It’s Illegal in Most of the World. In America, New Parents Are Embracing It—for Better or Worse.

Amy Yin always envisioned having at least two daughters. She spent her 20s working as an engineer and founding a startup in San Francisco. When she wasn’t working, vacationing with friends, and spoiling her cats, Amy dedicated herself to helping other women take charge and launch high-powered careers. Now 32, she’s bringing that same energy to her family planning. She has frozen her eggs and, when she’s ready, will undergo IVF so that she can select the sex of her future children. “I think I’ll raise really powerful women who are going to be rock-star leaders,” Amy told me, without hesitation.

In vitro fertilization is invasive, grueling, and expensive. One round costs an average of $20,000. Only 15 states require that insurance plans offer any kind of coverage for it—and even then, the coverage is usually minimal. The treatment is often a last resort for those who are eager to be parents but who face one roadblock or another when it comes to conceiving; some couples are struggling with fertility issues, some couples are the same sex, and some people are single and making a go of it on their own.

Having a baby via IVF first requires creating an embryo in a Petri dish. Embryonic testing can reveal secrets like genetic disorders. That allows it to serve as a screening tool for parents who carry genes for rare diseases. Such testing also lets parents know the sex of their prospective children. It essentially allows patients to pick whether they will have a male or female baby. Sex selection was once controversial in the U.S. and is banned in almost every other country. Many Americans unaware of the process still assume that it’s that way. In reality, it has now become a standard part of IVF here. For some, the option to sex select is a perk of an otherwise exacting process. For others, it’s the whole point of doing IVF in the first place.

Over the past two decades, enterprising clinics have attracted thousands of fertile customers like Amy, who are so invested in selecting their kid’s sex that they’re willing to undergo weeks of shots, submit to surgery, and risk rare but life-altering complications. Jeffrey Steinberg, the founder of the Fertility Institutes in Los Angeles, figures that elective IVF for sex selection rakes in an estimated $500 million annually for clinics. (He puts it at about 5 percent of the $8 billion market.) But its growth potential is unlimited, Steinberg told me: “The market is the size of the human race.”

Two things are true about America’s blazing-hot fertility industry, a sector that is largely unregulated and increasingly owned by private equity firms and hedge funds: It serves a real need—for many prospective parents, access to these technologies is vital. And yet, it is fueled in part by consumer whims. You can have a baby when it suits your career, thanks to egg freezing (or at least you can try). You can sequence your embryos’ genomes for $2,500 a pop and attempt to maximize your future child’s health (or intelligence, attractiveness, or height). At Steinberg’s clinic, you can even select eye color. There is a vast disparity between who gets to use IVF—many struggle to access the technology at all because of the cost and, now, political restrictions—and who is using it to create designer families.

These patients are seeking not just choice. Many, like Amy, want daughters. The ability to act on that desire—an option mostly unheard of in the rest of the world—has sparked a small but growing trend in American family planning. It has expanded the concept of reproductive choice and bodily autonomy to for-profit procedures that will alter future generations. It speaks to a crisis in boys and lopsided expectations for daughters. And even among the people who are opting in, it’s creating concerns about the degree of control some parents are attempting to wield over a baby’s destiny—and whether they can ever really exert that control at all.

Lexi and her husband, both software engineering managers at major Bay Area tech companies, have always wanted girls. (Lexi asked to be identified by a pseudonym because her parents are unaware of her plans.) Lexi, who is 32, longs to replicate the close relationship she has with her mom; her husband values traits “more associated with girls,” including empathy, social skills, and kindness. But they had no plans to act on their preference—that is, until they learned that their companies would foot the bill.

Lexi’s husband was more excited than she was: All he needed to do was masturbate into a cup. Lexi’s immediate thought was, I don’t know if I want to put my body through that in order to guarantee a girl. A fertility work-up suggested that the couple would have no trouble conceiving the old-fashioned way.

Still: Lexi did really, really want a girl. She craved a close friendship with her future child, one that would last into old age. That seemed possible only with a female child. “I was just like, How do I convince myself to do this”—to undergo the discomfort and hassle of IVF—“if this is what we want to do for our family?” she said.

