Can You Pick a Baby's Sex Using IVF?

Some parents who use in vitro fertilization (IVF) can select the sex of their baby thanks to PGT-A (preimplantation genetic testing for aneuploidy), a type of preimplantation genetic testing (PGT).

During PGT-A, embryos are tested for chromosomal abnormalities, which includes testing the embryo's sex chromosomes. This can identify abnormal or nonviable embryos prior to embryo transfer into the uterus for implantation. It can also identify the sex of the embryo.

Selecting a baby's sex using genetic testing is controversial, especially for nonmedical reasons. Although some fertility centers offer this service, medical organizations like the American Society for Reproductive Medicine (ASRM) do not encourage nonmedical sex selection.

Here's what to know about picking a baby's sex with IVF, including why people do it, how it works, and ethical considerations.

Knowing Your Baby's Sex Early

Expectant parents might want to choose their baby's sex for personal or medical reasons.

Some parents want to choose their baby's sex for "family balancing," where they already have several children of the same sex and want to have a child of a different sex. Other parents may be emotionally biased toward one sex and desire a child of a particular sex. Parents who have lost a child may also feel strongly about choosing the sex of their next child.

In other cases, choosing a baby's sex is a medical decision. Certain genetic disorders only affect children of a particular sex or are more severe for one sex. Selecting a baby's sex ensures you won't have a child with a sex-linked genetic abnormality. This can reduce the chances of your child needing special medical care after birth or dying young from a sex-linked genetic disorder.

Most medical professionals agree that using sex selection to prevent health problems is ethical, whereas choosing a baby's sex for nonmedical reasons is more controversial. Other people think that all of it — using science to prevent possible medical problems and/or select children's genetic traits, known as "designer babies" —  is unethical.

PGT-A Testing for Sex

Preimplantation genetic testing for aneuploidy (PGT-A) is one type of preimplantation genetic testing (PGT). The purpose of preimplantation genetic testing is to evaluate embryos before they are transferred into the uterus. PGT-A screens embryos for "whole chromosome abnormalities," such as missing or extra chromosomes, that could lead to abnormalities or other health concerns.  

Because PGT-A looks at all the chromosomes present in an embryo, including the sex chromosomes X and Y, it can tell you an embryo's sex. (XY is a male embryo, and XX is a female embryo.) Still, sex selection is not the primary purpose of PGT-A.

PGT-A is mainly used to lessen the chances that a transferred embryo will have a chromosomal abnormality. However, “normal” or negative screening results do not guarantee you’ll have a baby without genetic abnormalities. According to ASRM, PGT-A is also one of the reasons why IVF now results in fewer multiple births, since fewer embryos need to be transferred to ensure IVF success.

Although many couples decide to do genetic testing as part of IVF, it's considered an "extra" procedure and is not part of the baseline costs of IVF. According to the Society for Assisted Reproductive Technology (SART), the average IVF cycle costs $10,000 to $15,000. Multiple IVF cycles could cost upwards of $27,685. Adding the cost of PGT-A will increase your IVF bill about $1,500 for the biopsy procedure, plus another $150 per embryo. All of these prices may vary depending on your insurance coverage, treatment center, location, health circumstances, type of PGT, and other factors.

Transferring an Embryo

Some parents may not want to know the sex of their embryo before it’s implanted, so ASRM advises all IVF providers to share that PGT-A can tell parents the sex of their baby during informed consent for the testing. 

Using PGT-A to choose a baby's sex for medical reasons is generally accepted. But ASRM's current guidance advises that "sex selection should not be encouraged for nonmedical indications." In addition, ASRM states that IVF practitioners are under no obligation to provide or refuse to provide nonmedical sex selection services.

In fact, selecting a baby's sex for nonmedical purposes is actually quite prevalent among IVF providers. Ethical arguments in favor of nonmedical sex selection often cite reproductive liberty and patient autonomy. While arguments against nonmedical sex selection include the potential for sex discrimination and added pressure on offspring to meet their parents’ gender desire and bias.

A Quick Review

Picking a baby's sex using IVF and PGT-A screening is a controversial topic. While many fertility specialists will provide this service for nonmedical reasons — and many parents are eager to use it — there are some ethical considerations to keep in mind. Some believe picking a baby's sex may be seen as sex discrimination or impose a parent's gender bias. Others think people have the right to choose their baby's sex for nonmedical reasons, without healthcare provider influence over their bodies. 

Whether or not you are able or willing to select the sex of your baby, many parents are interested in learning the sex of their baby before birth. You can still learn the sex of your baby early in your pregnancy, even before your anatomy scan, through simple blood tests like noninvasive prenatal tests (NIPTs).

If you have any questions or concerns about your baby's sex or sex selection specific to your situation and needs, contact your healthcare provider.