Can You Choose Sex with IVF?

In vitro fertilization(IVF) is a revolutionary assisted reproductive treatment that has changed the lives of many families. One of the reasons why it’s increasingly becoming a popular option for many couples is because it can allow you to choose the gender of your child. 

Though controversial, gender selection can be achieved through advanced fertility technology. Fertility doctors can now determine the gender of a child using modern screening and testing of embryos during in vitro fertilization (IVF).

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.

Sex vs Gender

The distinction between sex and gender requires differentiation. For many years, sex selection was known as “gender selection” but recent studies have ensured there’s inclusivity for individuals whose gender identity does not align with their assigned sex at birth. This distinction looks like follows:

• Sex: Is based on biological factors especially the reproductive organs, chromosomal and hormonal makeup of a person’s body.
• Gender: This is based on behavior, lifestyle, and experiences. It is more fluid and falls within a spectrum of identities. 

IVF and Sex Selection

IFV has made it possible for prospective parents to choose the sex of an embryo before it is implanted in the uterus. In recent years, this has become more popular as the number of couples doing IVF has increased. 

How is this possible? Prospective parents use preimplantation genetic testing or PGT to predetermine the sex of the embryo. The ability to choose the sex of the baby has become more widely available. However, the question of whether prospective parents should choose the sex of the embryo is an ethically challenging one that has troubled different countries. 

Some countries such as Europe, Canada, India, and China have outlawed sex selection for nonmedical reasons, while others like the USA have legalized it. The ethics surrounding the practice have been 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 why a prospective parent would choose the sex of an embryo prior to implantation. One of the main reasons is the prevention of sex-linked genetic disorders that can affect the baby’s development or future health. 

Sex-linked genetic recessive disorders 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. 

Non-medical reasons for sex-selection

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. 

Sex-Selection Testing

Besides being a way to preselect the sex of your baby, preimplantation genetic testing (PGT) is the best way to test for genetic disorders or predispositions for future complications. PGT evaluates embryos for genetic disorders before they are transferred into the uterus during IVF. PGT can be done at Dallas IVF, where our healthcare professionals will take you through what you should expect. 

Two main PGT protocols are used to 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. The 

Preimplantation Testing for Aneuploidy

Pre-implantation genetic testing-aneuploidy (PGT-A) tests abnormalities in the number of chromosomes in an embryo’s genetic makeup. Each person has 46 chromosomes, including 22 pairs from each parent and two sex chromosomes. PGT-A can tell you an embryo's sex by looking at the sex chromosomes XY for males and XX for females.

This protocol can also help identify if an embryo will miscarry or chromosome-related disorders like Down syndrome. 

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.

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

Sex selection with IVF is highly accurate and research has found that it will likely result in the desired sex if you become pregnant with IVF making it extremely successful. Not only that but choosing the sex of a baby during IVF is a great way to prevent sex-related genetic diseases and disorders. But, the ethics of such testing can be a fine line. 

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.