IVF and Sex Selection

One of the steps of the IVF treatments is screening sperm and eggs for hereditary conditions or diseases. In this way, the embryo that is formed during the fertilization phase has the best chance at a healthy life. This process is known as preimplantation genetic testing (PGT). 

PTG is not only effective in disease detection, it is also effective in determining the sex of an embryo. As a result, prospective parents use this step to select the sex of their child. There is a medical rationale behind sex selection, but there are also legal and emotional implications to this. So let us look further into PTG and what it means for potential parents.

Sex vs. Gender

In the past, the words gender and sex were used interchangeably, over time, this has changed. There is a study that has described ‘gender’ as a spectrum of identities which include behavior, experiences, and lifestyle, and ‘sex’ as biological characteristics.  

Today, gender and sex are not synonymous, as the sex a child has at birth may change over time. Consequently, to accommodate this potential change, the terminology used to describe sex has also changed to ‘assigned sex at birth’ (ASAB), and refers to a person’s reproductive organs, chromosomal and hormonal makeup at birth.

Therefore, although potential parents can use PGT to select the sex of an embryo, there is no guarantee that the child born will assume the same gender identity as that assigned to them.

Sex Selection Legality

When it comes to the legal aspect of PGT, India, China, Canada and most European countries have outlawed sex selection. The only exception to this is if there is medical proof that sex selection is necessary, such as using sex selection as a preventative measure against passing down a genetic disease. 

In America, sex selection has been under scrutiny, as there is uncertainty over how ethical the practice is. In fact, although the American Society of Reproductive Medicine (ARSM) has expressed concern over how ethical sex selection is, there has not been a direct called for it to be outlawed.

IVF and Sex Selection

Medically, sex selection has been possible since the 1990s, but the use of this opportunity by potential parents has increased only in recent years. Exciting as this may be, it has also brought with it previously unknown challenges for these parents. 

Reasons for Choosing Sex

The primary reason for sex preselection is to mitigate against sex-linked diseases. Some examples of sex-linked diseases are hemophilia, duchenne muscular dystrophy, red-green color blindness, and certain forms of high blood pressure. 

In the world of medicine, it has been discovered that there are conditions that are genetically carried on the X chromosome. As a result, male embryos are affected disproportionately because they only have one X chromosome. In such cases, female embryos stand a better chance because they have two X chromosomes, which means that a disease could potentially leave the second X chromosome unaffected. 

Sex-linked diseases, out of necessity, have created the much needed window for preselection, which reduces or eliminates the risk of future possibilities of poor health. As a result, parents participating in sex preselection due to potential disease prevention are less likely to undergo legal scrutiny.

Typically, other non-medical reasons an individual or couple may want to preselect the sex of their child have to do with personal preferences. Two such preferences are cases where parents desire an equal number of children of both sexes, or desire a child of a specific sex because they want to have one child only. 

How Sex Selection Works

PGT protocols can typically identify the sex of an embryo accurately to almost 100 percent. These tests are conducted after fertilization but before implantation, during the time that an embryo develops for a few days independently outside the uterus. After five days of development, a small biopsy is taken for genetic testing.

Preimplantation Testing for a Monogenic Disorder

This is known as a PGT-M - or PGD - test, and is used to test for single-gene disorders, and has very effectively identified hereditary conditions such as cystic fibrosis, sickle cell anemia and Tay-Sachs disease.

Apart from disease, the PGD test is also able to identify  if there are anomalies in the chromosomal count of an embryo’s DNA. This is a particularly positive thing because chromosomal anomalies are the leading cause of early miscarriage, thus helping potential parents know whether or not an embryo can be carried to term ahead of time.

Preimplantation Testing for Aneuploidy

This is known as the PGT-A test and is normally used to check for anomalies in the number of chromosomes within an embryo’s DNA. Although primarily used to identify the risk of miscarriage, it is also used to detect chromosome-related disorders such as Down syndrome. It is not as thorough a test in detecting specific disorders as PGT-M tests are.

In Summary

The use of PGT prior to implantation in the course of  IVF treatments, was done as a measure in the prevention of sex-linked disorders and chromosomal diseases. The increased use of PGT as a matter of personal preference raises many unanswered ethical questions. 

With countries outlawing non-medical sex selection for reasons and medical organizations advising providers to exercise “ethical caution”, fertility clinics have put policies in place to regulate PGT for personal preference as opposed to medical necessity.

If you are interested in sex selection as part of your IVF treatment, check the PGT guidelines at potential clinics and consult with your health insurance to verify whether the additional costs are covered in your plan, before you begin treatment.

Frequently Asked Questions (FAQs)

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

PGT tests usually cost between $1,000 and  $4,000. It is important to note that this cost is separate from the costs associated with IVF treatments. 

Will my insurance cover the cost of PGT testing?

This is something only your insurance provider can answer as they can break down exactly which aspects of your fertility treatment your plan covers.

What sex are most IVF pregnancies?

Interestingly, even with the advantage held by female chromosomes over some types of diseases and conditions, PGTs have resulted in more male embryos being implanted than female embryos. With male embryos being implanted over one and a half times more than female ones. 

Contact Us

If you have any further questions about starting a family, contact the team of fertility experts at Reproductive Partners Medical Group.