risks of gender selection
There’s no suffering. Mrs. Carter had given birth to a beautiful, healthy baby girl 3 years earlier. Information on gender is easy to collect and accounts for a higher average use of health care services among women. Apart from the technical problems and possible associated risks, which first must be better evaluated, the most critical questions are ethical or legal. Hum Reprod. A significant ethical dilemma arising from IVF-PGD for the purpose of sex selection is subsequent discarding of the embryos of unwanted sex. Sperm sorting is associated with the minimum number of discarded embryos, less than the 50 percent resulting from the IVF-PGD-only method, since sperm sorting should produce a high percentage of embryos of the desired sex. She was the light of their lives, and they loved her dearly. Leung R. Choose the sex of your baby. Unlike natural selection which costs nothing, the medical procedure can cost too much. Another argument against sex selection for nonmedical reasons is exposure to unnecessary medical risks. ISSN 2376-6980, Sex Selection for Nonhealth-Related Reasons. The gender selection process is safe for the embryo and the mother. Human sperm sex selection. These methods work on the premise that they separate the X and Y-sperm by use of centrifugation. There’s no illness. Discussions regarding the couple’s wishes in these difficult situations should occur prior to beginning the IVF-PGD cycle to avoid presenting these dilemmas on the day of embryo transfer, when there is insufficient time for the couple to consider their decision carefully. She obtained her doctoral degree from the Department of Obstetrics and Gynecology at the Karolinska Institute in Stockholm and completed her postdoctoral fellowship in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco. As is clearly outlined in the latest statement of the ethics committee of the American Society for Reproductive Medicine (ASRM), PGD for sex selection to prevent the transmission of serious sex-linked genetic disease is acceptable and recommended [8]. Elective sex selection is not done for medical reasons, but to accord with a desire for “family balancing,” as in the present case, or a strong preference for a child of a particular sex [2]. Other countries either do not have any laws or policies regarding sex selection, or such policies are unknown [6]. Interestingly, Judaism and Islam largely allow sex preselection, while it is forbidden by the Catholic Church even for medical use [9]. Male children develop blindness, deafness, severe digestive disorders, and renal failure before ten years of age. Consequently, when they are exposed to UV light during flow cytometry, X-bearing spermatozoa fluoresce brighter than Y-bearing spermatozoa. All my life I’ve envisioned having a kid I can take fishing and play ball with.”, “So, what do you think?” Mrs. Carter pressed. These procedures also carry a large financial burden in countries where patients are usually responsible for treatment costs. Five countries prohibit it for any reason, while 31 countries prohibit it for social or nonmedical reasons. Mr. and Mrs. Carter had been married for 6 years when they visited Dr. Jones, a well-known infertility specialist, to ask for help creating their family. Dawson K, Trounson A. Applying this to the current scenario, Dr. Jones should not feel any legal or ethical obligations to provide reproductive services to the Carters, if doing so conflicts with his own clinical judgment, values, or beliefs. Are there any risks to the mother or the baby with of PGD for gender selection? Accessed January 23, 2012. What does that mean? However, I do not think that gender selection is a moral right because there is no inherent need to choose the gender of your baby, nor does it improve the life of the parents in any way. Preimplantation genetic diagnosis for elective sex selection, the IVF market economy, and the child--another long day’s journey into night?. Because her particular interests are human reproduction and infertility, she has focused her research on human implantation and biomarkers of uterine receptivity, as well as on endometrial dysfunction in women with unexplained infertility and endometriosis. In the middle of office hours, she sees a couple scheduled for an in vitro fertilization (IVF) consultation. Use of assisted reproductive technologies (ART) for nonmedical reasons presents several ethical dilemmas. The strongest argument for pre-implantation sex selection is that it may be considered a lesser evil than prenatal diagnosis (ultrasound or amniocentesis) and abortion solely for unwanted sex. Technology today allows for parents to not only know the gender of their child before birth, but to choose the child‟s gender before being implanted in the womb. Lusine Aghajanova, MD, PhD is a resident