Boy for You, a Girl for Me: Technology Allows Choice
Embryo Screening Stirs Ethics Debate
By Rob Stein
Washington Post Staff Writer
Tuesday, December 14, 2004; Page A01
Kristen and John Magill adore all three of their daughters -- 11-year-old
twins and a 5-year-old baby sister. But when they began to plan for their next
-- and last -- child, the Magills really wanted a boy.
"My husband is a 'Junior' and has a family business that he wants to
continue in the family name," said Kristen, 37, of Grafton, Mass.
After bearing three girls, Kristen Magill tried for a boy
-- and is having two. (Laurie Swope For The Washington Post)
So the Magills combined a family trip to Disneyland in August with a stop at
a Los Angeles fertility clinic that enables couples to pick the sex of their
babies. Kristen is now expecting twin boys.
"I'm excited," she said. "We always wanted a boy. We really
wanted just one, but we'll be happy with two."
The Magills are part of a small but growing number of Americans who are
selecting the sex of their children, using techniques developed to help couples
who are infertile or at risk for having babies with genetic diseases.
In addition to the standard in vitro fertilization procedure that Kristen
underwent, a Fairfax clinic is testing another approach that can sort sperm by
sex -- an easier and far less expensive method, albeit not quite as reliable.
The doctors offering the services, as well as some medical ethicists who defend
them, argue the procedures make it possible for parents to fulfill a natural
desire, harm no one, and enhance the joys of parenthood and family life.
"These are grown-up people expressing their reproductive choices. We
cherish that in the United States," said Jeffrey Steinberg, director of the
Fertility Institutes, which offers the service at clinics in Los Angeles and Las
Vegas. "These people are really happy when they get what they want. These
are heartwarming stories."
But others say the practice, which is prohibited in many countries, uses
expensive medical care for frivolous purposes, destroys some embryos just
because they are the "wrong" sex, and promotes gender discrimination.
Moreover, the critics say, the trend is a dangerous first step toward
transforming childbirth from a natural process full of surprise and wonder into
just another commodity in which a baby's features are picked like options on a
"It runs the risk of turning procreation and parenting into an extension of
the consumer society," said Michael J. Sandel, a political philosopher at
Harvard University. "Sex selection is one step down the road to designer
children, in which parents would choose not only the sex of their child but also
conceivably the height, hair color, eye color, and ultimately, perhaps, IQ,
athletic prowess and musical ability. It's troubling."
For generations, people who wanted to choose their child's sex resorted,
fruitlessly, to old wives' tales and folklore, such as the belief that eating
more salty food or meat raises the odds of having a boy. But techniques
developed to help infertile couples and to weed out genetic diseases have
changed that -- the same procedures used to make sure an embryo is healthy can
be used to determine its sex.
So far, most of the couples doing this either suffer from infertility or want to
avoid passing on devastating genetic diseases, primarily ailments such as
muscular dystrophy that afflict boys more often than girls. Only those who
oppose creating embryos in the laboratory for any reason object to sex selection
in such cases.
But a small number of clinics have begun offering the procedures to couples
with no medical reasons -- who simply want to do the kind of "family
balancing" the Magills sought or to plan the birth order of their children.
"The overwhelming number of couples who come in for this are couples who
have three, four, five children in one gender and come to us and say, 'Will you
guarantee us the opposite?' " said Norbert Gleicher, medical director of
the Center for Human Reproduction, which has clinics in the New York and Chicago
areas. "Why shouldn't patients have the right to choose this? It's one of
the most basic rights in our society that we can build our families the way we
The IVF procedure, which costs about $10,000 to $20,000, requires women to get
hormone shots so doctors can retrieve eggs for fertilization in the laboratory.
The lab harmlessly removes a single cell from 3-day-old, eight-cell embryos to
test them. Only embryos of the desired sex are implanted into the womb. The
process is almost infallible for picking sex and has the same overall success
rate for producing a baby as standard IVF.
This approach, called PGD from its original use for "preimplantation
genetic diagnosis," has been largely banned for nonmedical use in a number
of countries, including Australia, Britain, Canada, France, Germany, India,
Japan and Switzerland. In the United States, most fertility doctors say they
refuse to do the procedure except for medical problems.
