As pioneers in reproductive medicine, we are acutely aware that infertility and its treatment are highly personal, often sensitive issues involving difficult decisions. That has not changed since the first IVF baby was born in 1978. But today, with medical and genetic advances, infertile couples and individuals have even more decisions to make – and more options for creating a healthy family.
Genetic testing of embryos is making a huge impact on the field of fertility medicine. Couples going through in vitro fertilization (IVF) have the option of genetically evaluating their embryos through two tests, preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS).
Benefits of genetic testing of embryos
- Ensures that only healthy embryos are implanted.
- In certain cases, may screen for a specific genetic defect a child might inherit from its parents.
- Screens for a range of chromosomal abnormalities.
- Reduces the prospect of a failed pregnancy, as genetic defects in embryos are a primary cause for implantation failure and miscarriage.
- Promotes success of single embryo transplant, reducing the risks of a multiple pregnancy (twins or more).
- Allows the parent to select the gender of the embryo to implant.
PGD evaluates for one suspected genetic mutation, such as cystic fibrosis or sickle cell anemia. PGD was first used to select an embryo’s gender to prevent X-linked genetic diseases. Some single gene disorders affect only males, for example hemophilia. Scientists have identified 200 disorders that are passed only by gender, and selection of embryos based on their gender may prevent those diseases.
PGS evaluates for a range of genetic problems related to chromosomal abnormalities including Down syndrome, the most frequent birth defect due to defective chromosome numbers.
Sex selection & family balancing
In addition to providing information relating to genetic defects, PGS also reveals the sex of the embryos being evaluated. So parents of IVF embryos not only can select an embryo free of genetic flaws, but also the gender they might prefer. Now many parents wishing to determine the sex of their child are turning to IVF for the genetic testing benefit, even if they can conceive naturally.
Selecting an embryo of a certain sex, boy or girl, to implant in the mother’s womb for pregnancy is called sex selection or gender selection. It is a side benefit, so to speak, of PGS. The gender identification success rate is over 95 percent.
Servy Massey Fertility Institute (SMFI) offers sex selection for couples that desire a child of a certain gender. This requires IVF, biopsy of embryos, freezing of embryos and testing by a nationally renowned lab. Once tested, the embryos can be implanted in a subsequent treatment cycle.
Reasons for selecting the gender of an embryo
People wish to have a child of a certain sex for many reasons, listed below. Our physicians and staff will discuss the issues involved, which can be complex, and can guide patients to further counseling with a psychologist who specializes in this area.
We explain to patients the process of how genetic testing is done, from the IVF elements to the withdrawal of cells from the embryo to evaluate its genetic makeup. We also discuss scenarios that might arise so the patient is mentally prepared to act on the test results.
Following are some of the primary reasons couples and individuals chose to select the sex of their child.
- Medical. Sex selection can prevent a child being born with a birth defect. For example, certain genetic defects are more likely to affect male children, such as muscular dystrophy. Parents likely to have that genetic defect and pass it on, which can happen even if they do not have the disease themselves, may want to choose a female embryo.
- Family balancing. When people tended to have larger families, they had a greater chance of having children of both sexes. That is not the case in most instances today. When a family has several boys, they may definitely want a girl child next time. It is not unusual for a man to want a son and for a woman to want a daughter, so they want a balance of gender in their family.
- Cultural. In some cultures, such as Asian, Indian and Middle Eastern, it is often desirable to want to have a male child. Conversely, many women in Western cultures want to have a baby girl. These broad cultural preferences are often emphasized by the family members of prospective parents.
- Smaller families. When a couple plans to only have two children, they may want to ensure they have one boy and one girl. Or they only plan on having one child and want a specific gender. Similarly, a single woman may only want one child and has a gender preference.
- Delaying a family. Many women delay motherhood for career or social reasons, and this puts them in greater need of assistance to get pregnant, such as IVF. Once in that treatment, sex selection is an option.
- Personal reasons.
- Sometimes a couple has lost a child and they desire another child of the same sex.
- Women may want to have a daughter so they can experience the special female bond.
- A male may want a daughter because he had a bad relationship with his father and does not want to have a son and risk that happening.
- Some couples want to experience having a daughter rather than a son for all sorts of reasons – or for reasons they cannot even identify.
There are ethical issues one must address in considering sex selection, and we help our patients with these issues. These involve concerns that gender selection is a form of gender discrimination and that sex selection is the thin end of a wedge toward choosing genetic traits, such as height and eye color, resulting in “designer babies.”
Whatever the reasons our patients have for sex selection, SMFI will work with each couple and patient to assist them in building the family they want. We believe that sex selection is a great benefit for many parents. On the other hand, it is not for everyone.
It is not unusual for a couple to start out wanting to select the sex of their child and then change their minds. This is a powerful medical option that has various effects on different people. We understand all the aspects of this issue, as well as all the medical elements involved.