Can You Choose Sex with IVF?

Gender selection during conception and pregnancy has always been a controversial topic. While some individuals and couples are satisfied with any child they get, no matter their gender, some would like to have the choice in choosing the gender. For this reason, myths on how to select the gender of a child have been passed on throughout generations. 

Because of advanced technology, fertility doctors can now determine the gender of a child using modern screening and testing of embryos during in vitro fertilization (IVF). Let’s take a look at this process in detail.

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

For decades now, IFV has made it possible to determine the sex of an embryo before it is implanted in the uterus during an in vitro fertilization cycle. However, this has become more popular recently, as a growing number of couples and individuals undergoing IVF cycles have used preimplantation genetic testing to predetermine the sex of the embryo.

This is because this information has become more widely available to people due to the internet. The question of whether they should choose the sex of the embryo is a challenging one for many and countries in Europe, Canada, India, and China have outlawed sex selection for nonmedical reasons. 

Sex vs Gender

For many years, sex selection was known as “gender selection” but recent shifts in language ensure there’s inclusivity for individuals whose gender identity does not align with their assigned sex at birth. In one study, sex is based on biological factors, whereas gender is associated with behavior, lifestyle, and experiences.

Now, gender is understood to be fluid and more of a spectrum of identities, assigned sex at birth refers more specifically to the reproductive organs and chromosomal and hormonal makeup of a person’s body at birth. 

IVF Selection Legality

Nevertheless, sex selection in America is legal, but the ethics surrounding the practice are 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. 

Reasons for Choosing Gender

There are many reasons for selecting the sex of an embryo prior to implantation. One of the main reasons, and one that is subject to less ethical scrutiny than others, is the prevention of sex-linked genetic disorders that can affect the baby’s development or future health. 

Conditions that are carried genetically on the X chromosome can impact male embryos, as they only have one X chromosome rather than a second X chromosome that could be unaffected by the disease. 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. 
  
  

On the other hand, non-medical reasons for selecting sex include:

• Family balancing. This is where some parents may already have several children of the same sex and want to have a child of a different sex.
• Some parents may be emotionally biased toward one sex, especially those who have lost a child before. 
  
  

Some fertility clinics explicitly prohibit the practice of selecting an embryo’s sex based on personal preference rather than medical necessity and you should always check a fertility clinic’s policies. 

How Gender Selection Works

Preimplantation genetic testing or PGT is not only used to determine the sex of an embryo but it’s also a great way to test for genetic disorders or predispositions for future complications. PGT evaluates embryos for genetic disorders before they are transferred into the uterus. This can be done at Fertility Centers of Orange County, where our healthcare professionals will take you through what you should expect. 

There are a number of relatively common PGT protocols that 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 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.

Preimplantation Testing for Aneuploidy

Pre-implantation genetic testing-aneuploidy (PGT-A), previously known as pre-implantation genetic screening (PGS) tests abnormalities in the number of chromosomes in an embryo’s genetic makeup. Each person typically has 46 chromosomes, including 22 pairs from each parent and two sex chromosomes, and PGT-A can tell you an embryo's sex since it looks at the sex chromosomes XY for males and XX for females.

This can help in identifying the potential for miscarriage or chromosome-related disorders like Down syndrome. However, the test is not able to identify specific disorders in the same way that PGT-M tests are.

Success Rates

Sex selection with IVF is highly accurate and research has found that sex selection with PGT will likely result in the desired sex if you become pregnant with IVF.

Sex Selection and IVF FAQs

What happens to unused embryos?

An IVF treatment cycle usually has extra embryos left over after the cycle is complete. These embryos can be frozen and used again if the couple or individual wishes to undergo additional rounds of IVF. If an embryo is not the preferred gender, it can be donated if the prospective parent or parents do not wish to have future IVF treatments. In some cases, the embryo can be donated for medical research. If neither of these options is preferable, unused embryos can also be discarded as medical waste.

How much does it cost to choose the sex of an embryo?

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. Some insurance companies cover the cost making it a lighter burden. 

What sex are most IVF pregnancies?

Research has shown that significantly more male embryos are implanted than female embryos, particularly if the test is performed for reasons other than sex selection.

Bottom Line

Determining the sex of a baby during IVF is a great way to prevent sex-related genetic diseases and disorders. Nevertheless, research has shown that sex selection for non-medical purposes can pose ethical dilemmas and this can lead to choosing other traits, such as eye color, hair color, and height. Additionally, it can reinforce social ideas about gender stereotypes, and impose these stereotypes onto a child, potentially later harming their mental health.