Eventually, a double date with fellow techies swayed her. Their friends, too, had no known fertility issues and were creating embryos to select sex and potentially use a gestational surrogate. “They normalized it,” Lexi said.

I spoke to 15 women (and a couple of men) who are planning on doing IVF so that they can have a daughter. Being bullish on IVF is not just about sex selecting, several told me. Procedures that appear scary and unnatural to many can feel novel and exciting to science-obsessed computer nerds: IVF can seem “safer” than conceiving via intercourse because it’s monitored by scientists. “We spend so much time micro-optimizing so many things in our lives, even micro-optimizing how much time we spend at the grocery store,” Guthrie Ginzler, Amy’s partner and a software product manager, told me. Why not optimize having a baby, from the exact timing of conception to the shape of the chromosomes? Trends spread among hyperconnected peers. I know both Lexi and Amy through my own former career as a software engineer and have met multiple people influenced by their plans.

Case in point: A month after the double date, Lexi was stabbing needles into the fat around her navel, ripening her eggs for extraction.

Three rounds of treatment in, Lexi showed me her IVF spreadsheet. It resembles a software project tracker, except instead of deliverables and deadlines, it documents the amount of eggs that are harvested at each retrieval, the number of fertilized eggs that have developed into healthy blastocysts, and the number of embryos that contain two X chromosomes. (Lexi and her husband want two kids, both girls.)

They are not stopping at IVF: They have signed with a surrogacy agency and are waiting to get matched with the woman who will carry and birth their elder child, buying them more time to rave, travel, and “self-actualize” without worrying about a pregnancy. Their companies will foot $75,000 of the roughly $150,000 surrogacy fee. No one involved in making this happen for them has challenged or even asked about Lexi and her husband’s motivations. Lexi described her clinic’s attitude as “This is business as usual, and we get money from you.”

It’s impossible to pin down how many patients choose IVF purely for sex selection and how many are picking girls; as with most aspects of fertility care, this is something clinics are not required to report. The vast majority of clinics offer the service, with many listing it on their websites. Even when intended parents don’t begin fertility treatment intending to sex select, they often discover this option along the way. In fact, several people I spoke to for this story told me that their clinical intake forms asked for the “preferred gender” of the child they hoped to have. For many American couples desperate to conceive, the ability to pick feels like a silver lining of a process that is otherwise arduous in terms of both money and emotional health, says Sharon Moayeri, the founder of OC Fertility in Newport Beach, California.

Moayeri’s clinic does not prominently advertise sex selection—it’s fourth in a menu of services on the website—but she estimates that up to 15 percent of patients arrive without any fertility issues. I spoke to a doctor at the medical center at the University of California San Francisco who said their sense was that a low number of patients come in only for sex selection. They did, however, easily point out several examples of parents who, once they’re already there, are more likely to request girls: single mothers by choice, same-sex couples, and families with a history of autism. Steinberg, whose Fertility Institutes markets this service aggressively, estimates that 85 percent of patients are there purely for “gender selection.”

Old debates around sex selection focused on the wish for sons. Today in America, that preference is often reversed. One study found that white parents picked female embryos 70 percent of the time. (Parents of Indian and Chinese descent were more likely to pick boys.) Anecdotes back this up, with message boards filled with moms dreaming of a “mini me.” A 2010 study showed that American adoptive parents were 30 percent more likely to prefer girls than boys and were willing to pay $16,000 more in finalization costs to ensure a daughter. (Agencies have since stopped sharing those costs, after criticism of the differential pricing across gender and race.) Close looks at demographic data suggest that families with daughters tend to have fewer subsequent children than do families with sons, indicating a sense that a daughter is what makes a family complete.

In fact, according to most of the doctors I spoke with, the majority of parents selecting for daughters already have sons, a situation fertility clinics call “family balancing.” Denise, who requested that I use just her first name, works in tech and has four boys who like pink and glitter, will wear nail polish, and enjoy My Little Pony. But Denise still wants a daughter—a child with whom she can feel an even greater sense of “relatability.” Her husband can understand some of her sons’ experiences in ways she can’t, she explains. She also hopes her husband will treasure the “precious moments” possible only between a father and his daughter.

