IVF Gender Selection: Is It a Slippery Slope?

When it comes to in-vitro fertilization options (IVF), the US operates more like the Wild West: almost anything goes.

For a long time, IVF was viewed with suspicion. In fact, federal funding was banned (through a provision in a 1995 appropriations bill) for any entities working with embryos. It was supposed to limit experimentation, which it did for the National Institutes of Health (NIH), but it ended up limiting ethically-based regulation for private IVF companies and clinics that don’t take federal funds. Thus, the US has virtually no limits on what an IVF clinic can offer its customers.

Recently, CNBC visited a clinic, The Fertility Institutes in Encino, California, that offers a panoply of options for potential parents, including picking the embryo’s gender. In fact, the institute’s IVF specialist Dr. Jeffrey Steinberg told CNBC about 85% of his patients come to him for this specific service, which can cost up to $20,000.

Steinberg has other things to offer, like eye color. Apparently, blue is the most popular choice. Go figure.

ivf gender selection — Photo: Tamilisa Miner, iStock

IVF Technology Outpaces Ethics

IVF is a long, labor-intensive and expensive ordeal, especially for the woman. First, the woman’s eggs are harvested, which requires injections of drugs and hormones to produce them. The eggs are combined with the man’s sperm to create embryos, which are then implanted in the woman’s uterus. Lack of viability and miscarriage are always risks, and each round of IVF is very expensive.

Standard screenings for things like Down’s Syndrome and other genetic disorders have always been in IVF practice, but the gender selection technique, called preimplantation genetic diagnosis (PGD) is relatively new. PGD is being used commonly now, and there are other tests on the horizon, like polygenic risk scores, which claim to be able to winnow out embryos with less than average intelligence.

Ironically, the 1995 ban on embryo experimentation using federal funds shut down what, in the 1990s, the NIH saw as the biggest problem on the IVF horizon: a lack of federal ethical guidelines. By locking federally-funded scientists out of the IVF experimentation race, the ban locked the feds out of meaningful regulation of IVF, too. While Congress could, if properly motivated, revisit the idea of ethics based IVF regulation, the political will seems to be lacking.

“IVF clinics have had pretty free rein, and some would look at their pathway as being a bit free and easy in terms of new developments,” Francis Collins, head of the NIH said to the Washington Post.

Collins is also concerned about the rise of testing for traits like eye color, height and intelligence. They all raise ethical flags, but the federal government’s hands, as far as the private sector is concerned, are tied.

Why Would Parents Want to Choose Gender?

There are some genuine health-related reasons for using PGD. There are some gender-specific genetic disorders that can be avoided through embryo gender selection; pretty much no one takes issue with health-related reasons.

The AMA Journal of Ethics states it pretty plainly:

“The American Society for Reproductive Medicine (ASRM) Ethics Committee condones the use of PGD for serious adult-onset conditions for which there are no treatments. Similarly, its most recent committee opinion on “sex selection and preimplantation genetic diagnosis” suggests it’s ethically acceptable to use PGD and sex selection for medical reasons. “

The next reason to do PDG is for what’s called family balancing, like when a family already has two boys and is looking to balance it out with a girl. This is usually done after the family already has had a child or two. And it does fall into a rather murky ethical area, which the IVF market ignores. At the aforementioned Fertility Institutes, for instance, there are no caveats to PGD at all.

“The bulk of the patients we see are doing in vitro fertilization only to choose the gender,” Dr. Steinberg told the Washington Post. “We do not require people to have a first baby in order to request the gender on the second baby.”

And, the Washington Post reported, “A survey published in March in the Journal of Assisted Reproduction and Genetics found nearly 73 percent of US fertility clinics offer gender selection. Of those, nearly 84 percent offer it to couples who don’t have fertility problems, but are considering IVF solely to control the pregnancy’s outcome.”

The ASRM has a stance on this as well, stating:

“The use of PGD for elective sex selection, even by couples already undergoing medically indicated IVF, is not encouraged, and certainly initiating IVF and PGD solely for sex selection infertile patients is discouraged.”

What Do The IVF Parents Have To Say?

Maggie (not her real name), had two children via IVF, a boy and a girl. She didn’t opt for PDG, and in fact went to a fairly conservative IVF specialist who didn’t even believe in implanting multiple embryos (a common practice to up the odds of successful implantation, which often can lead to twins). Maggie and her partner simply opted for the healthiest embryo.

“I had IVF because it was the only way I could have a baby,” Maggie tells Parentology. “I didn’t find the process that difficult, but I don’t understand doing it just to get a certain gender. Shooting yourself full of hormones and drugs isn’t good for you, and I can’t imagine doing it for those reasons.”

While she’s grateful the technology allowed her to have children, she has some pretty strong feelings about going through a shopping list of traits and designing your own baby.

“I understand choosing an embryo of a specific gender for medical reasons, that makes sense to me,” Maggie says. “But when you do it just because that’s what you want, whether it be for gender or eye color or whatever, that’s different. It seems you’ve already failed in your parenting because you’ve demonstrated you can’t love your child unconditionally. How narcissistic and controlling are you that you’d only want certain things? Our children are their own people, different from us. That’s just part of parenting.”

Of course, some parents, like model and celebrity mom Chrissy Teigan, went to Steinberg for fertility issues and did spend up for the PDG. She and husband John Legend have the model family of one boy, one girl. She’s offering no apologies for her decision, and she doesn’t need to. It’s all allowed as long as you have the money or the insurance to pay for it.

Gender Selection and Other Options Could Lead to Inequities

IVF gets a lot of press, but it’s actually not that common. Only about 180,000 people undergo IVF each year, and not all of them opt for extra selection testing like PGD and polygenic risk scores. Compare that to the annual birth rate, and it’s not a huge percentage.

Still, it’s growing. Many companies, especially in Silicon Valley, offer health insurance covering IVF. And the wealthiest will always have access to very expensive testing like PGD. There are simply no rules, no safeguards to keep people from trying to design babies.

And, in countries that outlaw the technology, like China, the IVF wild west attitude holds a lot of appeal for its wealthiest citizens. While a doctor like Steinberg receives plenty of criticism at home, he noticed that in China he was greeted with warmth and enthusiasm. People often want what they cannot have.

Then again, those pesky ethics pop into play. The AMA Journal of Ethics weighs in again on the issue, with a pretty definitive statement of the risks:

“The more difficult scenarios are sex selection requests from otherwise healthy or subfertile couples without medical indications for IVF. The treatment is driven only by a desire to have a child of a certain sex. Even with IVF risks relatively low for women undergoing the process, the use of a limited health care resource without normal clinical justifications may be cause for concern. Because these elective and nonindicated procedures will not be covered by any insurance, only patients of a certain socioeconomic class would be able to afford them, which might not be equitable.”