Sex Selection of Babies Forces New Debate

Dr. Zalman Levine had a decision to make.

The mother sitting before him confessed that she cried herself to sleep each night, mourning the child she’d never had. Of course she loved her sons, now 3 and 6 years old, but the lack of a daughter consumed her. Only with a girl, she said, could she replicate the intense bond she had shared with her own mother.

Tearfully, she and her husband asked Levine to create embryos from their genetic material, incubate them in his Westwood lab and implant the most robust girl of the bunch.

Levine hesitated. The process, he told them, was risky, physically invasive and, at $20,000, wickedly expensive. Even then, it was no sure bet.

The parents were not deterred.

Pre-implantation genetic diagnosis offers both promise and predicament. Originally designed to weed out genetic diseases, it helps couples who carry serious disorders avoid passing them on to their children. That’s still its most common application. But enterprising doctors can also rely on PGD to select a baby’s sex far more accurately than ever before, a use that has sharply divided the international medical community and prompted Canada, Britain, France and the Netherlands to ban it.

Critics say sex selection is a brazen attempt to control nature. They argue that it uses an invasive technology for frivolous ends and worry it’s the first step toward babies bred for height, intelligence or talent. Even if it goes no further than gender, they maintain it perpetuates bias.

"Sex selection is the exercise of sexism at the most profound level – deciding who gets to live," says David King, director of the Human Genetics Alert, a London-based group that tracks research. "If you are not prepared to accept and parent both a boy or a girl, you should not be a parent."

Increased demand for sex selection is forcing American doctors to parse decisions like never before. Many refuse to participate, but growing numbers of physicians are pressing ahead.

At the Fertility Institutes in Las Vegas and Encino, Calif., 40 to 50 couples a week seek the chance to "balance" their families. They come from every state and every continent. The waiting list is now a year long. Requests for boys and girls run about even.

"It took off about a year and a half ago," says Jeffrey Steinberg, who, as the practice’s sole physician, flies between the two offices to see each couple. "The classic situation is a woman comes in, she has three boys and has always wanted a girl to dress up and have as a friend, or the man has only girls and wants a boy to carry on the family name and play sports with him. And I have no problem helping them.

"Medicine isn’t just about making sick people healthy. It’s about making people feel better, helping them reach certain outcomes in life. Hey, people get their noses done all the time, right?"

An age-old quest

The idea of choosing the sex of a baby is as ancient as time, with women of one generation passing on their secrets to the next. Some try altering their diets. Others swear by a change in bath temperature or the timing and position of intercourse.

In the 1970s, with the popularity of ultrasound and acceptance of abortion, the methods became more precise, albeit troubling. In China, where ultrasounds are cheap and abortions are free, the ratio of male to female births – normally less than 105-to-100 – reached 133-to-100 in one southern province, prompting the government this year to ban selective abortions of female fetuses.

No one keeps data on how often Americans use abortion to pick the sex of their babies, but what is clear is that couples here are more comfortable intervening before fertilization, or shortly after. Now they can.

Using experimental technology initially designed for livestock breeding, doctors can now sort X- from Y-bearing sperm somewhat reliably and inject only the desired ones. But the method, still awaiting FDA approval, is not perfect.

For couples who want to leave little to chance, doctors instead choose PGD, which is far more physically burdensome and expensive. A woman is injected daily with hormones to stimulate egg production. Upon ovulation, she is put under general anesthesia so her eggs (typically 10 or 20) can be harvested.

Using microscopic pipettes under high-power magnification, lab workers inject a sperm into each egg, then incubate the embryos until they are three days old, by which time they are about eight cells apiece. Extracting a cell from each, they determine its sex. By day five, an embryo of the desired sex – now 70 cells – is implanted in the woman’s womb. The others are discarded, or donated to research.

Called sexist, immoral

Powerful forces, however, oppose the procedure for this purpose.

More than two-thirds of the 1,300 doctors surveyed by the American Society for Reproductive Medicine felt parents should not be allowed to select the gender of embryos for non-medical reasons, and almost as many opposed sperm sorting in the absence of sex- linked disease.

In 1999, the society’s ethics committee said PGD for non-medical reasons was ethically problematic, because among other things, it identified "gender as a reason to value one person over another." The process, the committee concluded, "should be discouraged." Two years later, the group hedged its stance, saying that because sperm sorting did not destroy prenatal life, it was ethically acceptable. Still, the committee counseled against "widespread use."

The American College of Obstetricians and Gynecologists, for its part, argued that sex selection without medical justification was bad social policy: "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."

And for people who believe human life begins at conception, PGD – with its destruction of unwanted embryos – is as immoral as abortion.

The clash is evident in New Jersey.

Reproductive Medicine Associates in Morristown, the state’s largest infertility lab, provides sex selection for family balancing. "We try not to be judgmental," says Dr. Michael Slowey, a physician there. "We believe the decision ought to be left to the couple."

But the Institute for Reproductive Medicine and Science of Saint Barnabas in Livingston, whose doctors pioneered PGD, refuses to use the technology for non-medical reasons. "What happens if their case is one of the tiny percent where the technology fails and they wind up carrying the ‘wrong’ gender?" asks Dr. Natalie Cekleniak, the institute’s director. "What’s their attitude going to be toward that pregnancy, or that child?"

Guidance from Talmud

At Zalman Levine’s office at the Fertility Institute of New Jersey & New York, a framed photo of his five children – four girls and a boy – sits on a shelf overlooking his desk. Even if all five had been the same sex, Levine says he would not have intervened. As an Orthodox rabbi turned reproductive endocrinologist, he was perfectly content to accept God’s plan, whatever it was.

Jewish law holds an embryo does not have any legal status until after the 40th day of pregnancy. Still, before Levine waded into these controversial waters, he consulted leading rabbinical authorities and the Talmud, the ancient collection of Jewish legal text and commentary, to make sure he had considered every angle.

For the couple awaiting Levine’s decision, however, the question wasn’t theoretical. They would try anything, they said, even abort a healthy son, to get the daughter they wanted.

For Levine, that prospect tipped the moral balance, and he agreed to help.

"I shudder to think someone would terminate a pregnancy for the wrong gender," he says, "and I feel ethically bound to intervene."

Of the 12 eggs he eventually harvested, he grew eight embryos. Three were female.

Nine months later, the couple had their long-awaited little girl.

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E-mail: padawer@northjersey.com