"My job is to help people make healthy babies, not help people design their
babies. Gender is not a disease," said Ralph R. Kazer, a Northwestern
University fertility doctor. "We would rather spend our time helping people
who want to have babies who can't have babies."
With scientists rapidly identifying genes for various human traits, the
potential for tailoring children in many other ways is becoming increasingly
possible, critics say.
"It is the first step towards the concept of a designer baby," said
George Annas, a Boston University bioethicist. "If you don't draw the line
at disease, where do you draw the line? If gender is okay, it's hard to say any
other characteristic we might be able to select in the future is
But the doctors doing the procedures and independent experts say science is not
even close to allowing parents to pick other traits -- and in all likelihood
never will be.
"The overall concern that we have one foot over the edge of the slippery
slope is overstated because of the limited role that individual genes play in
complex human traits," said Kathy Hudson, director of the Genetics and
Public Policy Center at Johns Hopkins University. "There are real
biological limits to how much control you can have over the characteristics of
Nevertheless, research that her center will release next month found 60 percent
of Americans are uncomfortable with sex selection for nonmedical reasons.
"The use of a technology to fulfill parental desires is viewed as vain,
capricious and frivolous," Hudson said.
The sperm-sorting approach being tested by the Genetics & IVF
Institute of Fairfax sidesteps some of these concerns because it does not
require scientists to create embryos in the lab and the process can select
no traits other than sex.
Originally developed for livestock breeding, the MicroSort technique can
sort male-producing sperm from female-producing sperm because the latter
carries slightly more DNA. A woman can then be artificially inseminated with
the sperm for the sex she wants.
The clinic is offering the procedure -- for about $2,800 to $4,000 per
attempt -- at its Northern Virginia headquarters and a new center in Laguna
Hills, Calif., for a study aimed at winning Food and Drug Administration
approval. Several thousand couples have used it and more than 400 babies
have been born, producing boys with about 75 percent accuracy and girls with
90 percent, said David Karabinus, scientific director of the MicroSort unit.
"For someone that really has a desire for that little girl or that
little boy . . . this is a very, very important and useful technology,"
But critics say both techniques allow parents to discriminate on the basis
of sex, and they point to countries such as India and China, where a
preference for boys has led to abortion of female fetuses and abandonment of
baby girls, creating a shortage of women.
"It is clear that sex selection targets women," said Alfonso
Gomez-Lobo, a philosophy professor at Georgetown University. "From an
ethical point of view, all of this is quite unacceptable."
Because MicroSort is not 100 percent reliable, critics fear it may lead to
the selective abortion of fetuses, particularly females.
"If you ask couples coming in what they will do if they get the wrong
sex, these couples say very frankly they will terminate the pregnancy,"
said Mark V. Sauer, director of the division of reproductive endocrinology
at Columbia University. "I don't want to be a party to that."
Proponents counter that there is no bias against girls in the United States.
In fact, American couples are just as likely, if not more likely, to want a
"We get roughly the same number of parents coming in who will request a boy
as will request a girl," said David L. Hill, scientific director of the ART
Reproductive Center in Beverly Hills, Calif. "It's not as if everyone is
coming in wanting a female."
At MicroSort, 75 percent of parents have been seeking girls, Karabinus said.
Still, concern remains about the possibility of more subtle, emotional
consequences. What happens in cases where, after paying thousands of dollars and
suffering months of discomfort and inconvenience, parents are bitterly
disappointed by a baby of the "wrong" sex?
"Consider the father who wants a boy in the hope of having as a son the
athlete he had never been. Suppose the son isn't really interested in
sports," Sandel said. "What sorts of expectations will burden a child
who was designed with certain purposes in mind?"
These kinds of questions raise fears that the increasing ability to control and
commercialize childbearing will fundamentally transform parenting.
"This is . . . a threat to the core value of parenthood that is usually
expressed by the commitment to unconditional love," Gomez-Lobo said.
"Our children should not be the result of our desires. We should love them
as they are, not as we wanted them to be."
For their part, the Magills are looking forward to introducing their daughters
to their little brothers.
"It's a good thing this is out there and available," Kristen said.
"I don't think it's for everybody -- it takes money and patience and
everything. But we felt like it was worth it. I'm sure having boys will be a