ACOG Denounces Embryo Gender Testing to Achieve 'Family Balance'

WASHINGTON, Jan. 31 -- Gender testing of an embryo at the blastocyst stage simply for "family balancing" is ethically untenable, determined a panel of the American College of Obstetricians and Gynecologists.

"The Committee on Ethics supports the practice of offering patients procedures for the purpose of preventing serious sex-linked genetic diseases," panel members wrote in an opinion published in the February issue of Obstetrics & Gynecology.

"However, the committee opposes meeting requests for sex selection for personal and family reasons, including family balancing, because of the concern that such requests may ultimately support sexist practices," they continued.

The committee opinion is in line with that of other groups, the authors noted, including the United Nations International Conference on Population and Development, and Britain's Human Fertilization and Embryology Authority Code of Practice.

The American Society for Reproductive Medicine also opposes the use of pre-implantation genetic diagnosis for other than medical reasons, although the group issued a statement in 2001saying that if pre-fertilization techniques such as sperm sorting can be proven to be safe and effective, they would be ethically acceptable.

There is currently no reliable technique for steering a fetus toward one gender or another prior to fertilization of the ovum, the ACOG authors noted, but techniques under development, including flow-cytometry sorting and separation of sperm bearing X or Y chromosomes prior to in vitro fertilization or intrauterine insemination, may soon make such choices possible.

Current pre-implantation genetic diagnosis techniques, designed to help parents who avoid the possibility of a sex-linked disease such as Duchenne's muscular dystrophy or hemophilia, can also be used to determine sex through karyotyping. This allows implantation of only embryos with the desired sex.

"After implantation of a fertilized egg, karyotyping of fetal cells will provide information about fetal sex," the committee members wrote. "This presents patients with the option of terminating pregnancies for the purpose of sex selection."

They noted that clinicians involved in procedures performed to detect or rule out medical problems in a blastocyst, embryo, or fetus (such as amniocentesis) may inadvertently become involved in sex selection if they reveal the gender at the mother's request, the authors noted.

"The ACOG's Committee on Ethics maintains that when a medical procedure is done for a purpose other than obtaining information about the sex of a fetus but will reveal the fetus's sex, this information should not be withheld from the pregnant woman who requests it," they wrote. "This is because this information legally and ethically belongs to the patient. As a consequence, it might be difficult for health care providers to avoid the possibility of unwittingly participating in sex selection."

The committee members acknowledged that some families may feel justified in trying to select the sex of a child on the basis of balance in a family, with options ranging from sperm sorting, to transfer of only select embryos, to using sex of the fetus as the basis for selectively reducing fetuses in a multi-fetal pregnancy, to abortion of fetuses of the "wrong" sex.

"In these situations, individual parents may consistently judge sex selection to be an important personal or family goal and, at the same time, reject the idea that children of one sex are inherently more valuable than children of another sex," the authors commented. "Although this stance is, in principle, consistent with the principle of equality between the sexes, it nonetheless raises ethical concerns."

They pointed out that patients who are planning to abort a fetus of the undesired sex would be likely to hide their intent from physicians if they thought that their request for the procedure for sex selection might be refused.

Additionally, "even when sex selection is requested for nonsexist reasons, the very idea of preferring a child of a particular sex may be interpreted as condoning sexist values and, hence, create a climate in which sex discrimination can more easily flourish," they added.