All the moms I spoke to were looking to add a little estrogen to their brood because they feel they could never have the same connection with a son as they could with a daughter. But some were blunter about their preferences.

Grace, a 31-year-old who works in human resources (I’m referring to her by her middle name), told me, “When I think about having a child that’s a boy, it’s almost a repulsion, like, Oh my God, no.”

Grace and her FAANG (Facebook, Apple, Amazon, Netflix, Google) engineer fiancé are freezing embryos to preserve their fertility—and to ensure they avoid that “Oh my God, no” scenario. After she turned 30, her fiancé wanted to make embryos right away. Grace wasn’t particularly eager to kick off the kid-having process: “I don’t like kids. I don’t want kids anytime soon. Especially one that’s a boy.” But she also thinks that her feelings around kids may change—and she wants to be able to dodge the possibility of becoming a “boy mom” if they do.

What’s so bad about boys? “Toxic masculinity,” said many women I spoke to, even those who were, sadly, already boy moms. For many, going through all the trouble to ensure a girl feels like a social good. Amy’s partner, Guthrie, believes that because oldest children tend to be more successful, if everyone did sex selection we could squash inequality by manipulating birth order. “Maybe one of our best chances at trying to destroy the glass ceiling is to have women first,” said Guthrie. Among the moms I spoke to who already have boys, many want to give their sons sisters to make them into better men. They believe that girls can do anything—a conviction that often comes with the subtext that boys are incapable of doing their own laundry, calling their moms, expressing empathy, or even really being part of the family as they get older. “I don’t know a guy who has a strong relationship with his mother or his father,” Grace told me.

The perception is that boys are trouble—or at least are susceptible to a particular kind of trouble. There’s been a heavily reported-on crisis of masculinity, with men lagging in almost every metric that matters to success-obsessed Silicon Valley. Men are less likely to finish high school, graduate college, and have children. One study found that 60 percent of young men are single, compared with 30 percent of young women, who are more likely to be in a queer relationship.

To many, the prospect of raising a girl just feels as if it will be easier. She’s far less likely to commit a mass shooting or to idolize Andrew Tate. She’s also, points out Moayeri, less likely to be diagnosed with autism. Although a man striving to make as much money as possible might feel capitalist and gross, a woman who does the same is a #girlboss—a beloved trope among millennials making their way in an industry in which only 23 percent of technical roles are filled by women. A daughter, if you squint, can have all of the achievements with none of the baggage.

Could that really be so bad, valuing strong women to the point where you want to make sure you raise one? Many American ethicists argue that sex selection can’t be discriminatory if some parents—even most—opt for daughters. Further, if mothers are the ones choosing sex, that could be seen as an empowering new form of reproductive autonomy (an argument that becomes more complicated when men are picking too but women are bearing the brunt of IVF). For millennia, sex selection was performed via infanticide. This is not that.

Still, “the very act of sex selection is sexist,” argues Arianne Shahvisi, a professor of philosophy at Brighton and Sussex Medical School in the U.K., where elective sex selection is illegal.

You can’t actually foresee your child’s gender—let alone how they will choose to express it or the qualities they will possess as a human being. So sex selection requires making a decision based on stereotypes. In turn, this “feeds damaging systems of social organization,” Shahvisi told me, by reinforcing the idea that certain traits are biologically tied to sex—a view that has, historically, limited women. Selecting for girls might perpetuate negative views of boys and men: If you believe you can create a daughter with whom to have a deep emotional bond, why even try to cultivate that with a son?

Is it unfair to bring a child into the world, assuming she’ll fulfill gendered obligations, however positive? The women I spoke to are open to many different gender expressions—Lexi, Amy, and Grace would all be thrilled to raise a queer, athletic engineer—but at the end of the day, they expect their daughters to be compassionate, to relate well with their moms, and, once they fly the nest, to FaceTime their parents. They don’t expect the same things from sons.

“Boy children tend to be less caring towards their parents,” Lexi explained. “It doesn’t really matter if it’s socialized or biological. It’s probably socialized, but I can’t change all of society.”

