Can You Pick a Baby's Sex Using IVF?

It's possible to pick a baby's sex, but the practice is controversial.

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In vitro fertilization (IVF) is an assisted reproductive technology (ART) that combines medicine and surgical procedures to help sperm fertilize eggs and fertilized eggs implant in a uterus. People may choose IVF if they are having difficulty conceiving with other methods. Some choose IVF if they are about to begin treatment for conditions like cancer that could affect their ovary function; or if they would like to maintain the option of getting pregnant in the future, as noted in an overview updated in May 2022 in StatPearls.

During IVF, the subject of selecting a gender may arise. However, gender is a social construct; it refers to the roles we give ourselves, and how we identify with those roles. Gender exists on a spectrum. Sex, commonly categorized as female or male, refers to a person's biological attributes.

You cannot select a baby's gender during IVF, but you can select its sex. To do this, you must get your embryos genetically tested. You can do this through preimplantation genetic testing (PGT).

Knowing Your Baby's Sex Early

Choosing a baby's sex is controversial. Still, people undergoing IVF have cited reasons for selecting sex like "family balancing." An example of family balancing is when a person has a child whose sex assigned at birth was male, and they now want their second child to be assigned female at birth. In a 2022 opinion, the Ethics Committee of the American Society for Reproductive Medicine (ASRM) noted that patients argue their right to choose their baby's sex is reproductive liberty and a matter of autonomy.

Still, the medical community debates the ethics of sex selection for several reasons. A child whose sex is chosen may be exposed to gender bias, which can negatively affect their mental health. Selecting sex, the ASRM notes, also creates a potential for population imbalances.

Others worry the ability to select a baby's sex could create a slippery slope where parents pick out a baby's attributes like eye color, height, athletic ability, or intelligence. You may have heard this referred to as creating a "designer baby."

PGT-A Testing for Sex

Preimplantation genetic testing for aneuploidy (PGT-A) analyzes the chromosomal makeup of preimplantation embryos. It's performed to identify embryos with what's called "normal chromosome complements," or "euploid embryos;" and embryos with "abnormal" chromosomal numbers, or "aneuploid embryos."

PGT-A is performed by taking a small biopsy of the preimplantation embryos. Historically, the test has been run to identify genetic disorders or, as noted in a 2018 review published in the Journal of Human Reproductive Sciences, to try to reduce the chance of miscarriage. However, a retrospective study published in November 2021 in Reproductive Sciences suggested PGT-A "is not associated with an increased likelihood of a live birth or a decreased rate of miscarriage among women younger than 38 years without recurrent pregnancy loss."

PGT-A comes at a cost and increases the financial barrier of assisted reproductive technology. The Pacific Fertility Center in Los Angeles estimates that PGT-A can cost between $4,000 and $10,000. This is on top of the expense of IVF, which averages $12,400, according to the American Society for Reproductive Medicine. These costs contribute to concerns that IVF is only available to those with enough resources.

During PGT-A, healthcare providers can determine the embryo's sex. If the fertility clinic allows you to choose your baby's sex—and you have both genetically male and female embryos—this is where you would select which embryo you want to be transferred to a uterus.

Transferring an Embryo

Not all fertility clinics will let you choose your baby's sex. In 2018, the Ethics Committee of the American Society for Reproductive Medicine (ASRM) wrote that fertility clinics should develop policies regarding identifying and disclosing sex during PGT-A. Clinics are allowed to tell patients they cannot choose which of the transferrable embryos will be implanted. The clinic may randomly select which embryo to transfer in these cases, but patients should be informed of the policy before PGT-A.

In 2022, the ASRM's Ethics Committee opined that sex selection should "not be encouraged" for nonmedical reasons. No state in the United States legally prohibited nonmedical sex selection, as of 2022, but the practice is prohibited in Canada.

Takeaway

Preimplantation genetic testing for aneuploidy (PGT-A) makes it possible for you to select your baby's sex (but not gender) during in vitro fertilization (IVF). However, nonmedical sex selection is controversial, and one should consider the ethical implications of selecting a baby's sex.

IVF and PGT-A are expensive and potentially emotionally and physically stressful experiences. Talk to your healthcare provider to fully understand if these options are possible and right for you.

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