in obstetrics and gynecology at Baylor College of Medicine in Houston, Texas. Because of unavailability of sex selection in a majority of countries around the world, patients from China and India undertake “sex-selection traveling” to the clinics that provide such services in the U.S. 2. Prior to flow cytometric sorting, sperm are labeled with a fluorescent dye, Hoechst 33342, which binds to the DNA of each spermatozoon. ; Family balancing reasons – here couples choose to have a child of one sex because they already have one or more children of the other sex. One multicenter study reported that some couples pursuing IVF-PGD for sex selection for nonmedical reasons view this procedure as an ethically complex decision and express considerable uncertainty about its ethical acceptability [17]. However, it is important to know that practitioners who offer assisted reproductive services are under no legal or ethical obligations to provide nonmedically indicated preconception methods of sex selection [8]. They had trouble conceiving naturally due to Mrs. Warren’s blocked Fallopian tubes, presumably related to extensive scarring due to complications from a childhood appendectomy. The risk of accidental damage to an embryo during removal of the cell(s) is very low – around 0.6%. Any patient who is already … IVF alone can cost Up to $20,000. You can only legally choose your baby’s sex in the UK if you have a serious genetic condition that you risk passing on to your children and only affects one of the two sexes (HFEA 2009). sex-linked genetic disorders or, serious genetic disorders that are more likely to occur in one gender or the other. Lusine Aghajanova, MD, PhD and Cecilia T. Valdes, MD, Copyright 2020 American Medical Association. In the interests of all patients, no variations to this treatment programme are permissible under any circumstances. Some genetic diseases are linked to gender, such as hemophilia, which primarily affects boys. The nonmedical reasons are the area of continuing debate. Moral attitudes and beliefs among couples pursuing PGD for sex selection. That is about several-years-worth of savings. Current status of sexing mammalian spermatozoa. However, gender selection is not without risks. This already exists in China and India, where male children are particularly favored [10, 11], but is less likely to happen in the Western world [12, 13], where “family balancing” is the usual reason for nonmedical sex selection [3]. Reasons for sex selection can be divided into two categories: medically indicated and elective (nonmedical) reasons [1]. For callers outside the UK +44 20 3608 4426. Last Update: 09/03/2018. Siegel-Itzkovich J. Israel allows sex selection of embryos for non-medical reasons. In the so-called "sex-linked diseases," genetic diseases are inherited via the mother, and only male offspring are affected. Implantation rates might be detrimentally affected by embryo biopsy, although observation so far suggests this possibility is outweighed by the beneficial effect of PGD. Center for Genetics and Society. The risk of population sex imbalance in the U.S. is not great, largely due to its ethnically mixed population, in which different preferences in sex selection balance each other. 60 Minutes. Another contention of critics is the high cost of scientifically implanting an embryo with a specific gender. It has been shown that embryos with chromosome problems are at a much greater risk of miscarriage than those without. The Australian Health Ethics Committee believes that admission to life should not be conditional upon a child being a particular sex. Therefore, pending further community discussion, sex selection (by whatever means) must not be undertaken except to reduce the risk of transmission of a serious genetic condition. This discussion should help us to work out the moral dilemma that Dr. Jones is facing with his patients in this case. 1996;11(12):2577-2578. We understand that there are many factors at play when it comes to deciding whether to screen your embryos or to choose to balance your family. This type of genetic diseases include muscular dystrophy and hemophilia, among others. Many patients who were planning to go abroad were completely confused as to where it was legal and where it wasn't. 1. Personal desires of patients and social obligations of geneticists: applying preimplantation genetic diagnosis for non-medical sex selection. Gender selection is the process of selecting single-sex embryos so that the result is a possible fertilization of the gender the parents select. Family balance is considered to be another valid reason for sex selection. Are there any risks to the mother or the baby with of PGD for gender selection? Every man has one X and one Y chromosome. Germany, publicand private health insurance, risk selection, unisex