It’s not just the U.K. Virtually all the industrialized world—including Canada, Australia, and every European country besides Cyprus—bans sex selection except in rare medical cases. Most nations prohibit the practice on the grounds that it promotes sexism and that the children born from it may be harmed by gendered expectations. Widespread preference for a certain sex can also skew the population—as in India and China, where abortion and infanticide of girls have resulted in tens of millions more men than women. (Amy, who is Chinese American, views her plan to select for girls as a reversal and correction of her culture’s historical preference for sons.) In countries where infertility care is covered by insurance or provided by the government, sex selection is also seen as a frivolous waste of taxpayer funds.

In 1994 the American Society for Reproductive Medicine, the nonprofit that provides the industry’s professional guidelines, condemned sex selection for nonmedical reasons. Yet with no enforcement power, the guidelines remained just that. Unlike in most peer nations, IVF in America is mostly privately paid and weakly regulated. Instead, market forces dominate. By 2018, despite the ASRM’s recommendation that they not offer sex selection, 75 percent of clinics continued to provide the service. Since then, the ASRM’s ethics committee has updated its position to a neutral stance.

While public sentiment toward sex selection has grown increasingly negative abroad, in the U.S. the ability to select sex is framed as a matter of personal autonomy: just one of many expensive choices that make our country free.

This particular freedom is big business. The U.S. market for fertility is growing. Clinics are increasingly owned by venture capital; at least 30 percent of fertility services in America are provided by private equity–backed firms, whose priority is maximizing profits. Some thousands of patients a year—though it’s hard to know just how many—travel to the United States in order to sex select, which could easily account for millions of dollars in revenue.

Convincing parents that it’s worth undergoing IVF to have a child of a specific sex is an effective way to increase clinics’ customer base beyond the 15 percent of couples of reproductive age who experience infertility. As more tech companies provide IVF benefits, their employees are especially attractive bait. (Grace says she’d never be considering freezing embryos to sex select if her job didn’t pay for it.)

But what can go wrong?

Laura Kerwin, a Harvard-trained psychologist in California, sees many parents like Amy, Lexi, and Grace. In her practice of filthy-rich clients, sex selection is so common as to be unremarkable. She can relate to her patients. She followed all the old wives’ tales—including “drugging” her husband with supplements, timing intercourse, and eating acidic foods—in an attempt to maximize the odds that her third child would be a daughter. She has a message for those patients: Be careful what you wish for.

“You have this picture in your mind of the family that you want,” Kerwin said. “But what do you do if the girl comes out and she doesn’t want to be a girl or she isn’t the ideal girl that you have in your mind?” Not only will parents be disappointed, Kerwin cautions, but the children will rebel.

She has also seen seemingly open-minded parents who—after investing time, money, and pain into selecting their child’s sex—are devastated after their kid comes out as trans.

“As a parent, your role is to accept the child you have. Not to mold them into someone that you want them to be: That’s narcissism,” she said. Kerwin did have a daughter—but her daughter has totally defied her expectations. “My boys were much sweeter,” she told me.

“It’s a moneymaking industry,” she said. “People need to realize that [clinics] have a fiduciary duty to their shareholders to make money. They’re trying to sell you on an option.”

Some of the sex selectors admit that this is all fraught. “My main concern is that that puts pressure on the child to be a certain way,” Lexi told me. She reassures herself by saying that she’s not choosing specific personality traits or even gender: She and her husband are merely “weighting the dice.” One mother, who’s doing IVF to give her daughter a sister—a built-in best friend, she hopes—told me that the pressure can be crushing. She admitted to feeling as if “anything that goes wrong is my fault.”

Grace is aware that her disdain for boys may “seem dumb or offensive” to someone who is struggling to conceive, let alone the millions of infertile Americans who can’t afford even the most basic fertility care. In fact, all of the prospective girl parents I spoke to expressed enormous empathy for those unable to have a child of either sex; almost everyone agrees that the way IVF is funded in the U.S. is unfair. But in the end, these daughter-desiring patients have the means— so they’re going to use them.