Question 17. Can I choose the sex of my baby?

Years ago I saw a patient that had 3 girls and wanted a boy. Their solution was to take fertility shots and have timed intercourse with the logic that even if they had a multiple pregnancy, one should be a boy. I tried to explain that their logic was not very sound and that they could end up with a real surprise. They were not to be dissuaded and went to another clinic. They followed through with that plan and ended up with triplets....all girls. Six girls under 6 years of age is hard for me to contemplate. Wow. That is a lot of squealing under one roof.

So although we are sympathetic to those who are hoping for family balancing, there still has to be consideration given to the wisdom of certain solutions to this question. As we head into a glorious weekend of weather here in DC, I leave you with the following Question of the Day:


17. Can I choose the sex of my baby?


Gender is determined at the moment of fertilization, when a sperm bearing either an X or Y chromosome penetrates the egg, resulting in formation of either a female or male embryo, respectively. The event is random, and the sex ratio of females to males conceived is fairly even.

Several techniques exist that can enhance the likelihood that a couple will conceive a child with the desired gender. The Ericsson method is a simple, noninvasive method that separates X-bearing sperm from Y-bearing sperm using centrifugation techniques. The sperm are placed on the top of a column of either albumin or Sephadex, and the specimen is centrifuged to isolate the desired gender-selected sperm. This sperm sample is then used for either intrauterine insemination or IVF. The success rates reported with this method vary from no benefit to as high as 75% for the desired gender. The Ericsson method is not associated with any known risk to either baby or mother.

Microsort is a newer experimental technique that involves the labeling of the DNA of the sperm, followed by passage of the sample through a cell-sorting machine. This process yields a smaller sperm sample than the Ericsson method, and IVF with ICSI may be required for pregnancy. Nevertheless, the results appear encouraging in terms of gender selection.

The gender of a child can also be selected using IVF and preimplantation genetic diagnosis (PGD). This technique is expensive and much more complex than the Ericsson method, but success rates for the selected gender routinely exceed 90%. Couples who elect to pursue IVF and PGD for gender selection often do so to prevent genetically inheritable medical diseases, such as Duchenne muscular dystrophy, from occurring in their children.

Many medical authorities consider gender selection to be unethical except in a few circumstances, such as when the couple runs a high risk of having a child with an inheritable medical disease. Others support the use of gender selection when a couple has at least one child but want to limit their family size and desire a child of the opposite gender.