Can You Choose Sex with IVF?

In vitro fertilization (IVF) has been a saving grace for many couples looking to start their families. While many couples struggling to conceive would just like a baby no matter their sex, others would prefer to make that choice. This can be done with the help of IVF. Let’s take a look at how this process works. 

Key Takeaways

• Determining the sex of an embryo in an in vitro fertilization cycle has been possible for many years through the use of preimplantation genetic testing.
• There are many situations in which it is medically necessary to select the sex of an embryo to prevent the transfer of a genetic disease, and many other prospective parents use the testing to choose the sex of an embryo due to personal preferences.
• Many countries (not including the United States) have banned elective sex selection for non-medical reasons, and medical organizations in the US have advised “ethical caution” for providers who offer the service.

IVF and Sex Selection

Though it’s controversial, sex selection is a possibility through IFV, and prospective parents can choose the sex of an embryo before it is implanted in the uterus. IVF sex selection is done through preimplantation genetic testing or PGT. This process helps to predetermine the sex of the embryo. 

Sex determination is based on an individual’s genetic makeup. Every human cell carries 23 pairs of chromosomes, including one pair of sex chromosomes. Females have two X chromosomes (XX), while males have one X and one Y chromosome (XY). 

When conception happens, the baby's sex is determined by which type of sperm (X or Y) fertilized the egg first. However, with IVF, the process can be guided, allowing parents to have a say in their baby's sex.

With IVF, the ability to choose the sex of the baby has become more widely accepted. However, this isn’t possible in many countries, as some countries like Europe, Canada, India, and China have banned sex selection for non-medical reasons. 

While the USA has legalized it, the ethics surrounding the practice have been highly scrutinized. In a 2022 revision of their guidance on sex selection, the American Society of Reproductive Medicine states that sex selection for non-medical reasons requires serious ethical caution. 

Cost of IVF Sex Selection

The cost of sex selection varies based on the fertility clinic but can cost between $1,000 and $4,000 on top of the other IVF costs. Nevertheless, some insurance companies cover this cost, making it a lighter burden.

Reasons for Choosing Sex

Different reasons can make a prospective parent choose the sex of an embryo before implantation. While some would just like to have a specific-gendered baby or would like to balance their family gender-wise, other parents do it to prevent passing on sex-linked genetic disorders that can affect the baby’s development. 

Sex-linked genetic recessive disorders are carried genetically on the X chromosome. These disorders tend to impact male embryos, as they only have one X chromosome. By selecting the sex of the embryo before implantation, it is possible to reduce or eliminate the risk of these conditions. 

Examples of sex-linked genetic diseases include:

• Hemophilia.
• Duchenne muscular dystrophy.
• Red-green color blindness.
• Certain forms of high blood pressure. 

How Does Sex Selection Work in IVF?

Preimplantation genetic testing (PGT) is the best way to test for genetic disorders or predispositions for future complications. PGT looks at the embryos for genetic disorders before they are transferred into the uterus during IVF. PGT can be done at NOVA IVF, where our healthcare professionals will take you through what you should expect. 

Gender selection is done before the embryo is placed into the woman’s uterus. A single cell is taken from the embryo using a biopsy. This is done from a Day 5 embryo that has about 100 cells. This cell is then analyzed for its chromosomal content, which includes future gender, and only the embryos of the desired sex are transferred.

In other cases, pre-fertilization sperm sorting is done. Through this method, only a semen sample rich with sperm with the desired sex chromosome is used to fertilize an egg. However, this is not yet available in the US.

There are two main PGT protocols used to identify an embryo’s sex with nearly 100 percent accuracy. These tests are performed on an embryo after five days of development. A tiny biopsy is taken from the embryo for genetic testing, which provides insight into a wide variety of conditions and risk factors. 

Preimplantation Testing for Aneuploidy

Pre-implantation genetic testing-aneuploidy (PGT-A) tests abnormalities in the number of chromosomes in an embryo’s genetic makeup. Each person has 46 chromosomes, including 22 pairs from each parent and two sex chromosomes. PGT-A can tell you an embryo's sex by looking at the sex chromosomes XY for males and XX for females.

Preimplantation Testing for a Monogenic Disorder

Pre-implantation genetic testing-monogenic (PGT-M), previously known as pre-implantation genetic diagnosis (PGD), is used to test for single-gene disorders. This test is extremely effective at detecting cystic fibrosis, sickle cell anemia, Tay-Sachs disease, and many other genetic conditions. It can also be used to identify abnormalities in the number of chromosomes found in the DNA of the biopsied tissue, which is one of the leading causes of early miscarriage.

Ethical Debates on Gender Selection

Most ethical debates surrounding gender selection focus on respect for natural processes. Some people believe that selecting a child’s gender reinforces harmful societal biases towards a specific gender and has the potential to contribute to societal inequality. 

Additionally, some experts argue that allowing fertility clinics and parents to choose their child’s sex is one step closer to genetic manipulations that can lead to the creation of 'designer babies.'

Bottom Line

Sex selection using IVF is a highly accurate process that can help prospective parents prevent passing on genetic abnormalities to their children. However, unless your insurance provider covers it, genetic testing for sex selection can be costly as it adds to the other IVF costs. As the technology for gender selection in IVF continues to advance, it's important to weigh the ethical and social implications.