Sex Selection Practices, Policies & Prospects Prepared for Gender and Justice in the Gene Age New York, May 7, 2004 Presented by Diane Beeson

Prenatal diagnosis techniques  Amniocentesis 99.9% accuracy at weeks.5-1% risk of miscarriage  CVS (Chorionic villus sampling) 99.9% accuracy at weeks 1-2% risk of miscarriage  Ultrasound 90% accuracy at 12 weeks  Maternal blood test experimental only-unreliable to date

Sperm Sorting: Ericcson Technique  Developed in 1970s  Drug use + sperm sorting  70-75% accuracy claimed & disputed  Distributed by U.S. based Gametrics, Inc.

Sperm Sorting: MicroSort  Available since 1995  Undergoing clinical trials in U.S.  Uses florescent dye to facilitate sperm sorting  Two U.S. labs currently licensed  $2,300 min. lab fees per try  88% success for girls; 73% for boys

Preimplantation Genetic Diagnosis (PGD)  First performed in 1989  Accuracy >95%  Removes 1-2 cells from embryo 3 days after fertilization produced via IVF  Tests each embryo and implants the one(s) that possess the desired chromosomes or genes  Pregnancy rate of less than 20% per PGD cycle  Cost varies usually about $ cost of IVF  Practiced in about 50 clinics worldwide  More than 1000 babies born worldwide

Sex Selection Policies – U.K.  Human Fertilization and Embryology Authority (HFEA Established in 1991 Licenses and monitors reproductive and genetic technologies IVF, sperm donation & storage Sperm sorting not yet covered by HFEA PGD may be used for medical reasons only 2003 public consultation -2/3 believe sex selection should be regulated

Council of Europe: Convention on Human Rights and Biomedicine  Article 14: The use of techniques of medically assisted procreation shall not be allowed for the purpose of choosing a future child’s sex, except where serious hereditary sex-related disease is to be avoided.

Canadian Policy on Sex Selection  Assisted Human Reproduction Agency Canada (AHRAC)  Established in 2004  Governed by 13 member board  At least 50% female

Canada: Continued  Prohibited Activities (under AHRA) 5.1.e. No person shall knowingly for the purpose of creating a human being, perform any procedure or provide, prescribe or administer any thing that would ensure or increase the probability that an embryo will be of a particular sex, or that would identify the sex of an in vitro embryo, except to prevent, diagnose or treat a sex-linked disorder or disease;

US Policy on Sex Selection  No direct regulation of PGD or sperm sorting  Claims of professional self regulation

Professional Self Regulation  American Medical Association Unethical to engage in selection on the basis of non-disease related characteristics or traits  American College of Obstetricians & Gynecologists PGD acceptable for sex selection only for medical conditions

American Society of Reproductive Medicine Advocates exemption from IRB oversight on PGD on grounds that it is a clinical practice 1999 Ethics Committee report discourages sex selection 2001 Ethics report deems sex selection ethically acceptable. Clear internal divisions with some members actively promoting sex selection

New York Times Ad First appeared in the Styles section in summer 2003

Sex Selection as Promotion Bonus to New IVF Customers

Commercialization of Sex Selection  Aggressive sales strategies Newspaper & internet advertising Sales & Free offers Guarantees  Ad agency justifications/euphemisms Normalizes process in historical terms “Family balancing” and “gender variety” Claim that most seek girls

Recent Study of U.S. College Students  Significant overall preference for firstborn males  Specific preference among potential SST users for firstborn males D. Swetkis, F.D. Gilroy & Roberta Steinbacher. “Firstborn preference and attitudes toward using sex selction technology.” Journal of Genetic Psychology, June 2002, v.163, p. 228

Dahl & Moretti (2003) suggests that gender bias in US is significant:  Women with girls more likely to be divorced  Women with only girls more likely to have never been married that women with only boys  Gender of child affects marital status at delivery when gender is known in advance  Single pregnant women having ultrasound are less likely to be married at delivery if results show girl  Child gender has strong effect on fertility stopping rules  Child gender affects probability of alimony payments, second marriages and second divorces.  Dahl, Gordon B. and Moretti, Enrico, "The Demand for Sons: Evidence from Divorce, Fertility, and Shotgun Marriage" (January 2004). NBER Working Paper No. W Available at

Questions for Consideration  How do we negotiate the tension between personal choice and social justice in developing regulation of sex selection?  Is our current situation a result of our failure to challenge the validity of the distinction between medical and non-medical uses of genetic testing?  Are there dangers in abandoning the above distinction with more non-medical interventions on the horizon?  What is the best strategy for combating sex selection?

High-tech methods of sex selection  Prenatal diagnosis followed by sex selective abortion  Sperm sorting and medical (artificial) insemination  Preimplantation genetic diagnosis (PGD) of early embryos + IVF