Ethics of sex selection for family balancing. Why balance families?

Why parents should not be told the sex of their fetus

A new technique called non-invasive prenatal testing (NIPT) has been developed, which can detect a range of genetic and chromosomal diseases, as well as fetal sex earlier, more easily and more reliably. NIPT, therefore, potentially expands the market for sex determination and sex selective abortion. This paper argues that both practices should be prevented by not including fetal sex in prenatal test reports. This is because there is a discrepancy between what parents are concerned with (gender) and what the prenatal test can provide (sex). The paper first presents arguments, which indicate a difference between sex and gender before presenting parental motivations for sex selection and sex determination to show that parents are not concerned with their child's sex chromosomes, or even their genitalia, but the gender role that their child will espouse. That, however, is not something that a prenatal test can provide. We are thus left with a situation in which what parents are told, and what they think they are being told, are two different things. In other words, as the conflation of sex with gender is implicit in the disclosure of fetal sex, it may be more accurate to refer to it as misinformation. This misinformation promotes sexism via gender essentialism, which is neither in the interests of the future child nor society.

Environmental Exposure of Sperm Sex-Chromosomes: A Gender Selection Technique

Preconceptual sex selection is still a highly debatable process whereby X- and Y-chromosome-bearing spermatozoa are isolated prior to fertilization of the oocyte. Although various separation techniques are available, none can guarantee 100% accuracy. The aim of this study was to separate X- and Y-chromosome-bearing spermatozoa using methods based on the viability difference between the X- and Y-chromosome-bearing spermatozoa. A total of 18 experimental semen samples were used, written consent was obtained from all donors and results were analysed in a blinded fashion. Spermatozoa were exposed to different pH values (5.5, 6.5, 7.5, 8.5, and 9.5), increased temperatures (37°C, 41°C, and 45°C) and ROS level (50 μM, 750 μM, and 1,000 μM). The live and dead cell separation was done through a modified swim-up technique. Changes in the sex-chromosome ratio of samples were established by double-label fluorescent in situ hybridization (FISH) before and after processing. The results indicated successful enrichment of Xchromosome-bearing spermatozoa upon incubation in acidic media, increased temperatures, and elevated H₂O₂. This study demonstrated the potential role for exploring the physiological differences between X-and Y-chromosome-bearing spermatozoa in the development of preconceptual gender selection.

Ethical arguments for and against sperm sorting for non-medical sex selection: a review

Much has been written about the ethics of sex selection. This article thoroughly explores the ethical arguments put forth in the literature both for and against non-medical sex selection using sperm sorting. While most of these arguments come from philosophers, feminist scholars, social scientists and members of the healthcare community, they are often echoed in empirical studies that have explored community values. This review is timely because the first efficacious method for sex selection via sperm sorting, MicroSort, is currently in clinical trials and moving closer to FDA approval for marketing in the USA. While the clinical trials are currently focused on the use of MicroSort to avoid X-linked genetic diseases, MicroSort can also be used to satisfy parental preferences.

Social sex selection and the balance of the sexes: Empirical evidence from Germany, the UK, and the US

Preconception sex selection for nonmedical reasons is one of the most controversial issues in bioethics today. The most powerful objection to social sex selection is based on the assumption that it may severely distort the natural sex ratio and lead to a socially disruptive imbalance of the sexes. Based on representative social surveys conducted in Germany, the United Kingdom, and the United States, this paper argues that the fear of an impending sex ratio distortion is unfounded. Given the predominant preference for a "gender balanced family," a widely available service for social sex selection is highly unlikely to upset the balance of the sexes in Western societies.

