Can You Choose Gender with IVF?

Determining the sex of an embryo in an in vitro fertilization cycle has been possible for many years. This can be done during the process of preimplantation genetic testing  (PGT), a procedure used to detect and prevent genetic diseases.

Many prospective parents have taken the PGT opportunity to choose the sex of an embryo due to personal preferences. In this article, we shall be exploring the possibilities of sex selection with IVF by learning about the science, legal considerations, and emotional implications of choosing your baby's sex.

Sex vs. Gender

Sex selection was known as “gender selection” for many years. There has been a shift in language more recently, in an effort to be inclusive of individuals whose gender identity does not exist. Determining the sex of an embryo in an in vitro fertilization cycle has been possible for many years. This can be done during the process of preimplantation genetic testing  (PGT), a procedure used to detect and prevent genetic diseases.

Many prospective parents have taken the PGT opportunity to choose the sex of an embryo due to personal preferences. In this article, we shall be exploring the possibilities of sex selection with IVF by learning about the science, legal considerations, and emotional implications of choosing your baby's sex. Elusively align with their assigned sex at birth (ASAB).

While gender is now understood to be fluid and more of a spectrum of identities, ASAB refers more specifically to the reproductive organs and chromosomal and hormonal makeup of a person’s body at birth.

One study on sex and gender differences in healthcare describes sex as being based on biological factors, whereas gender is associated with behavior, lifestyle, and experiences.

Therefore, while it is possible to select the sex of an embryo before it is implanted in the uterus, it is not possible to choose the gender identity that the child born from that embryo will assume.

Sex Selection Legality

In most of Europe, Canada, China, India, and many other countries, sex selection for non-medical reasons, such as in cases where a genetic disorder may be passed on to a child of one sex but not the other, is outlawed. 

In America, however, sex selection is legal, but the ethics surrounding the practice are highly scrutinized. While the American Society of Reproductive Medicine (ARSM) expresses concern over the ethical implications of sex selection, it stops short of calling for it to be outlawed.

In a 2022 revision of the sex selection and preimplantation genetic diagnosis, the ASRM states, “The cumulative weight of the arguments against nonmedically motivated sex selection gives cause for serious ethical caution."

IVF and Sex Selection

Determining the sex of an embryo before it is implanted in the uterus during an in vitro fertilization cycle has been possible since the 1990s. More recently, couples and individuals undergoing IVF cycles have increasingly been using PGT to check, among other things, the sex of the embryo.

With this information readily available to prospective parents undergoing IVF treatments, the question of whether they should choose the sex of the embryo tends to be challenging for many. 

Reasons for Choosing Sex

There are many reasons for selecting the sex of an embryo prior to implantation. The leading reason for preselection, and one that is subject to less ethical scrutiny than the rest, is the prevention of sex-linked diseases.

There are conditions that are carried genetically on the X chromosome that can disproportionately affect male embryos because male chromosomes only have one X chromosome. 

Female chromosomes, on the other hand, have two X chromosomes, which could potentially leave the second X chromosome unaffected by the disease. 

Some examples of sex-linked diseases include hemophilia, Duchenne muscular dystrophy, red-green color blindness, and certain forms of high blood pressure. 

By selecting the sex of the embryo before implantation, it is possible to reduce or eliminate the risk of these conditions.

Some non-medical reasons potential parents have for selecting the sex of the embryo include a desire for an equal number of children of both sexes - sometimes referred to as “family balancing” - or a desire for a child of a specific sex in families who only desire to have one child. 

How Sex Selection Works

Different forms of preimplantation genetic testing are used to determine the sex of an embryo, while also testing for genetic disorders or predispositions for future complications.

Regardless of the protocol used to determine an embryo’s sex, the process is generally the same. There are a number of relatively common PGT protocols that identify an embryo’s sex with nearly 100 percent accuracy.

PGTs are performed on an embryo after five days of development where a tiny biopsy is taken from the embryo for genetic testing. This provides insight into a wide variety of conditions and risk factors.

Preimplantation Testing for a Monogenic Disorder

PGT-M, also known as PGD, tests for single-gene disorders and is extremely effective at detecting conditions such as cystic fibrosis, sickle cell anemia, Tay-Sachs disease, and many other hereditary conditions.

It can also be used to identify abnormalities in the number of chromosomes found in the DNA of the biopsied tissue. This is crucial, as chromosomal abnormalities are one of the leading causes of early miscarriage.

Preimplantation Testing for Aneuploidy

PGT-A specifically checks for abnormalities in the number of chromosomes in an embryo’s genetic makeup. It is used to identify the potential for miscarriage or chromosome-related disorders like Down syndrome. This test, however, is not able to identify specific disorders in the same way that PGT-M tests can.

In Summary

For many years, it has been possible to determine the sex of an embryo before it is implanted during IVF. However, this practice was typically done to avoid sex-linked disorders and chromosomal diseases until fairly recently. 

The recent increase in the use of PGT for IVF has made the practice more widespread for reasons of personal preference, bringing with it many ethical questions that remain unanswered.

Many countries (not including the United States) have banned elective sex selection for non-medical reasons, and medical organizations in the US have advised “ethical caution” for providers who offer the service.

Further, some fertility clinics have policies explicitly allowing or prohibiting the practice of selecting an embryo’s sex based on personal preference rather than medical necessity.

Frequently Asked Questions (FAQs)

What happens to unused embryos?

In many cases, unused embryos are frozen for future use or donated if the prospective parent or parents do not wish to have future IVF treatments or discarded as medical waste.

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

Typically, sex selection treatments will cost anywhere from $1,000 to $4,000, aside from the existing costs associated with IVF. It is also important to check what aspects of your fertility treatment your insurance plan will cover.

What sex are most IVF pregnancies?

Due to the increased use of PGT, significantly more male embryos are implanted than female embryos. The discrepancy could be as large as 164 male embryos for every 100 female embryos. 

Contact Us

If you are interested in sex selection as part of your IVF therapy, it is important to check the guidelines in place at potential clinics before treatment begins.

If you have questions about starting your family, the experts at Ivy Fertility can help. We have a variety of locations across the country ready to help you in your family planning journey.