Do pregnant women want to know the sex of the expected child at routine ultrasound and are they interested in sex selection?

Use and misuse of ultrasound in obstetrics with reference to developing countries

Maternal and neonatal health is one of the main global health challenges. Every day, approximately 800 women and 7,000 newborns die due to complications during pregnancy, delivery, and neonatal period. The leading causes of maternal death in sub-Saharan Africa are obstetric hemorrhage (28.8%), hypertensive disorders in pregnancy (22.1%), non-obstetric complications (18.8%), and pregnancy-related infections (11.5%). Diagnostic ultrasound examinations can be used in a variety of specific circumstances during pregnancy. Because adverse outcomes may also arise in low-risk pregnancies, it is assumed that routine ultrasound in all pregnancies will enable earlier detection and improved management of pregnancy complications. The World Health Organization (WHO) estimated in 1997 that 50% of developing countries had no access to ultrasound imaging, and available equipment was outdated or broken. Unfortunately, besides all the exceptional benefits of ultrasound in obstetrics, its inappropriate use and abuse are reported. Using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication can be considered ethically unjustifiable. Ultrasound assessment when indicated should be every woman's right in the new era. However, it is still only a privilege in some parts of the world. Investment in both equipment and human resources has been clearly shown to be cost-effective and should be an obligatory step in the improvement of health care. Well-developed health systems should guide developing countries, creating principles for the organization of the health system with an accent on the correct, legal, and ethical use of diagnostic ultrasound in pregnancy to avoid its misuse. The aim of the article is to present the importance of correct and appropriate use of ultrasound in obstetrics and gynecology with reference to developing countries.

The importance of pre- and post-test counseling for prenatal cell-free DNA screening for common fetal aneuploidies

INTRODUCTION

Prenatal cell-free DNA screening for common fetal aneuploidies has rapidly changed the paradigm of prenatal care. Despite its advantages compared to conventional screening methods, its unexpectedly rapid implementation in clinical practice has generated several ethical and medical issues and misconceptions. Aggressive commercial marketing of cell-free DNA screening and media dissemination of misleading information have added confusion. Areas covered: This review provides an extensive update and will focus on the importance of pre-and post-test counseling for prenatal cell-free DNA screening not previously discussed extensively in the available literature. Additionally, we report cell-free DNA screening implementation in the largest obstetrical tertiary unit in Finland which is one of few countries that provides all prenatal screening methods free of charge for all women and has a very high uptake of first-trimester screening. This is not a systematical review, but rather a narrative overview which includes the most relevant and recent original publications and reviews covering this issue. Expert opinion: Despite being the most accurate method for screening of common fetal aneuploidies, the knowledge and counseling should be substantially improved. Cell-free DNA screening is not a replacement for diagnostic testing and its use in prenatal testing is complex and limited.

Bovine sperm sex-selection technology in Japan

BACKGROUND

In Japan, Livestock Improvement Association of Japan started commercially producing sexed bovine semen 10 years ago, and sexed bovine semen is currently used for the artificial insemination (AI) in the farms. In this review, the authors introduce the technology for sperm sexing by flow cytometry, the efforts at commercializing sexed semen in Japan, and recent field data on artificial insemination of the cattle with sexed semen.

METHODS

In the procedures of the flow cytometric method, X-chromosome-bearing sperm and Y-chromosome-bearing sperm were fluorescently stained, separated from each other by analyzing the difference in the DNA content, and cryopreserved. The authors surveyed the conception rates after AI with these sperm and sex ratios of the offspring with the cooperation from livestock associations, AI technicians, and farmers.

MAIN FINDINGS RESULTS

Although AI with sexed semen was associated with lower conception rates in comparison with AI with conventional semen, the accuracy of sex selection using AI with sexed semen was beyond >90%.

CONCLUSION

Sexed semen produced by flow cytometry has the potential to produce offspring of the preferred sex with high accuracy and reliability. Thus, it is expected that sexed semen is used for AI more frequently in the farms.