As medicine has advanced, fertility patients now have options that previously did not exist. As recently as thirty-five years ago, if you had blocked fallopian tubes or a low sperm count, chances are you were going to be sterile. With the advent of in vitro fertilization, it is now routine for patients with these problems to have children. For the past twenty-plus years now it has been possible to do pre-implantation genetic screening (PGS) of embryos and screen for chromosomal disorders.
Should expectant parents be able to select the gender of the baby?
PGS has also made it possible to determine if the embryo is a male or a female with almost 100% certainty. This advancement raises the question of should expectant parents be able to select the gender of the baby?
There are two types of gender selection:
sex linked genetic disease prevention: usually for medical reason and is recommended for couples who have certain genetic diseases linked to one gender. Selecting the gender that is not affected by the disease can prevent these. e.g. Duchennes muscular dystrophy, hemophilia etc.
family balancing: commonly related to non-medical reasons, this is used by couples that already have a child or children of one gender and wish to have a child of the opposite sex to complete their family. These couple can now turn to gender selection to fulfill their hope of having a family with offspring of both sexes.
The Ethics Committee of the American Society for Reproductive Medicine (ASRM) recently published a document titled “Use of Reproductive Technology for Sex Selection for Nonmedical Reasons” published in Fertility and Sterility (Vol 103, No 6, p 1418-1422, June 2015) that discusses this very issue in detail.
The committee pointed out that using PGS for sex selection is a controversial practice and that there are differences of opinion about the use of this practice. The committee does not a have a consensus on the use of sex selection for non-medical use. The document outlines arguments for and against the use of sex selection, and since it is ethically controversial, clinics are encouraged to develop policies for non-medical sex selection.
Argument Supporting the Use of Assisted Reproductive Technologies (ART) for Non-medical Sex Selection:
The committee supports patient autonomy and reproductive liberty, which is the right of the patient to make decisions about their medical care without their health care provider trying to influence the decision. Patient autonomy does allow for health care providers to educate the patient but does not allow the health care provider to make the decision for the patient. Parents may have their own reasons to parent a child of a particular sex. Parents who are undergoing IVF for medical reasons may wish to include PGS for sex selection. Parents who are otherwise able to conceive naturally may seek In Vitro Fertilization (IVF) with PGS for sex selection in order to avoid unnecessary abortion of the undesired sex.
Argument Against ART for Non-medical Sex Selection:
The committee stated, that one of the possible objections to non-medical sex selection is the long-term medical risks of some procedures to offspring are unknown, and additional risks are unjustified. Long-term risks of PGS and IVF to offspring are unknown, however, currently no serious risks have been identified. There are also concerns about risks of gender bias and social injustice, at least within certain populations. Gender discrimination is not as prevalent in the economic structures of the United States as it is in some other countries.
In conclusion, the committee pointed out that practitioners are under no ethical obligation to provide or refuse non-medical methods of sex selection. In addition, practitioners must take care to ensure that parents are fully informed about the burdens and risks of the procedures and are not be coerced to undergo sex selection. When non-medical sex selection is offered in clinical practice, employees with objection to the technique must be permitted to absent themselves from its provision.