to the uterus. “Since this technology involves a post-conception gender selection, it’s considered to be an unethical use of IVF unless the couple requesting the technology is at risk for conceiving a child with a sex-linked genetic disorder,” says Dr. Jacobs. “We offer this service, but only when it’s indicated medically.”

“Patients and doctors should exercise extreme caution in deciding to proceed with a treatment plan that involves sex selection. The couple should know the chances of success with regard to pregnancy rates of the treatment option they choose, the cost, the failure rate and therefore, the chances of obtaining the results they seek,” says Dr. Najmabadi.

“They should also be clear about what they will do if the treatment isn’t a success and are they willing to make difficult choices?”