Child sex selection deemed ethical

Recently, the American Society for Reproductive Medicine established positions on ethical issues involving the parents' ability to choose the sex of their children. The acting head of the fertility professional society's ethics committee stunned many leading fertility specialists by saying in a letter that it is sometimes acceptable for couples to choose the sex of their children by selecting either male or female embryos and discarding the rest. Most clinics say they abide by this position.

In an attempt to help couples who can't produce naturally, clinics with reproductive technology create embryos and end up with thousands of embryos left frozen and unused. The ethical issue of the concept of sex-selection of these embryos by the parents is attracting current debate among professionals and researchers.

In the 1970s, assisted reproductive technologies (ARTs) began with efforts to create "test tube babies" with in vitro fertilization. The federal government banned the use of federal funds for research on human embryos; the decision was mostly influenced by the debate on the issue of abortion. The research on human embryos occurred outside of federal regulation and oversight and beyond public scrutiny.

Assisted reproduction became market-driven because of its unique history and the lack of insurance coverage. New technology introduced by one clinic is quickly offered by others as a matter of survival. Unlike other areas of medicine, where new therapies are developed after controlled research in humans, ARTs are often introduced directly from the lab as clinical services for patients.

Dr. Norbert Gleicher, a fertility specialist, whose group has nine centers and who had asked for the opinion of the ethics committee, was quick to act on it.

"We will offer it immediately," Gleicher said of the sex-selection method. "Frankly, we have a list of patients who asked for it."

Couples would have to undergo in vitro fertilization, which allows their embryos to be examined in the first few days when the embryo consisted of just eight cells.

Gleicher is chairman of the board of the Center for Human Reproduction, which has five fertility centers in the Chicago area and four others in Manhattan and Brooklyn. The acting chairman of the ethics committee at the reproductive medicine society, John Robertson, an ethicist and lawyer at the University of Texas, said he was responding to a request by Gleicher for clarification of the society's position.

Robertson said that he wrote the letter after consulting with another committee member and that he thought it reflected the group's position. The committee would have discussed the question at its meeting this month, he said, but the meeting was canceled because of the terrorist attacks. Robertson added that he expected the committee to discuss the letter in January at its next meeting.

Robertson used the term "gender variety" to explain the acceptable uses of the sex selection technique. "Gender variety" means that a couple who already had a child of one sex could ethically select embryos that would guarantee them that the embryo selected was of the opposite sex.

Robertson wrote that embryo sex selection could be offered for gender variety "when there is a good reason to think that the couple is fully informed of the risks of the procedure and are counseled about having unrealistic expectations about the behavior of children of the preferred gender."

Dr. James Grifo, a reproductive endocrinologist at New York University Medical Center, added that publicity over centers offering such sex selection would sully the field and could ultimately make it impossible to help patients with a medical need for the technology.

Other leading fertility specialists said they were taken aback by the new letter and could hardly believe its message because the group's previous statement, in 1999, said that selecting embryos solely to have a child of a particular sex "should be discouraged."

"Sex selection is sex discrimination, and I don't think that is ethical. It's not ethical to take someone off the street and help them have a boy or a girl." said Grifo, the president- elect of the Society for Assisted Reproductive Technology, an affiliate of the reproductive medicine society.

"What's the next step?" asked Dr. William Schoolcraft of the Colorado Center for Reproductive Medicine in Englewood. "As we learn more about genetics, do we reject kids who do not have superior intelligence or who don't have the right color hair or eyes?"

The embryo selection method, called preimplantation genetic diagnosis, has been available for about a decade, but was reserved almost exclusively for couples at risk for having babies with certain genetic diseases. Doctors can test their embryos to see if they have the disease gene before implanting the embryos in the woman's uterus. The method could easily be used for sex selection. It is simple to see if the embryo is male, with an X and a Y chromosome, or female, with two X chromosomes.

Fertility specialists say patients often ask if they can use preimplantation analysis solely to select the sex of their embryos. But most doctors say they refused.

"I could have financed my research from now until the day I die if I honored all the requests. But this is not the way we want this to go. We want to protect this technique for our genetic patients," Grifo said.

Gleicher said he felt otherwise. He said he was prompted to ask about using preimplantation genetic diagnosis for sex selection when the reproductive medicine society issued a statement in May that it was ethical to use a different method - sperm sorting - for that purpose.

Genetics and IVF Institute in Fairfax, Va., is using a sperm-sorting technique that allows it to pick out the vast majority of male sperm. The reproductive medicine society said that if a couple already had one child and wanted to use the method to select the sex of subsequent children, that was ethically permissible.

Gleicher said, "if sperm sorting is all right for sex selection, why prohibit preimplantation diagnosis for sex selection? How can you say that a method that would be 100 percent reliable is not ethically acceptable?" he asked. "Our institutional review board felt that it was unethical to offer an inferior method if a superior method is available," Gleicher said.

Schoolcraft pointed out a real difference between the two methods. "With sperm sorting, you are not throwing away potential babies," he said.

Like Grifo, he worried about the future of his field. "We have a responsibility to be conservative and cautious," Schoolcraft said. "It's our responsibility not to misuse these technologies.