It has been suggested that the development of IVF (in vitro fertilization) and assisted reproductive technology have been the standout achievements of clinical and scientific discovery over the last century, perhaps ever. If you ask anyone of the millions who have benefitted from IVF you would be hard-pressed to find anyone who would disagree. IVF and assisted reproductive procedures have made the impossible, possible, including the opportunity to choose the sex of your newborn. Should IVF however be used for sex selection or is ‘family balancing’ by IVF a step too far? Let us take a closer look.
So, how easy is it to identify or choose the sex of your baby with an IVF procedure? Well, from the scientific point of view it is relatively easy, or so I am told. Here in terms most of us will understand, is how it’s done. Using a very clever technique called Pre-Implantation Genetic Testing for Aneuploidy, or the more memorable abbreviation, PGT-A, the scientists are able to take a closer look at embryos to check whether there are any abnormalities in the number of chromosomes. This check is important as any abnormality could negatively affect the chances of the embryo developing into a baby or potentially result in the baby being born with a genetic condition. The procedure involves removing at least one cell from the embryo which is tested, without harming the embryo itself.
During the procedure the person undertaking the analysis will be able to determine the sex of the embryo after just a few days by counting the chromosomes. In countries where sex selection is legal and accepted it is at this point where the patient could legitimately ‘choose’ the boy and girl embryo.
Preimplantation genetic testing for aneuploidy has been used increasingly in IVF cycles, and results in information regarding the sex of the resulting embryos, even when the initial indication for IVF was unrelated to sex selection. This possibility of knowing the sex of the resulting embryo(s) is an option that patients may not have considered previously and for which they may have a variety of opinions. Knowledge of embryo sex at time of transfer and its potential impact or lack thereof on embryo selection for transfer should be discussed at the time of informed consent for PGT-A
Ethics Committee of the American Society for Reproductive Medicine
Is PGT-A the only procedure that can be employed by those seeking to select the sex of baby, in countries where it is allowed?
In terms of reliability and accuracy PGT-A leads the field but there are a number of other techniques which are championed by some to be an effective way of enabling you to choose the sex of your baby.
One of the more commonly relied upon procedures to facilitate sex selection in IVF clinics (where it is allowed) is the use of Flow Cytometry, commonly referred to as, ‘sperm sorting’. This technique which some claim has an accuracy rating of 80 to 90% involves a coloured dye being added to a sperm sample. The extent to which the dye binds to the genetic material found in the sperm can determine boy from girl. Another caveat, it can be an expensive procedure and many point to much lower accuracy figures.
There is one thing that we can agree on. Where it is legal and the procedure is undertaken by a medic or scientist, IVF sex selection cost is expensive. So, are there any cost-effective, reliable alternatives? Well, there are suggestions, and you take your chances regarding their supposed reliability. From timing sex to DIY sex selection kits, you have plenty of options to choose from but unfortunately, there is no consistent evidence to show that any of them actually work.
Science has given us two procedures, PGT-A and sperm sorting, to enable those seeking to select the sex of their baby (for whatever reason) but for a number of reasons (morally, ethically, and legally) access to these depends on the country in which you are undergoing any form of assisted reproduction.
IVF sex selection – where is it allowed?
There are many reasons why someone would want or need to choose the sex. For the majority, the simplest way to do this is to identify a clinic that offers the genetic testing of embryos and documents the sex of the embryo(s) on the test results. So where is this possible?
Well, there are national variations and possibilities, and these are based around complex notions of ethics, morals, and legislation; sometimes these variations are obvious, sometimes not as the examples below show,
- In some countries, the law states that choosing the sex of a baby is not allowed but there is no specific regulation placed on clinics. This is the case in countries such as Ukraine or Russia which means that in practice clinics may include the information alongside test results.
- In some countries, legislation is backed by guidance provided by a regulatory body (for instance, a national fertility body) which means that PGT-A test results should not contain any information about embryo sex. This is the situation in countries like Spain and Portugal
- In some countries – there is no specific legislation that covers the information that can be listed on PGT-A results, but clinics are recommended not to allow patients to select the sex of the embryo by the national regulatory body that oversees the work of those involved in assisted reproduction. This situation means that rules governing this could vary, clinic by clinic as is the case in North Cyprus
Complicated? Yes, it is, and that’s why it is so important to do your research and seek independent advice when you are considering so-called IVF family balancing or sex selection for any reason. We have put together a list which will help you begin your search for countries that have specific legislation in place regarding IVF and sex selection as well as those who are likely to provide such information on PGT-A test results on a clinic by clinic basis.
IVF sex selection – country specific conditions
| Country | Sex selection - legal | Embryo sex on the PGT test result (not universal) |
|---|---|---|
| Spain | No | No |
| Portugal | No | No |
| Czech Republic | No | No |
| Greece | No | No |
| North Cyprus | No | Yes |
| Ukraine | No | Yes |
| Russia | No | Yes |
| Georgia | No | Yes |
| Latvia | No | No |
| Poland | No | No |
| United Kingdom | No | No |
| USA | Yes | Yes |
| Mexico | Yes | Yes |
| Canada | No | No |
| China | No | No |
| India | No | No |
It would appear from this small sample of countries that legislation regarding IVF and sex selection is firmly sat in the ‘unlawful’ camp, but this is only part of the picture. As we have learnt, legislation may not be wholly specific or backed up by mandatory guidance for clinics. It is a procedure therefore that might be offered on a clinic by clinic basis and one which is very much dependent on the particular circumstances of the patient(s).
