Gender selection

28 September 2018 — The idea of choosing the sex of a baby has attracted a lot of media attention recently. Last week on the Today programme on BBC Radio 4 there was a discussion about how the prenatal harmony blood test (a test in early pregnancy to help detect genetic abnormalities) can also be used to find out a baby’s sex, and the resulting fear that some may be using that information to decide to terminate a pregnancy on the basis of gender.

“The desire for almost all couples is to have a family of both boys and girls.”

— Sara J Matthews

Whilst any woman has a right to terminate a pregnancy until 24 weeks at present, it is obviously illegal to do so on the grounds of gender, and extremely difficult for me to reconcile from my own moral stand point. It is of course impossible to collect data to assess whether this is actually happening in the UK. It would be a very unfortunate consequence of a wonderful advance in prenatal testing that allows excited new parents to find out whether they are having a healthy boy or girl and prepare for that. But it raises the whole issue of choosing the sex of children, which has been a taboo subject for a long time, and one highlighted by the World Health Organisation, as, in certain cultures a boy is very much favoured over a girl for financial and for economic reasons (a boy can work more on the farm and no dowry is required), and the fear has always been that the world would end up with many more men than women! Maybe it is time for a re-think, certainly in the developed countries, where couples are as likely to want a girl as a boy, and families are having fewer children.

The desire for almost all couples is to have a family of both boys and girls. Most couples in the UK want one boy and one girl. There are many old wives’ tales about how to increase the chance of having a baby of a particular sex. These include having sex at a certain phase of the moon, in certain positions, before or after ovulation, or by following an acid or alkaline diet, but contrary to what your grandmother may have told you, none are scientifically proven.

Scuba divers and cyclists have more girls as the more delicate Y sperm needed to make a boy are easily damaged by pressure or heat (respectively), but both obviously require a lot of effort and can never be completely reliable!

Science has been able to offer methods of ensuring a child of a particular gender for 15 years or so. Sperm can be ‘sorted’ into X for a girl and Y for a boy, and then those selected sperm are used for an insemination procedure at ovulation (the sperm is place into the womb and the couple do not have sex normally). This is more natural but less successful and less reliable than the modern preferred option of a specialist form of IVF, where several cells are removed from 5 day old fertilised eggs (embryos), and tested usually not only for the sex, but also for any genetic abnormalities.

A pregnancy rate of up to 75% can be anticipated after a genetically normal embryo that has been confirmed to be of the preferred sex, is placed in the womb. The risk of miscarriage is minimised as those embryos with major genetic abnormalities have been excluded.

More couples are approaching me about these techniques, which are currently illegal in the UK, but legal for family balancing purposes in some USA states, Mexico, Dubai and Northern Cyprus. The majority of these patients have had no problems having their other children and usually have at least 2 sons or daughters. They are not looking for a ‘designer baby’. They simply don’t want to continue having more children than they would ideally like, in the quest to balance their family. Many couples decide not to proceed, as the use of IVF when it is not required worries some, and of course the cost is considerable when travel and accommodation also have to be factored in.

Couples who have needed IVF before to have a baby are more likely to go ahead with gender selection. These women tend to be older and so value the benefit of genetically testing the embryo for abnormalities in addition to gender. Most of the couples who come to me, if presented during their treatment, with an embryo of the ‘wrong sex’ as their only embryo available after treatment, will opt to replace that embryo and have another girl or another boy, rather than destroy or donate the embryo and start all over again. This tells me that, for almost all couples in this situation, a child of a particular gender will not come at any cost. There is a point when couples even after IVF, will say what will be will be, so nature takes its natural course in the end.

The UK celebrity Danielle Lloyd justified her position with regard to choosing the sex of her next baby on Loose Women earlier this year. Danielle has 4 boys and would dearly love a daughter. She envisaged only having 4 children but is now contemplating a fifth. Many other families have similar stories.

The Human Fertilisation and Embryology Authority code of practice due for publication next month, clearly states that selection of IVF embryos of a particular sex for social reasons is prohibited in the UK (HFEA.gov.uk). There was a discussion surrounding sex selection in 2003, but with shifts in society and fertility and pregnancy patterns in the UK in the past 15 years, maybe it is time for a re-think. At the moment, the treatment is only available to those wealthy enough to travel and do specialist fertility treatment. Whilst it could never be considered as a funded treatment under the NHS, maybe there is an argument that this type of treatment offers the modern UK couple an opportunity to take a very pragmatic, responsible attitude to parenting.