Thursday, October 27, 2005

Sex selection trial in China USA has been approved

This just in, a story in the Guardian referring to an article in the most recent issue of Nature:

A clinical trial into the effects of allowing couples to choose the sex of their babies has been given the go-ahead at a US fertility clinic. The controversial study was given the green light by an ethics committee after nine years of consultation. The purpose of the study is to find out how cultural notions, family values and gender issues feed into a couple's desire to choose the gender of their child.

Yes, you are reading that right, folks. A team of fertility specialists at Baylor College of Medicine in Texas will be conducting a trial that involves pre-implanation genetic diagnosis (which has only been used, until now, to identify serious disabilities and potentially life-threatening conditions) to find out why people might select one sex over another. And people are clamoring to get in: there have already been 50 inquiries from would-be parents asking to participate. Can it really be that this is a worthwhile research question? And are we really including selective termination of "wrong-sex" embryos as part of an empirical research protocol? Read more here.

Rumors have been floating around for some time (see Linda Glenn's earlier blog post re the "GenderMentor" test) that existing direct-to-consumer, mail-order prenatal tests, purportedly designed to help future parents plan for the arrival of their wanted child of either sex (Hmm, shall I buy the pink sleeper or the blue one?), have in fact been used as the basis for sex-based terminations.

Just in case you thought the no-girl-babies problem was something that only happened in other countries. . . .


davegkugler said...

Sex determination for 'variety' seems a bit of a stretch. Enabling people to choose the sex of their child would undoubtedly showcase any gender bias. However, if people are using methods for determination would it cut down the number of sex-based terminations?

Do you see this being preferentially directed at one gender versus another? In China this was evidently the case, would it be here?

Kevin T. Keith said...

This protocol certainly raises a lot of questions.

However, to address only the likelihood that this trial will "set a precedent" allowing gender selection to arise as a common practice in the US, I think the evidence on that is already available.

First, this is gender-selection in IVF procedures - which account for only about 1% of all births in the US, and only a fraction of which patients would be expected to employ gender selection even if it became widely available. So its impact on the overall sex ratio will be negligible unless IVF begins to account for a very much larger percentage of all births.

Second, informal sex selection is already possible using ultrasound or amniocentesis/chorionic villi sampling - which are common adjuncts to sex-selective abortion in other countries. As you note, the newly-available in-home sex text kits offer an even easier route to this end. However, there has been no noticeable trend in the US toward selection for a single sex using these methods - which are becoming cheaper and more available all the time. So, it appears that the US has not followed the path of those Indian states where sex-selective abortion is rampant (enabled by amniocentesis and later low-cost portable ultrasounds), or of China where selective abortion is a response to governmental population policies that do not exist in the US. There is certainly enough sexism to go around in the US, but the overwhelming preference for male children that is seen in those countries appears to be lacking here. And again, even if such a trend were to appear here, the introduction of sex selection to IVF procedures would make only a miniscule contribution to a practice that is already possible for the vastly larger population of non-IVF parents.

So, it's not clear that this experiment introduces a practice that (a) is capable of affecting the overall sex ratio in the US to any great degree, (b) responds to a consistent desire for children of only one sex across couples as a group (as opposed to the specific desires of individual couples that balance out randomly as both male and female across the group of all couples), or (c) is different in effect (although different in technology) from what is already possible for non-IVF couples. For these reasons, I don't think it will lead to any overt changes.

There is more to be said on the subject. However, as regards specifically the fear that this experiment opens a door to a new trend in highly-non-random sex selection, it's hard to see that happening given the facts of the case.

Sue Trinidad said...

One question this does raise is what the difference is (if there is one) between termination of pregnancy for sex selection and selective implantation of embryos for the same reason. As we also see in the stem-cell issue, technology has pushed the boundaries of this question beyond the parameters of the current abortion debate and thoughts about viability.

Re Dave's question about whether sex selection will be preferentially directed at one gender--well, in one way of looking at the question, yeah, the whole point is to choose one over the other (and this is assuming there are only two, which some contend is a false dichotomy--but that's a whole different subject).

I think what you really want to know is whether, in general, the people who use technology to select the sex of a future child will all choose the same way (girls over boys, for example). We don't know the answer to that question yet, and it likely is culturally and familially defined.

There's a tendency to say--in many bioethics issues--that so long as the state isn't mandating a particular choice (whether PGD for sex selection, the specific traits of notional "designer babies," or withdrawal of treatment), then it's purely a matter of self-determination. That is, individuals have the right to do what they want with their bodies. We're getting closer and closer to finding out what limits, if any, Americans think should apply to reproductive freedoms.

A few additional things to ponder. In the US today, more boys than girls are born each year (see CDC report: So maybe this technology would actually be used to select for girls. At the same time, there have been some early reports that, while the sex ratio worldwide is stable (with slightly more boys than girls born each year), in some countries the ratio of boys to girls is dropping. At what point would this be an issue? At what point might population imbalances lead to unforseen consequences--like the age of marriage for females, but not males, dropping precipitously?

Stay tuned. . . .

marin gillis said...

So-called "family balancing" is a reason cited by parents and fertility doctors for sex selection: "We have two boys so we wanted a girl" kind of thing. Just see microsort's statement: Also, at the First International Conference on Ethics, Science and Moral Philosophy of Assisted Human Reproduction last year in London, many claims were made about how the West was unlikely to go the way of China and India, selecting boys over girls.