Sex selection in IVF

Clinicians in laboratoryIntroduction

Sex selection is the attempt to achieve the preferred sex by controlling the sex of your offspring. There are several methods for sex selection, both pre- and post-implantation of an embryo, as well as at birth. Although initially the procedure was provided to avoid genetic sex-linked diseases it is often used for family balancing – which is when a family already has a son or a daughter and wants to have another baby but of the opposite sex.

Boy or girl?

Demand for sex selection rises each year partially because we know more and more about diseases of genetic origin. Some of the genetic diseases occur only in the female offspring so a couple which is a carrier of one of the sex-linked genetic mutations responsible for the disease could decide to have a boy to avoid passing it onto the offspring. The capabilities of estimating the embryos genetic features are increasing and we can lower the risk of the hereditary diseases to occur.
The normal biological sex ratio at birth is around 95 girls to every 100 boys but this number evens out because of the higher mortality rate of infant boys.
There is a visible son preference in various countries. In some of those countries where the sex selection is possible the ratio can get up to 130 boys to every 100 girls. It is a very concerning issue in some Central Asia, East Asia and West Asia countries. These distorted sex ratios will have great social and demographic impacts in the future. There is a number of reasons for preferring a son over a daughter in such countries including economics, culture and religion. Places where women are discriminated and cannot inherit or own land, sons are preferred because of the security of family assets. It is also said that parents in those countries are aware of difficulties that await females and they choose a boy to avoid them.
While the son preference is noticeable around the world the researchers from the Ulster University claim that sisters “make families happy”. People between the age of 17 and 25 were asked about their lives and it turned out that those growing up with sisters were happier and more balanced. According to the researches, sisters “make families more open and willing to talk about problems”. Lead researcher Professor Tony Cassidy said: “Sisters appear to encourage more open communication and cohesion in families”.

Chromosomes X&Y

Everybody is made of cells. Those cells carry chromosomes which have long pieces of DNA in them. DNA is the carrier of you genes and it is the building block of every human body.
Chromosomes normally come in 23 pairs in each cell (46 total). Half of the chromosomes comes from the mother and the other half from the father. Two of them are called sex chromosomes X and Y. Every female has two X chromosomes and each male has one of each, one X and one Y.
The female gives her X chromosome to the child and now it is all up to the father. If he gives the X chromosome it will be a girl, if it’s Y then it results in a boy.

Methods

Various methods give different chances of achieving the desired sex. We should keep in mind that there are couples that can’t have children or they have a high risk of giving birth to a child with a genetic disease and those methods were made for them. If you don’t have a child and the only motivation is the desire for a specified sex you should probably just stay with the natural way, the dream should be of a child not a gender.
The sex selection methods with the highest chance of achieving the desired effect are of course the most expensive. Furthermore those most accurate often require undergoing invasive infertility treatments and also taking fertility drugs which have potential side effects. If you want to use those methods for family balancing you will also have to meet some strict requirements like being married and having already one child of the opposite sex you are trying for. There are also age limits and all clinics have hormone tests to check if you are fertile.

Methods overview:

There are two types of infertility treatment that can use sex selection. Artificial insemination (AI) and in vitro fertilization (IVF).

Artificial insemination:

AI methods are all about putting the sperm closer to the place of fertilization. Intrauterine insemination (IUI) is the most common. In IUI the sperm is inserted directly into the uterus. It is also probable that fertility drugs will be needed.

In vitro fertilization:

Sex selection by IVF is just about placing the embryos of the preferred sex into the uterus. For details about IVF check our article.

Preimplantation genetic testing:

It is a procedure that can be done during IVF. One or more cells are taken from the embryo and tested for chromosomal or genetic disorders. Two types of tests are available:
preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS)
The type of the test you have depends on the reason why you want to select the sex of your offspring. Parents which carry inheritable genetic disorders can test the embryos by PGD and reduce the risk of passing these disorders onto the child.
PGS lets parents with normal number of chromosomes test the embryos of chromosomal disorders such as Down syndrome. PGS can also screen the embryos for sex. There are clinics which offer this test for family balancing and other non-medical reasons. PGD and PGS are almost 100% accurate when it comes to determining the sex of the child.

PGD and PGS advantages:

  • Almost a 100% certainty that when you get pregnant you will have a child of the chosen sex.
  • You can froze the embryos and use them in the future. With frozen embryos the success rate is similar but it’s a lot cheaper and less invasive.

Disadvantages:

  • It can cost even more than twenty thousand dollars.
  • It can be painful.
  • Using IVF rises the chance of multiple birth.
  • Side effects after using fertility drugs.
  • You will have to decide what to do with the unused embryos ( Freezing, discarding or donating for adoption or research).

Sperm sorting methods:

The Ericsson method:

Simply put Ericsson method is about separating the boy producing sperm – which is faster, from the girl producing sperm – which is slower. Using AI the sperm is placed directly to the uterus and becomes a baby of the desired sex. It is said that the effectiveness of this method is from 78 to 85 % when choosing a boy and from 73 to 75 % when you choose a girl.

Advantages:

  • Compared to the high-technology methods Ericsson is a lot cheaper, around 600 dollars per insemination.
  • It is non-invasive.
  • It is safe.

Disadvantages:

  • Evaluation of the effectiveness of Ericsson method has not been verified by other independent fertility experts.
  • AI is less effective than IVF, depending on your age and fertility it could take many cycles to achieve pregnancy.