IVF sex selection costs
The cost of the IVF sex selection procedure is exactly the same as the cost of any type of the IVF cycle where the embryo biopsy and PGT-A using NGS technique is used and may range from EUR8,000 (Europe, Mexico if possible…) to EUR 30,000 (in the US) depending on the destination country.
The cost of IVF in popular IVF destinations abroad may vary, so you need to make a decision based on your budget and the country where the procedure might be allowed. Which may be very difficult.
IVF sex selection dilemmas
IVF sex selection at clinics
You may wonder why this practice is still offered to, or requested by, IVF patients when legislation would suggest that it should not be. A mercenary answer would be profit, from a treatment providers point of view offering a sex selection service may be lucrative (procedures don’t come cheap) – more patients, more income.
The majority of treatment providers are not that mercenary however and merely want to offer their patients a service which is tailored to meet their specific requirements.
IVF sex selection – the patient perspective
There are patients who simply want to choose the sex of their baby for individual or cultural notions of family balancing. There are others who have a genetic disorder which might be passed more readily to a son or daughter who would seek to determine the sex of a baby if at all possible. For instance, a disease such as haemophilia almost always passes from mum to son.
We have learnt that sex selection is complex, it can be achieved by a small number of procedures, and it is sometimes governed by legislation and/or regulatory guidance. It is offered by treatment providers and requested by patients for many reasons and is opposed by individuals, religions, and whole societies (and we haven’t really got into this reasoning) for complicated moral and ethical considerations. So, what do the fertility experts say?
IVF sex selection – international associations recommendations
European Society of Human Reproduction and Embryology
The European Society of Human Reproduction and Embryology (ESHRE) maintains that sex selection should not be used for non-medical reasons, but it should be allowed in principle if it is aimed at avoiding offspring health risks.
ESHRE recommendations
- Sex selection should be allowed in principle if aimed at avoiding offspring health risks…
- Centres offering flow sorting should commit themselves to careful monitoring and follow-up in order to provide data for assessing the longer term safety of the technology…
- The advent of NIPT may become an easy alternative route for those wanting sex selection for non-medical reasons…
- If the present ban on sex selection for non-medical reasons is to be maintained, clarification is needed as to whether it applies to fulfilling parental requests for additional selection in the context of a medically indicated IVF/PGD (or PGS) procedure…
- If the arguments against a categorical ban are found convincing, there would still be a need for setting conditions defining the responsible use of sex selection for non-medical reasons…
Source: ESHRE Task Force on ethics and Law 20: sex selection for non-medical reasons
American Society for Reproductive Medicine
Whilst the American Society for Reproductive Medicine (ASRM) is behind sex selection for medical reasons it does not actively encourage its use for non-medical reasons and encourages individual clinics to develop and clearly promote their specific services offered for couples wishing to access such provision.
Human Fertilisation and Embryology Authority
The Human Fertilisation and Embryology Authority (HFEA), the regulatory body which oversees the work of fertility clinics and projects involving research with human embryo in the UK is very specific. It supports UK legislation which states that selecting the sex of a baby for a reason other than preventing a serious inherited illness is strictly prohibited.
We have purposefully not delved too deeply into the ethical debate around sex selection and as it would merit a text far more substantive than this to justify all the arguments, pros and cons. We begin this work where we started – whilst many view sex selection as a transformative milestone in preventing genetic disease, others view it as an invasive and unnatural intervention. Whether sex selection is an expression of someone’s reproductive rights or a failure to view all children as gifts from a higher being is a tough one, is emotive and very complex.
IVF sex selection FAQ
Where is sex selection legal?
This question probably should be reframed and ask, ‘Where is sex selection available’. We have spoken in this article how some countries have outlawed procedures designed to identify the sex of embryos, but treatment providers may offer it due to a lack of regulation in practice. These countries include Russia. There are other countries where sex selection is legal, and these include the United States, Mexico and Thailand amongst others.
How much does sex selection cost?
This would ultimately depend upon the country in which you were having treatment, the clinic and the procedure itself. You may be charged an inclusive price which covers an IVF procedure (with or without a donor) and a PGT-A or clinics may promote the PGT-A as an add on procedure.
In Europe generally a PGT-A procedure would cost an average of 1,500 to 2,500 Euros on top of the price of treatment. In the United States a PGT-A procedure usually equates to 25% to 30% of the overall cost of treatment so this would typically be in the region of $4,000 to – $10,000.
Can you choose the sex of a baby with IVF?
Yes, this is scientifically possible as we have discussed. We would recommend that if you were considering this you need to seek independent advice before committing to any procedure in any country. As we mentioned there are potentially large costs associated with any procedure and you have to choose a country in which explicitly says that it is permissible.
What is PGT-A (Preimplantation Genetic Testing for Aneuploidy), and how is it used for sex selection?
PGT-A, or Preimplantation Genetic Testing for Aneuploidy, is a method utilized during in vitro fertilization (IVF) to evaluate embryos for chromosomal abnormalities. In addition to identifying chromosomally normal embryos, PGT-A can also facilitate sex selection. This involves identifying embryos of the desired sex during the testing process.
