Can You Choose Gender with IVF?

Key Takeaways

• Preimplantation genetic testing has enabled the determination of an embryo’s sex during an in vitro fertilization (IVF) cycle for many years.
• Selecting the sex of an embryo is sometimes medically necessary to prevent genetic diseases, while other prospective parents choose the sex based on personal preferences.
• Many countries, excluding the United States, have prohibited elective sex selection for non-medical reasons. U.S. medical organizations recommend “ethical caution” for providers offering this service.

Overview of IVF and Sex Selection

In vitro fertilization (IVF) has brought hope to countless families struggling with infertility. Among the many advancements in reproductive technology, sex selection through IVF has emerged as a topic of interest and debate. This process allows parents to choose the sex of their baby, offering a unique opportunity for family planning. However, it also raises important ethical and emotional considerations. Understanding the science behind sex selection and the implications it carries can help prospective parents make informed and compassionate decisions.Since the 1990s, doctors have been able to determine an embryo’s sex during an in vitro fertilization (IVF) cycle, before transferring it in the uterus. During the last few years, more patients undergoing IVF have used preimplantation genetic testing (PGT) to determine the embryo’s sex, among other factors such as chromosomal issues.

IVF and Sex Selection Legality

As this information becomes more accessible, many people face the difficult decision of whether to choose the sex of their embryo. In numerous countries, selecting an embryo’s sex for nonmedical reasons is illegal. Although some exceptions exist, such as preventing genetic disorders that affect one sex, most countries, including those in Europe, Canada, China, and India, prohibit using this technology solely to prefer a child of a specific sex.

In the United States, sex selection is legal, but its ethics are heavily debated. In 2022, the American Society of Reproductive Medicine (ASRM) Ethics Committee noted that using PGT to select an embryo’s sex to prevent serious genetic diseases is ethically acceptable. However, the committee went on to say that using PGT for sex selection in IVF for nonmedical reasons can lead to gender bias, harm to individuals and society, and misuse of medical resources. ASRM recommends further studies to determine the effects of using PGD for sex selection. 

Sex vs Gender

For many years, sex selection was known as “gender selection.” Relatively recently, there has been a shift in many centers to instead use the term “sex selection” in an effort to be more inclusive to individuals who feel that their gender identity does not exclusively align with their assigned sex at birth. In the context of IVF, sex selection involves identifying the presence of either two X chromosomes (46XX) for females or one X and one Y chromosome (46XY) for males.

Reasons for Choosing Sex

One key reason for choosing an embryo’s sex before transfer, which faces less ethical scrutiny, is preventing sex-linked diseases.Genetic conditions on the X chromosome tend to affect male embryos more since they have only one X chromosome. By selecting the embryo’s sex, the risk of these conditions can be reduced or eliminated. Examples of sex-linked diseases include:

• Hemophilia
• Duchenne muscular dystrophy
• Red-green color blindness
• Certain forms of high blood pressure

Nonmedical reasons for sex selection include wanting an equal number of children of both sexes (family balancing) or preferring a specific sex in families planning to have only one child. For many patients undergoing IVF, sex selection allows the ability to plan out the order of male/female children they have. For these couples and individuals, sex selection simply guides the decision of which embryo to transfer at a given time, with the goal of ultimately transferring all available embryos.

If you’re considering sex selection as part of your IVF treatment, check the practice’s guidelines before starting. Some fertility clinics have policies that either allow or prohibit sex selection based on personal preference. 

How Sex Selection Works

The determination of an embryo's sex, regardless of the motivation behind it, involves a similar process.  Several established Preimplantation Genetic Testing (PGT) protocols exist, offering highly accurate sex identification along with screening for genetic disorders or potential future health issues.  These preimplantation tests are conducted on embryos after five to six days of growth. A small sample is taken from the embryo and sent to a lab for genetic analysis, providing valuable information about various health conditions and risk factors. 

PGT-M

Preimplantation Genetic Testing for Monogenic Disorders (PGT-M) is a highly effective method for detecting single-gene disorders such as cystic fibrosis, sickle cell anemia, and Tay-Sachs disease. Additionally, PGT-M can identify chromosomal abnormalities in biopsied tissue, which are often linked to early miscarriages. 

PGT-A

Preimplantation Genetic Testing for Aneuploidy (PGT-A) actively screens embryos for chromosomal abnormalities, helping to identify risks for miscarriage or disorders such as Down syndrome. The adoption of PGT-A in the United States has been on a consistent rise, according to an ASRM committee opinion. Additionally, the technology behind 24-chromosome analysis is advancing swiftly. However, unlike PGT-M, it does not pinpoint specific genetic disorders. 

PGT-SR

Preimplantation Genetic Testing for Structural Rearrangements (PGT-SR) was among the earliest uses of PGT. This test identifies chromosomal structural abnormalities in embryos, which often lead to miscarriage.

IVF and Sex Selection FAQs

What happens to unused embryos?

Often, there are surplus embryos remaining after a treatment cycle. These embryos can be cryopreserved for extended periods, sometimes exceeding a decade, allowing couples or individuals the option to pursue additional IVF treatments in the future. If future treatments are not desired, these embryos can be donated. Alternatively, if neither option is suitable, the unused embryos can be discarded.

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

The cost of sex selection and IVF treatments can vary significantly depending on the clinic you choose and your personal medical history. Generally, adding sex selection to an IVF cycle costs an additional $3,000 to $5,000 on top of the existing IVF expenses. It’s crucial to verify whether your insurance covers any or all of the costs for sex selection services, as this coverage may differ from what is provided for general fertility services.

What sex are most IVF pregnancies?

Recent research on the growing use of PGT for sex selection has revealed a significant imbalance, with substantially more male embryos being implanted than female embryos. A 2023 study indicated that the ratio could be as high as 164 male embryos for every 100 female embryos. This disparity was observed even in cases where PGT was conducted for reasons other than sex selection, which accounts for the majority of PGT applications.

Is PGT harmful to the embryo?

No, the biopsy for PGT is not harmful to the embryo. The procedure involves taking a very small number of cells from the area that will develop into the placenta. The inner cell mass, which will become the baby, remains untouched.

The Bottom Line

For many years, determining the sex of an embryo before implantation during IVF has been possible. Initially, this was primarily done to prevent sex-linked disorders and chromosomal diseases. However, the recent rise in preimplantation genetic testing for IVF has made this practice more common for personal preference, raising numerous ethical questions that remain unresolved.

If you have questions about starting your family, the experts at San Diego Fertility Center are here to help. Contact us to schedule your personalized consultation.

This blog is for informational purposes only and should not be considered medical advice.  Please consult with your physician or a qualified healthcare provider for any health concerns or before making any decisions related to your health or treatment.