Sex selection for medical and nonmedical reasons

Selecting the sex of an embryo before transfer into the uterus is a controversial practice. The increasing use of preimplantation genetic testing for aneuploidy (PGT-A) led to an increase in the percentage of cycles in which embryo sex is knowable before transfer. Couples may seek sex selection for either medical or nonmedical reasons.

Medical reasons

Sex selection for medical reasons is used to avoid the birth of a child with a severe genetic disorder. Medical indications include:

Nonmedical reasons

Nonmedical sex selection is used purposely to select embryos of a specific sex for personal or social reasons. In addition, some patients who elect to screen their embryos with PGT-A may not have anticipated that they would be faced with the possibility of selecting the sex of the embryo that is transferred – a choice that they had not intended on making and that they now must consider whether or not to exercise. The reasons for sex selection for nonmedical reasons include:

Arguments supporting the use of sex selection for nonmedical reasons

  • Patient autonomy and reproductive liberty.
  • Parents may believe reasonably that there are differences between the experience of rearing male and female offspring.

Arguments against the use of sex selection for nonmedical reasons

  • Long-term medical risks of some procedures to offspring are unknown and that, therefore, it is unjustifiable to take any such risks for nonmedical reasons.
  • Perpetuates sexism with risks of discrimination and perpetuation of gender injustice.
  • Might lead to slippery slope towards designer babies.
  • Failure to show appropriate respect for embryos.
  • May result in significant gender imbalances in the society.
  • May be psychologically harmful to children and disruptive of the parent-child relationship.
  • May be available only to those with the resources to pay for it.

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