Where Does Gender Selection Fit into the IVF Process?

Where Does Gender Selection Fit into the IVF Process?

For centuries, couples have come up with ways to influence the gender of their offspring. More than seven centuries ago, the Chinese developed a calendar. This helped to predict the gender of offspring based on when conception occurred. Centuries later, the ancient Greeks suggested that during intercourse if the woman lied on her right side, she is more likely to have a male child. And not more than 300 years ago, the French suggested something similar. They believed that placing a ligature around the male’s right testicle would improve the chances of having a male child.

In the last few decades in the United stated, we have proposed many methods for gender selection . These methods include timing intercourse, assuming different positions during intercourse, and most recently employing rapid sperm centrifugation. We do this to separate male chromosome bearing sperm from female chromosome bearing sperm prior to artificial insemination. But the fact is, none of these methods have shown or proved to have any real validity.

Currently, despite several medical approaches, reliable gender selection can only be achieved by way of In Vitro Fertilization. During the IVF process, we can reveal the gender through Preimplantation Genetic Diagnosis (PGD) prior to the embryo being transferred.

Various thoughts about Gender selection process

Nevertheless, the idea of gender section challenges moral and ethical beliefs at their very foundation. There are many who believe that assisted reproductive technology should be outlawed. People believe that the growing popularity of gender selection is solely for “family balancing ”. This represents an unwanted example of how technology is subject to abuse. Some may also see it as a disturbing trend towards “designer babies.” We can also use Genetic engineering to manipulate features such as build, height, body configuration and talents of future offspring. Having said that, questions do follow this assertion such as to where all this would end and whether society would want to live in such a world.

However, there’s one clear exception that is worth mentioning. This applies in some rare cases where we use gender selection to avoid the occurrence of a serious medical disorder that selectively affects one gender. An example of such disease is Hemophilia, a life-threatening disorder which affects male offspring.

Evaluating Currently used Methods for Sex Selection

Sperm Gradient Method (highly unreliable)

Sperm Gradient Method is one of the simplest methods available and unfortunately, it remains in widespread use. Here sperm is rapidly centrifuged, or spun down, in the hope of separating male sperm (Y-chromosomes) from female sperm (X-chromosomes). This method assumes that X-chromosomes make sperm heavier, allowing the separation of male and female chromosome bearing sperm. This method involves low cost. But this is highly unreliable. The truth is that it simply does not work when it comes to gender selection of the offspring.

Flow Cytometry-The Microsort Technique

The flow cytometry method uses a fluorescent dye that sticks to genetic material in the sperm. Since X-chromosome bearing sperm contains more genetic material than Y bearing sperm, they are supposed to pick up more dye. Both X and Y chromosome bearing sperm are separated into two groups and are used for Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF). This method yields a 60 to 70 percent accuracy rate with IUI. Because of such a high IUI accuracy rate, many advocate the use of this method. However, its efficiency and reliability in the IVF setting has been disappointing. It is also significant to note that because of certain problems, MicroSort has not been approved by the FDA.

Preimplantation Genetic Diagnosis (PGD)

Preimplantation Genetic Diagnosis involves the removal of one or more cells from the embryo, for chromosomal or genetic analysis. A technique used during the PGD process to help identify gender is fluorescence in-situ-hybridization (FISH). However, this method has limitations. It cannot identify all 23 pairs of chromosomes in the embryo cells. The very best it can do is identify 12 pairs of chromosomes. Even though FISH provides an excellent option for gender selection and identification of structural chromosomal aberrations, it’s not reliable for diagnosing embryo aneuploidy or competency.

Another PGD testing method, Comparative Genomic Hybridization (CGH). This method will be useful to both detect all the embryo’s chromosomes and to determine the embryo’s competency reliably. It is useful to determining gender but it’s not quite as reliable as FISH. Typically, a reliable CGH test will require a “Staggered IVF” approach, where the embryo is biopsied on day 3 or 4 (post-fertilization), and then vitrified and held for transfer in a subsequent cycle.

It is possible to perform CGH on day 3 and have the results in time for a  fresh embryo transfer on day 5. This would require array CGH, also referred as aCGH. We can perform Array CGH on the small amount of DNA present in a single biopsied cell but can lack reliability. If aCGH is used, it should be performed on the pooled DNA derived from several cells biopsied from a blastocyst on day 5. This would mandate the use of a “Staggered IVF” approach.

FISH takes about 24-36 hours to complete. After that, the couple can select which embryo they prefer to transfer to the uterus. This method is particularly helps when there’s a risk of having a male child with an X-chromosome linked genetic disease.

Use of Gender Selection for “Family Balancing”

The use of gender selection simply for “family balancing” remains controversial. It does raise concern that if gender selection methods became widely available then such practices could distort the natural male to female ratio. This can lead to population gender imbalance. However, for this to happen, it requires a significant portion of the current population to use gender selection. But in reality, the contrary seems to apply. That’s because the high IVF treatment cost along with the added cost of gender selection makes it unlikely that the demand would be large enough to impact the overall population. Several studies also indicate that most people are not concerned about the gender of their offspring and that gender preference doesn’t appear to be slanted in the direction of either male or female. Thus, such concerns are overstated.

Given that in the United States, selecting the sex of children interests a very small number of couples, and most do not even care about the gender of their offspring. There’s currently no risk that gender selection with IVF will impact gender balance. So, this freedom of choice should prevail and gender section with IVF should be freely available.

At Coastal Fertility, we offer gender selection with IVF in the following circumstances.

• Medical indication of a significant risk of gender related disorders or serious genetic disorders.
• For couples who have at least one child and want to “balance” their family. It may be useful for women who do not have any children but wants a child of one particular gender.

To learn more about gender selection with IVF, visit us at coastalfertility.com or call us at 949-726-0600 to Schedule a Consultation