Is It Ethical to Choose a Baby's Sex?

Celebrity couple Kim Kardashian and Kanye West might not have simply wished for a boy when they found out they were expecting their second child — some sources claim the couple chose their baby’s sex during an in vitro fertilization procedure. The couple is denying the claim, but in any case, is such sex selection ethical, or is it a slippery slope toward designer babies?

Earlier this year, Kardashian and West underwent an IVF procedure in which an egg was fertilized in a lab dish and was then implanted in the uterus, after the couple had trouble conceiving. During this type of procedure, it’s possible for a fertility clinic to screen the embryos and determine their sex, and in the case of Kardashian and West, an unnamed source told US Weekly that the couple had only male embryos implanted. The couple already has a 2-year-old daughter named North.

“Kanye loves [North] more than anything, but to make his world complete, he wanted a little boy, an heir,” the source said. The couple announced this week that they are having a boy, but a spokesperson for the couple said the report of sex selection is false, according to the Daily Mail.

The issue of selecting a baby’s sex is controversial.

Most organizations agree that if the goal of the parents is to avoid certain diseases linked to a child’s sex — such as hemophilia, which occurs mostly in boys — then sex selection is acceptable. But sex selection for nonmedical reasons is dicier, because there are concerns that the practice supports sexism, and that some parents would request a certain sex simply because they want only boys or only girls.

“When you just have preference for one sex over the other, you’re kind of a sexist, as a parent,” said Arthur Caplan, director of the Division of Medical Ethics at New York University’s Langone Medical Center. “That seems unacceptable.”

But some parents already have a child and want their next child to be the opposite sex. This is known as “family balancing,” and some experts view it as ethically acceptable.

“What we’re really opposed to in gender selection is sexism, but there, the motive [with family balancing] is almost the opposite — it’s to try to experience parenting both genders,” Caplan said. “I think that probably would pass ethical muster because it’s really trying to respect and celebrate both genders.”

The American Society for Reproductive Medicine does not take a firm stance either way on sex selection, but instead encourages doctors to develop policies for their own practices about whether — and under what circumstances — they will conduct sex selection.

“Practitioners offering assisted reproductive services are under no ethical obligation to provide or refuse to provide nonmedically indicated methods of sex selection,” the ASRM said in a recently released report from the society’s ethics committee.

However, the American College of Obstetricians and Gynecologists opposes sex selection for the purpose of family balancing. “Although [family balancing] is, in principle, consistent with the principle of equality between the sexes, it nonetheless raises ethical concerns,” a statement from ACOG says.

For starters, it may be hard to ascertain parents’ real motives when they request the sex of their child, because parents are unlikely to tell their doctor explicitly that they prefer one sex to another, ACOG says.

In addition, “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,” ACOG says.

ASRM notes that there are other concerns about nonmedical sex selection, including that the long-term effects of the procedure that is done to determine an embryo’s sex — known as preimplantation genetic screening (PGS) — are unknown.

Some people are concerned that sex selection might represent a “slippery slope” toward choosing other traits in children, like their eye color, height or intelligence. Because sex selection is already practiced, that line has been crossed, Caplan said. But in the future, he added, “I think we are going to have an enormous debate in how far to go” in selecting traits in embryos.

Regardless of the ethics of the procedure, doctors say they are getting more requests for sex selection.

Dr. Tomer Singer, a reproductive endocrinologist at Lenox Hill Hospital in New York, said he is seeing more and more patients requesting PGS, including for family-balancing reasons. In the last year, Singer saw about 150 patients who used PGS, he said. Most used the procedure to screen for certain diseases or conditions, but a smaller fraction used it for sex selection alone, Singer said.

Currently, couples who want to screen their embryos to determine their sex must pay for the procedure themselves.

“There’s no doubt in my mind that once preimplantation genetic screening will be covered by insurance companies, this will become a much more popular procedure,” Singer said.

But right now, PGS is not the norm — only about 6 percent of IVF cycles done in 2013 involved the technique, Singer said.
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