By Alison Bowen
Sunday, September 2, 2007
Fertility technology is allowing parents to determine the sex of a child before it's conceived and, in the United States, couples are mostly trying to have daughters in an act of family balancing. Ethicists say the practice is on slippery ground.
(WOMENSENEWS)--Leslie Jordan just wanted to dress up a dainty, delicate baby girl. But after giving birth to four sons, she was well established as a "boy mom" and playing kickball outside.
When Jordan married her husband about 10 years ago, they had a playful agreement to have four children; she wanted all four to be daughters. When she became pregnant, the ultrasound revealed their first son, Christian.
"I was thrilled when I saw him on the monitor," she said. "I didn't care what kind of package he came with. I was having a baby, and that's all I cared about."
Three similar ultrasounds later, and three failed attempts at folk remedies to conceive a girl including wearing tight underwear, taking Sudafed and tracking ovulation, the Jordans had their four children. She and her husband decided to try one more time, but didn't leave it to nature.
Jordan used a pre-conception sperm-sorting method and in vitro fertilization, which offered her an 85 percent chance of conceiving a girl. The procedure cost about $5,000, after insurance, which covered the in vitro and she became pregnant on the first try with Natalie, now a year old.
The Microsort method of sperm sorting, which uses a dye to separate male and female sperm before fertilization, and a second high-tech method called PGD--or preimplantation genetic diagnosis--which identifies the sex of embryos in the test tube before they are implanted in the womb, are drawing parents in to fertility clinics, where costs can rise up to $18,000 per cycle.
"They're having to save up for a BMW, or a baby," said Dr. Jeffrey Steinberg, director of Fertility Institutes in Los Angeles and Las Vegas. The clinic sees about 4,000 patients a year.
The success ratio for selecting girls is higher: In a Microsort clinical trial, 726 babies were born to parents who selected girls with a 92 percent success rate, compared to 81 percent success among 211 babies born to those who wanted boys.
The technology was initially developed to help prevent genetic disorders, which are often carried by one of the sex chromosomes, but a 2006 report from the Washington-based Genetics and Public Policy Center found that 42 percent of fertility clinics that offer the PGD embryo selection method used it for non-medical sex selection.
Jordan is one of thousands of parents to choose the gender of a child in the name of "family balancing." It's often used by women who want a daughter to add to a brood of sons, says Robin Weiss, author of "Guarantee the Sex of Your Baby," a 2007 book published by Ulysses Press that explains both low- and high-tech methods available to parents.
Up to 80 percent of U.S. families choose to try for girls, using methods ranging from sperm separation to money-back-guarantee kits complete with digital thermometers and ovulation predictors to use at home, according to the Web site In-gender.com, which informs parents interested in gender selection. Fertility professionals also say they have noticed a trend to select for females.
On Web sites such as In-gender.com and iVillage.com--where a message board thread cheerfully begins, "A healthy baby is all that really matters, of course. But we know you're dying to find out if you can help the sperm carrying a particular chromosome be the one that wins the race"--women fill forums with topics like "gender disappointment," which is what happens when methods don't produce the expected child. The anonymity the Internet provides--with sex selection jargon like a "dh, "ds" or "dd" (dear husband, dear son or dear daughter) dotting the posts--serves as a useful tool for a topic Weiss said is normally taboo.
"Women are not talking about it," she said, noting that the standard line of parents is that they just want a healthy baby. "Nobody says, 'We just plunked down $18,000, and it's a girl.'"
Jordan used sperm-sorting to conceive Natalie as a participant in a clinical trial conducted by the Fairfax, Va.-based Genetics and IVF Institute. More than 900 babies had been born in the trial as of January 2007. It is so popular the Fairfax center suggests patients call for an appointment several months before a planned conception.
Both sperm-sorting and the embryo selection method were developed as a way to avoid passing along genetic disorders, which are carried by one of the sex chromosomes, but parents began calling fertility institutes, however, to find out if they could use it solely for choosing gender.
In his practice, Steinberg said he sees a nearly 50-50 split of which sex a couple desires. If a mother calls to make the appointment, he said, she almost always wants a girl, and when the father calls, it's usually for a boy. Most couples come in after having two or three children of the same sex, but the clinic will perform the procedure for a first child. (The Microsort clinical trial requires that families already have at least one child.)
Steinberg said about half his patients are from abroad, and typically those from China and India--where the national sex ratio is skewed--generally use the procedure to select males. Gender selection is outlawed in China, India and throughout much of Europe amid fears that sex selection will lead to sex discrimination. Largely, however, concerns over gender selection have focused on prenatal tests and ultrasounds that lead to selective abortions.
In the United States, non-medical gender selection is on vague ground ethically. The Chicago-based American Medical Association has neither endorsed nor condoned the practice. The American Society for Reproductive Medicine, in Birmingham, Ala., says it is ethical when the couple is informed about the procedure and don't have "unrealistic expectations about the behavior of children of the preferred gender."
Michael Wilkes, a professor of medicine at the University of California, issued a warning in a July 21 Sacramento Bee article about technology moving faster than the discussion surrounding it. "We've not yet had the debate and discussion to develop a rational approach to use of the technology," he wrote, adding that the doctor's job is not just to fill the requests of patients but to fulfill an integrity based on "reasoned, rational logic."
Steinberg said the real ethical conundrums may come later, when doctors can dissect an entire embryo's DNA, determining what the child will look and act like.
"We've been accused of being on the slippery slope for 20 years," he said. "The future's maybe a bit scarier than things are right now."
For Jordan, and the scores of other women posting due dates on message boards and discussing the best way to convince their "dh" to invest in sperm-sorting or embryo selection, her daughter is not an ethical quandary but the scientific fulfillment of a dream.
Natalie is not the dainty, delicate thing she'd envisioned, she said of her fifth child, but is instead an adorable squealer she discovers sitting in the toilet or tearing through cupboards.
"There's just this hole in my soul that I had to have filled," she said. "And it's filled."
Alison Bowen is a New York-based reporter with Women's eNews.
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