Microsort method:

Microsort is a more advanced version of the Ericsson method. It is the most accurate sperm sorting method available. Genetics and IVF Institute developed and patented the Microsort sperm spinning. The sperm is separated into two groups, one group is made of female X chromosomes and other of male Y chromosomes. Then the selected sperm is inserted to the uterus (IUI). In contrast with other sperm spinning techniques Microsort shows the highest accuracy. 9 out of 10 baby girls for couples wanting a girl and 3 out of 4 for those who want a boy.

Advantages:

  • High accuracy.
  • Cheaper then IVF and PGD.
  • Less invasive then IVF and PGD.

Disadvantages:

  • It has not received a full FDA approval.
  • It still is quite a cost.

There are also affordable, non-invasive at home methods but their effectiveness is questionable.

Whelan method:

This method is all about timing the intercourse on the specific days of your cycle. According to Elizabeth Whelan her method is 68% effective when you want a boy and 56% if you want a girl so if you take under consideration the fact that normally you always have a 50% chance for either sex the numbers don’t look that well. Furthermore many experts doubt that this method really works. So how does it work? Well if you want a boy you should have intercourse 4 to 6 days before your basal body temperature rises and if you want a girl 2 to 3 days before ovulating.

Advantages:

  • It’s free or very low cost.
  • It’s safe.
  • It does not require invasive procedures or drugs.

Disadvantages:

  • You have to know when you’re ovulating by taking your basal body temperature every day or by using an ovulation prediction kit.
  • It doesn’t give you no guarantee of success.

Shettles method:

Just like in the Whelan method it’s all about having intercourse on specific days. It is claimed that it gives an 80% of success when you choose a boy and 75 % when it’s a girl but again experts are doubtful. The theory is that chromosomes Y (boys) are faster but chromosomes X (girls) live longer. So if you want a girl you should have intercourse 2 to 4 days before ovulation and if you want a boy you should have sex closest to the ovulation possible.
The advantages and disadvantages are the same as in the Whelan method.
There are also sex selection kits based on the Shettles method which should rise the chances of having a child of desired sex but yet again scientist say it has no scientific merit.

Myths and folk believes

You’ll find different home sex selection methods in every society. They continue to be recommended by the word of mouth. Even if the method is ineffective the chance is still 50%. Couples trying a home method recommended by neighbours or family (because it “worked” for them) should remember that a 50% chance it completely unreliable when it comes to measuring its effectiveness in home conditions.
Astrological charts influencing sex of the child, Chinese conception charts and the like have no scientific merit. Not to mention some extreme measures like in the 18th-century French book titled “The art of boys”. The book suggests that one testicle and one ovary is intended for each sex so removing it will guarantee a child of the opposite gender. This idea of course has no scientific truth to it and it is simply ridiculous. But then again it isn’t a lot more nonsensical then other sex-selection folk believes, only a lot more painful.

Ethical and moral concerns

While part of the medical community agrees that high-tech sex selection is a great way for family balancing the other part thinks that it isn’t a suitable path for medicine. Program director at the Center for Women’s Reproductive Care at Columbia University in New York and fertility specialist Mark Sauer said “I can’t endorse the destruction of normal human embryos because they happened to be of the wrong sex,”
However The American Society for Reproductive Medicine doesn’t condemn sex selection in all cases and says it shouldn’t be illegal but believes it ought to be used mainly for medical reasons.
The problem is that in many countries women would be under pressure from families and community and they wouldn’t really have a free choice at all.
The question rises, should we let methods that were created to help couples have healthy children or have children at all be used for gender selection?

Demographic concerns

Demographic issues are common in countries where sex selection is widely practiced. Combining the desire of having a child of a specific gender with economic concerns, cultural biases and a high frequency of sex selection will cause gender imbalance in the future.
In many nations of the Far East such as China as India and in several countries of Eastern Europe like Albania and Azerbaijan, sex selection induced abnormally high male/female ratios in societies. According to the UNFPA (United Nations Population Fund) because of the prenatal and postnatal gender discrimination a great gender gap has arisen. China’s gender imbalance problem is strengthened even more by the “one child policy”. Chance for marriage drastically lowered which is believed to cause increased crime, mass emigrations, demand for prostitution and even selling of brides.
In comparison there is no evidence that sex selection in most Western cultures causes gender imbalance. There is no noticeable male/female ratio imbalance for e.g. in USA where family balancing is quite common. Therefore individual parents deciding to try sex selection don’t have to worry about demographic issues. In the end it is a hard nut to crack, prohibiting gender selection in one country and permitting it in another causes medical tourism and illegal treatments. There is however no doubt that gender selection isn’t the direct cause of the problem but the issues within the society that cause gender inequality.

Legality

Sex selection is legal in the majority of the world but various countries have different limitations and restrictions. There are countries in which restrictions and limitations in sex selection practically don’t exist. In other countries the family balancing is legal but only if you’re married and you already have a child (the one you’re trying for has to be the opposite sex to the one you already have) and then there are countries where gender selection is allowed only for medical reasons such as sex-linked diseases and other hereditary disorders. A lot of countries don’t have sex selection legislations and are in a so called “grey area” for e.g. Poland.
Here’s a little insight on how the world is divided legal-wise.

Legal overview of sex selection around the world

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