Chance, choice and control: Lay debate on prenatal social sex selection

Assisted reproductive technologies are typically positioned as increasing the range of choices open to the healthcare consumer, thereby enhancing 'reproductive freedom'. In this paper, we question the equivalence of reproductive choice and personal freedom in ethical theory, using results from a project investigating how lay people make ethical evaluations about the new genetic and reproductive technologies. We took the topic of social sex selection by preimplantation genetic diagnosis (PGD), and used group discussions and interviews in the north-east of England to trace how lay people develop and express their ethical evaluations, and to identify the implicit or explicit normative framework that gave rise to their opinions on prenatal sex selection. There was a striking level of ambivalence towards choice in general and reproductive choice in particular. Participants offered few positive statements and numerous reasons why reproductive choice might be problematic. Our participants' argumentation shares with mainstream bioethical analysis the weighing of the possible harms of prenatal sex selection for social reasons against the harm of restricting reproductive freedom. However, unlike most secular-liberal bioethicists, many of our participants concluded that prenatal sex selection is undesirable because it is an expression of parental preference instead of a response to the future child's need. Our interpretation of their reasoning is that they work from an ideal of "good parents", one of the features of which is the relinquishing of control over their children, except to protect them from harm. This voluntary self-limitation does not indicate reduced autonomy, because parental autonomy can only operate within the limits set by this relational framework. We suggest that a model of relational autonomy captures our lay participants' framing of the problem better than a more traditional understanding of autonomy. Our study also shows that in appropriately structured discussion of bioethical issues, lay people can articulate reasons for their opinions that are grounded in sophisticated and morally relevant concepts.

Preimplantation genetic diagnosis for elective sex selection, the IVF market economy, and the child--another long day's journey into night?

The promise of medical innovation has long evoked social commentary, particularly when personal reproductive autonomy may be involved. Development of the oral contraceptive, effective and safe surgical sterilization, and later IVF and ICSI are among the revolutionary developments where the initial reactions were dubious but were accorded mainstream status with sufficient clinical experience. In each instance, debate about the moral and social implications of these treatments accompanied their introduction into the medical marketplace. This pattern appears to be repeating itself in connection with the use of preimplantation genetic diagnosis (PGD) for elective sex selection of human embryos. As with prior challenges in reproductive medicine, the development of meaningful "guidelines" for this latest controversy has proven to be a contentious task. Indeed, the progression of ethics committee reports from the American Society for Reproductive Medicine seems to echo the ambivalence within society at large regarding this issue. In this report, we chronicle sex selection claims based on sperm sorting, and describe how flow cytometry and especially PGD have facilitated this selection at the gamete and embryo stage, respectively. In doing so, we also explore market forces and practitioner considerations associated with the application of PGD for this; related ethical issues with particular emphasis on the progeny derived from such treatment are also reviewed.

Sex selection in practice among Hong Kong Chinese

The aim of this study is to identify factor(s) influencing imbalance in the sex distribution of children (more children of the same sex) of the multiparous women attending an antenatal clinic in Hong Kong. A retrospective study was carried out to compare the expected and observed sex ratios of babies born to women with one previous live birth and women with two. All singleton pregnant women of parities 1 and 2 delivering after 22 weeks of gestation, between 1 July 1996 and 30 June 1998, were included. A total of 2604 women of parity 1 and 752 women of parity 2 were included. The sexes of the children of parity 1 women and the sex distribution of their newborns were consistent with the predicted value. The parity 2 women were more likely to have third children if their previous children were of the same sex (p-value < 0.001). This implies that the parity 2 women attending our antenatal clinic had third pregnancies because of social, economical or environmental reasons. Our parity 2 women with two daughters were more likely to have sons (p < 0.05). Thus, biological or parental factors were unlikely to be important in influencing the sex of the newborn. This suggested that sex selection or sex-selective abortion might be practiced among Hong Kong Chinese women.

Preconceptional sex selection: past, present, and future

Predetermination of sex in human and in farm animals is reviewed. Preconceptional sex selection has generated great interest and controversy over the years. Medical and commercial benefits outweigh the ethical issues. Technology has not yet provided a routine method for separating the X- and Y-chromosome-bearing sperm. Flow cytometry is the only technique that produces a clinically significant enrichment of X- or Y-bearing spermatozoa However, concern has been raised about the methodological implications of the flow technique because of the use of DNA stains and UV light. Some other techniques, such as gradient columns, appear to produce a slight enrichment of one type of sperm over the other, but this level of enrichment appears unlikely to affect the sex ratio at birth. It thus remains speculative whether 100% pure preparation of X or Y sperm can be obtained unless a major improvement in methodology is achieved. Fluorescence in situ hybridization (FISH) and polymerase chain reaction (PCR) are currently the methods of choice for evaluating the validity of the sex selection procedure. In view of the extraordinary pace of the technological and scientific progress, it can be expected that the clinical and commercial application of the technology of preconceptional sex selection by X and Y sperm separation will be a reality in near future.