Can You Choose Gender With IVF?

Wendy Wisner
·6 min read

Medically reviewed by Soma Mandal, MD

People can choose the gender of their baby with in vitro fertilization (IVF). A type of pre-implantation genetic testing (PGT) that looks at an embryo's sex chromosomes makes sex selection with IVF possible. Note that PGT is an optional step in the IVF process and not a part of the baseline costs.

Selecting a baby's sex using PGT is controversial, especially for non-medical reasons. Some argue that sex selection might lead to choosing other traits, like eye color, hair color, and height. Others say that this process expresses patient autonomy and reproductive liberty.



Sex vs. Gender

It's worth noting that gender is not the same as sex. Sex refers to the reproductive organs your baby is born with. Gender, in contrast, refers to your child's gender expression. This may or may not match their biological sex. It's possible to choose the sex of your baby, but you cannot pick your baby's gender.



<p>Antonio Marquez lanza / Getty Images</p>

Antonio Marquez lanza / Getty Images

Related: What Is a Surrogate?

Sex Selection With IVF

Many people decide to do genetic testing as part of IVF. IVF is an assisted reproductive technology (ART) that helps people get pregnant if they cannot naturally.

Genetic testing is optional in the IVF process and can determine the sex of the baby. Sex selection, however, is not the primary purpose of genetic testing. Healthcare providers mainly use genetic testing to reduce an embryo's chromosomal abnormality risk. Extra or missing chromosomes might lead to health concerns.

Some parents may not want to know the sex of their embryo before it's implanted. Experts advise all healthcare providers to share that PGT-A tells parents the sex of their baby during the informed consent process for genetic testing.

Possible Reasons for Sex Selection During IVF

Expectant parents might want to choose their baby's sex for medical or non-medical reasons. These include:

  • Emotional reasons: Parents may be emotionally biased toward one sex. Some parents who have lost a child may feel strongly about choosing the sex of their next child.

  • Family balance: Some parents want to choose their baby's sex for "family balancing." They may already have several children of the same sex and want to have a child of a different sex.

  • Known family history of genetic disorders: Certain genetic disorders only affect a particular sex or are more severe in one sex than the other. Selecting a baby's sex may ensure that you will not have a child with a sex-linked genetic abnormality. Sex selection can reduce the risk of early death or special medical care after birth.

How It Works

PGT evaluates embryos for genetic disorders before a healthcare provider transfers the embryo(s) into the uterus. There are a few types of PGT, such as:

  • Pre-implantation genetic testing-aneuploidy (PGT-A), previously known as pre-implantation genetic screening (PGS)

  • Pre-implantation genetic testing-monogenic (PGT-M), previously known as pre-implantation genetic diagnosis (PGD)

  • Pre-implantation genetic testing-structural rearrangements (PGT-SR)

PGD and PGS/PGT-A Testing

PGD tests for monogenic (single gene) disorders. Sickle cell anemia, a blood disorder, is an example of a monogenic disorder. People with sickle cell anemia have crescent-shaped red blood cells. This makes it hard for blood to flow and carry oxygen throughout the body.

PGS/PGT-A screens embryos for extra or missing chromosomes. Each person typically has 46 chromosomes, including 22 pairs from each parent and two sex chromosomes. PGT-A can tell you an embryo's sex since it looks at the sex chromosomes X and Y. XY is a male embryo, and XX is a female embryo.

Success Rates

Sex selection with IVF is highly accurate. Research has found that sex selection with PGT is essentially 100% accurate. Your baby will likely be the desired sex if you become pregnant with IVF.

Considerations

Research has shown that sex selection for non-medical purposes can pose ethical dilemmas. Some may argue that having access to the option to select your desired sex is a reproductive liberty. Advocates might say that policing your reproductive decisions violates your privacy.

Opponents may argue that non-medical sex selection:

  • Is an abuse of medical resources: Using reproductive technology to select your baby's sex may lead to choosing other traits, such as eye color, hair color, and height.

  • May harm the child: It's unclear whether PGT risks harm to an embryo. The risks generally outweigh the benefits only if you use PGT to test for genetic disorders.

  • Perpetuates gender bias: Sex selection might reinforce social ideas about gender stereotypes, or that specific traits are inherently female or male. Parents may impose these stereotypes onto their child, potentially later harming their mental health.

  • Poses risks to the parent: It's unclear whether PGT risks harm to the pregnant person. Experts advise healthcare providers to tell pregnant people about the possible risks of using PGT for sex selection. Pregnant people may feel pressure from their partner to choose one sex over another.

Next Steps for Unused Embryos

One cycle of IVF typically produces several embryos, some of which do not get transferred into the uterus. You might opt to freeze and save unused embryos for future IVF cycles. This process is called cryopreservation. A healthcare provider can later thaw and transfer these embryos into the uterus.

Some people decide to donate frozen embryos to another person who's experiencing infertility or to scientific research. Embryos that are not frozen do not retain viability, or the ability to live, so they are discarded.

Related: Should You Consider Fertility Testing?

A Quick Review

Many people want to know the sex of their baby before birth, though sex selection with IVF may be controversial. Many fertility specialists will provide sex selection for non-medical reasons.

There are some ethical considerations to keep in mind. Some believe picking a baby's sex may impose gender bias or lead to sex discrimination. Others think non-medical sex selection is an example of patient autonomy and reproductive liberty. Contact a healthcare provider with questions or concerns about your baby's sex or sex selection.

FAQs

Frequently Asked Questions

1. How accurate is PGT for selecting an embryo's sex?

IVF sex selection is highly successful, with nearly 100% accuracy. Your baby will likely be the sex you choose if you become pregnant with IVF.

A study published in 2021 looked at 2,872 women who underwent IVF. About 23% of those women became pregnant after an embryo transfer. The live birth rate among the women who became pregnant was almost 28%.

2. How much does it cost to choose the gender of your baby?

PGT is not part of the baseline costs of IVF, which totals about $10,000 to $15,000. Multiple IVF cycles may cost upwards of $27,685. Adding the cost of PGT will increase your IVF bill by about $1,500 for the biopsy procedure, plus another $150 per embryo. Those prices can vary depending on factors like your health, insurance coverage, location, treatment center, and type of PGT.

3. Are most IVF babies male or female?

Most IVF babies are males. Research has shown that female embryos are more likely to have lower survival rates and genetic abnormalities than male embryos.

For more Health.com news, make sure to sign up for our newsletter!

Read the original article on Health.com.