mandate JEL CLASSIFICATION I13; D82;H51 1 INTRODUCTION Gender is one of the most frequently used pricing factors in health insurance markets. This is not the case in the United States. No part of the future foetus will be lacking because one or two cells are removed from the embryo about 3-4 days after fertilisation. The risks associated with sperm sorting are still unclear due to the lack of relevant research, though some studies have found that Hoechst dye can have a mutagenic effect on sperm [15]. February 11, 2009. http://www.cbsnews.com/stories/2004/04/13/60II/main611618.shtml. Who is eligible for gender selection? Does gender selection require IVF? Studies indicate that embryo biopsy does not harm the embryos. The average cost of gender selection using PGD/PGS is approximately $3,000 to $5,000. A situation in which parents who have lost a child desire another child of the same sex may be considered another nonmedical indication for sex selection. Dr. Jones was confused about what they were asking for, and why. Then, only the embryos of the preferred sex are transferred back to the mother or frozen for future use, and the rest are discarded. Dahl E, Beutel M, Brosig B, Hinsch KD. Ethics of sex selection for family balancing. Sex selection for nonmedical reasons is not encouraged, but neither is it prohibited in the U.S., according to the latest guidelines. The ASRM committee advocates that use of PGD for nonmedical sex selection should not be encouraged but does not favor its legal prohibition [8]. Israel allows nonmedical sex selection only if a family has 4 children of one sex and desires a child of the opposite sex [7]. It is better to agree beforehand if the couple will still choose to transfer healthy embryos even if they are of the “wrong” sex, or if they will donate those embryos if there are none of the desired sex. There is no argument against medically indicated sex selection: the ASRM’s position is that all families have a genuine right to healthy offspring, and they can implement all available technologies to avoid a known genetic disorder. A designer baby is a baby genetically engineered in vitro for specially selected traits, which can vary from lowered disease-risk to gender selection. “Does this sound like something you can help us with?”. And I don’t think doctors have any business being there” [18]. There are two primary methods now available for sex selection: (1) the sperm-sorting technique, which is selection of sperm with the preferred sex chromosome (X or Y), followed by intrauterine insemination (IUI) or in vitro fertilization (IVF), and (2) pre-implantation genetic diagnosis (PGD) followed by IVF [3, 4]. Issues that should be considered include: (i) indications for medical, as well as for elective, sex selection, (ii) methods for sex selection, (iii) relevant policies in different countries, (iv) arguments for and against sex selection for nonmedical reasons, and (v) risks associated with the procedures. One of the concerns of elective sex selection is sex discrimination that results in an imbalance in the sex ratio within a given society. How much does gender selection cost? Dahl E, Hinsch KD, Beutel M, et al. Gender selection pros and cons are not easy to determine. By Zaira Salvador. Cell Removal . They sat down in the plush chairs in Dr. Jones’s office. The desire to have a child of a particular sex tracks back through centuries. Asian and Middle Eastern couples often prefer sons, while Caucasian and Hispanic couples prefer daughters [14]. The controversy of baby’s gender selection is not new and it is unlikely that there will be any consensus on the same, let aside unanimity. Of note, the sperm-sorting method still requires subsequent IVF and possibly even PGD for 100 percent accuracy. Now that their daughter was in preschool, they had decided it was time for them to complete their family by having another child—a son. Because the male gamete determines the gender of the offspring, sperm is an obvious target for selection. Detailed informed consent before initiating ART for sex selection, including scenarios specific to this treatment modality, are of particular importance. We support the use of sex selection by PGD in X-linked severe disease, but due to the potential risks of misuse, we are not prepared to support a more liberal attitude as long as the discriminated sex … BioPolicy Wiki. Gender selection patients are a group with needs and requirements distinct from general infertility patients that have differing goals and concerns that must be appropriately attended to. Ethical issues in new uses of preimplantation genetic diagnosis. A couple that we are friends with came to you to make sure they had a girl, since they have a disease in their family that runs in boys. Medical Indications for Gender Selection: For cases associated with. As discussed above, certain medical indications may exist which require gender selection in order to ensure the well-being of a child (see PGD/sex-linked disorders). In the meantime, do providers and proponents of sperm sorting have an ethical obligation to fully disclose the unknown risks of the DNA labeling of sperm on the health of offspring? With the implementation of new technologies, sex selection has become more precise and achieves the goal of avoiding a sex-linked genetic disorder. The risk of accidental damage to an embryo during removal of the cell(s) is very low – around 0.6%. We wanted to wait to see you, so that we could make sure we had a boy. For them, parents should not act like “God” and deliberately choosing the sex of their baby.2. Selecting only female embryos would mitigate that risk. Nonetheless, nonmedical sex selection risks indulging or reinforcing sex discrimination and may even contribute to sex-based stereotyping. Only pre-implantation genetic diagnosis (PGD) has been approved as a technique which does this. “Oh, no,” she responded. Besides slipping the stork some extra cash, would-be parents have a number of options for choosing the sex of their child. The choice of gender: is elective gender selection, indeed, sexist? The latter carries more significant risks for the mother’s health, not to mention stronger ethical concerns. These findings suggest caution when using sperm sorting as an elective procedure [15], as does the unknown risk associated with repeatedly freezing and thawing sperm. As they pass through the flow cytometer in single file, they are separated by means of electrostatic deflection and collected in separate tubes for processing. Gleicher N, Barad DH. Parents who are carriers of these genetic diseases may want to reduce the … “I just think we should have a boy and a girl. Non-Medical Family balancing. There is no country that explicitly permits sex selection. Even Microsort, which is still an investigational technique, can cost around $3,500—and that’s in addition to the cost of the IVF! List of Cons of Gender Selection. In the former category, sex selection is used to avoid so-called sex-linked diseases, which male children inherit from their mothers, such as hemophilia A and B, Duchenne muscular dystrophy, Lesch-Nyhan syndrome and others. We’re here to see if you can help us conceive a son for our family.”. “It really began as a way of avoiding the transfer of embryos that would produce a child with a deadly disease,” Keye says. Sperm selection allows for prefertilization sex selection and is based on the flow cytometry technique. Gender selection is a technique which allows couples to increase the odds of delivering a child of a particular sex. “We haven’t been trying. Moreover, in such cases, no preference of one sex to another is expressed based on its supposed value. This programme is fully explained on this website and in our detailed information. Another argument against sex selection for nonmedical reasons is exposure to unnecessary medical risks. Before the advent of genetic engineering and in vitro fertilization (IVF), designer babies were primarily a science fiction concept. “Have you been having trouble getting pregnant?” he asked Mrs. Carter. Fertility tourists from these countries and others can visit California to take advantage of accessing this service here without the restrictions imposed in … In that case, couples are to be offered alternatives, such as donating their embryos to infertile couples or for research. However, until now, there were no effective means of sex selection, except for highly speculative and unproven methods relating to the timing of intercourse and positions of the partners during intercourse. It is an impractical expense. Firstly, there are no additional to women undergoing IVF but only those experienced by any other patient undergoing IVF, which include multiple pregnancy , ovarian hyperstimulation syndrome (OHSS), pelvic infections, internal bleeding during egg collection , ectopic pregnancy … In some cases, parents use sex selection to serve a medical need. 1. The methods of sex determination by separating spermatozoa are, in our opinion, still not safe enough for routine clinical use. This sperm-sorting technique has a success rate of 91 percent for selecting girls and 76 percent for selecting boys [5]. AMA Code of Medical Ethics’ Opinions on Confidential Care for Sexually Active Minors and Physicians’ Exercise of Conscience in Refusal of Services, AMA Council on Ethical and Judicial Affairs, Protecting the Confidentiality of Sexually Active Adolescents, Funding for Abortion Training in Ob/Gyn Residency, Kristina Tocce, MD, MPH and Britt Severson, MPH, Selecting the Traits of Children Prior to Birth, Genetics/Preimplantation genetic diagnosis, Reproductive health/Preimplantation genetic diagnosis, http://www.cbsnews.com/stories/2004/04/13/60II/main611618.shtml. One of the issues opponents are raising is the ethical and moral implication of breaking the law of nature, that is, the traditional way of conception without interfering with the gender of the unborn child. PGD is not devoid of risks but these are outweighed by the benefits. The procedure merely delays development for a few hours, after which the embryo reaches the same number of cells as before and continues its normal development. Resemblance to real events or to names of people, living or dead, is entirely coincidental. Others would like to choose gender so they can have the experience of raising both genders of children, or for what we sometimes refer to as family balancing. Gender selection: cultural and religious perspectives. Advances in assisted reproduction technologies allow many dreams to come true: infertile couples are able to experience parenthood, and parents affected by chromosomal mutation or carriers of an abnormal gene can select healthy embryos for implantation. The definitive method during the past few decades with the ultrasound era has been prenatal diagnosis and elective abortion of a fetus of undesired sex, which raises many ethical issues as well as risks to maternal health. It is expensive. It offers no assurance. The Warrens are longstanding patients who have already had three boys via IVF. There is no official policy in the United States of America. This procedure, however, is not risk-free and is associated with significant cost. Extending preimplantation genetic diagnosis: the ethical debate. However, the rapid advancement of technology before and after the turn of the twenty-first century makes designer babies an increasingly real possibility. Kings were desperate to have a male heir to the throne, peasants desired sons to help with the work, while some families with many boys were longing for girls. Two years later, in a 2001 report, this Committee analyzed preconcep-tion methods for sex selection, such as sperm sorting. There are three core motivations for engaging in sex determination and sex or gender selection: Medical reasons – such as preventing the birth of children affected or at risk of X-linked disorders. because of risks of gender bias and social harm. So you can’t medically intervene with conception just to balance your family, or for social or cultural reaso A balanced family.”, “Hmm,” Dr. Jones said. It is a breach of morals and ethics. “We have done sex selection for patients in the past, but only based on medical conditions that occur in certain families, like what we did for your friends—”, “No, it’s nothing like that,” said Mr. Carter. 2005;330(7502):1228. I found whole websites devoted to discussion about where gender selection was legal (not the UK or most of Europe) and the cost of treatment (anything from £7,000 to £17,000). By Zaira Salvador BSc, MSc (embryologist). Sharp RR, McGowan ML, Verma JA, et al. BMJ. Implantation rates might be detrimentally affected by embryo biopsy, although observation so far suggests this possibility is outweighed by the beneficial effect of PGD. 1. All the cells of the embryo remain able to develop normally on their own until about the fourth day, which means that each cell by itself can grow into a whole and perfect foetus. Why balance families? As a result, designer babies have become an important topic in bioethical debates, and i… Gender selection is not legal everywhere, including in Australia, Canada, the United Kingdom, and China. Despite these risks, selecting a female child would be preferable because male children who inherit the “damaged” X chromosome of Alport’s Syndrome fair worse. The people and events in this case are fictional. Based on available research data, we believe that sperm sorting should not be used until more safety data are available. All Rights Reserved. Because the X (female) chromosome is 2.8 percent larger (i.e., has more DNA) than the Y (male) chromosome, the spermatozoa bearing X chromosomes will absorb a greater amount of dye than those bearing Y chromosomes. The Ethics of Gender Selection Whitney Akchurin, Ryan Kartzke Introduction Over the course of human history, the gender of a newborn child has mostly been a surprise and an uncontrollable aspect of the lifecycle. Gender selection is legal in the United States. Dr. Valdes is certified in REI, and her clinical and research interests include assisted reproduction, polycystic ovarian syndrome, insulin resistance, and metabolism. We invite submission of manuscripts for peer review on upcoming theme issues. When embryos are 3 days old and have about 8 cells, one of the cells is taken from each embryo for chromosomal analysis. Gender Selection. Rights verdict: Allow sperm sorting in cases where genetic disorders are involved. Proponents of elective sex selection argue about one’s right to reproductive choice—including sex selection—in terms of constitutional rights. Hum Reprod. Once the sample is processed, there is often only sufficient quality and quantity of sperm for laboratory-controlled IVF rather than the less costly and less invasive IUI. A fairness perspective focuses on the equal distribution of benefits and burdens among all people. We love our daughter, and we always thought it would be perfect to have one of each. Dr. Shah is surprised to see this couple again because, at the time of the last pregnancy… Sex selection for sex-linked disease prevention is well established and not controversial. Preconception sex selection for non-medical reasons: a representative survey from the UK. As mentioned above, IVF carries certain risks, such as ovarian hyperstimulation syndrome. Patients need to be informed of the small possibility of having a child of the unwanted sex despite the procedure or of having produced embryos only of the “unwanted” sex. Ethics Committee of the American Society for Reproductive Medicine. Does gender selection pose any risks? This however, is not the case with the Carters, who are aware of IVF, but need to be informed about the specific risks and side effects of PGD for sex selection. When gender selection is used to prevent a genetic disease, the process is called "medical gender selection." Gender selection is a subject matter that seems to elevate ethical questions. Gender selection, also known as sex selection, is the practice of choosing the gender (male or female) of a child before conception. Thus, detailed informed consent should be obtained prior to initiation of the whole process, because many couples seeking help with nonmedical sex selection are usually not aware of the seriousness and full complexity of either IVF and PGD or flow cytometry sperm sorting procedures. Sex selection and preimplantation genetic diagnosis. Yes, gender selection is a component of the IVF process. Candidate After nine years, an ethics committee has granted investigators at a Texas medical school approval to conduct a study involving couples who wish to choose the sex of their unborn children. Gender selection is certainly a gift when you consider the ambit of medically assisted conception but when we talk about natural pregnancy, the premise becomes contentious. Nonetheless, nonmedical sex selection risks indulging or reinforcing sex discrimination and may even contribute to sex-based stereotyping [8]. We realize that in some parts of the world, gender selection is illegal. That means gender selection, which not all clinics offer anyway, is a side effect of helping those who can't conceive a child naturally. Accessed January 23, 2012. Fetal Sex Selection Research Study Approved By Linda P. McKenzie, J.D., LL.M. Anyone unwilling to comply with this provision will be excluded from the programme. Dr. Shah is the medical director of a busy fertility practice. Please note that we work to an established programme which has been validated over hundreds of treatments. 2007;22(11):3038-3041. Preconception sex selection for non-medical reasons: a representative survey from Germany. Thus, we can summarize the above discussion in a few points: Dr. Mark Hughes, one of the pioneers of PGD in the U.S., expressed a clear opinion on the topic: “Your gender is not a disease, last time I checked. Due to patient demand and financial pressures, reproductive endocrinology and infertility physicians may consider providing ethically controversial services. For many, the controversy regarding gender selection is separated in natural fertility versus medical conception choice strategies; however, there are pros and con which can be used in both ways. As mentioned above, IVF carries certain risks, such as ovarian hyperstimulation syndrome. Cecilia T. Valdes, MD is an associate clinical professor with an appointment in the Department of Obstetrics and Gynecology and associate director of the Reproductive Endocrinology and Infertility (REI) Fellowship at Baylor College of Medicine in Houston, Texas. The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA. 1994;9(5):757. Hum Reprod. http://www.biopolicywiki.org. Another issue in countries where patients pay treatments costs is the fairness of access to medical resources [8, 16]. Sex selection is an ethically controversial issue. Safety of human sperm selection by flow cytometry. 6 Pros of Gender Selection. In some cases, conditions are more severely expressed in one gender (e.g., fragile X syndrome in males) than the other. Pre-implantation genetic diagnosis sex selection is the most reliable method, with almost 100 percent accuracy. Further studies are warranted before recommending sperm sorting. 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