Sex Selection

by John Wyatt

It seems obvious that all parents would want to have healthy children and happy families. Part of this can mean trying have not only the desired number of children, but also children of a desired sex. The motive may be to avoid certain genetic disease or to meet particular social desires. The question is whether in making these choices people are trying to seek too much control.

A woman is pregnant. She and her partner already have two children, both of whom are boys. Friends meet them in the street, and over normal conversation say, ‘Let;s hope it is a girl, you’d be unlucky to get three boys’. When the third child is a boy, the same people probably say, ‘Oh well, never mind, so long as he is healthy – that’s all that counts’.

Underlying these statements is the recognition that while we have no choice in the matter, many parents wish that they could take more control over what kind of children they have. Medical technology is now moving to the point where parents can make this choice (see Methods box), and so the question arises – is it ever right to choose our offspring’s sex?

Many Different Motives

The pressure to choose the sex of your children can be very real and can come from social or medical motives.

In some cultures, boys are seen as a sign of blessing, especially a male first born. This is often a very practical issue and the need than simple prestige. In countries where support in old age comes predominantly from within the family, many elderly people live with their sons – having no son can be the social equivalent of having failed to invest in a pension.

This can be further complicated when national legislation restricts the number of children a couple is allowed. The classic example is China. Here sons look after elderly parents, but couples suffer financial and other penalties if they have more than one child. The need to provide a ‘pension’ means that they go to extreme lengths to ensure they have a son. This can include infanticide or abandoning their female children.

Western cultures are not exempt from pressure. Until recently a family’s inheritance passed down the male line. With no son, the family’s wealth build up over generations could be lost. Even now, losing the family name is still an issue for some, particularly if the family runs or owns a business, or is a titled family.

Parents who already have one or more children of a particular sex may want to balance their family runs or owns a business, or is a titled family.

Parents who already have one or more children of a particular sex may want to balance their family by ensuring that their next child is of the opposite sex. On the other hand parents may simply want to choose the sex of their children, purely as a matter of personal preference.

Parents who wish to replace a lost child raise a more emotive issue. No one doubts that the death of a child through sickness or an accident is traumatic. Occasionally people who have lost a child argue that selecting the sex of any future children will enable them to reduce the trauma by restoring the original balance within their family.

On top of this there is a variety of genetic X-linked conditions where women act as carriers, but the full effects of the disease are only seen in males. X-linked disorders include Duchenne muscular dystrophy, haemophilia and familial red-green colour-blindness.

These disease are caused by mutated genes carried on the X chromosome. Females are seldom, or only mildly, affected because they have two X chromosomes and it is very unlikely that both carry the same defective gene. Statistically, a woman will, however, pass the defective gene onto half of her offspring. If the child is female, there is a 50:50 chance that she will be a carrier herself.

If the child is male, he again has a 50:50 chance of inheriting the disease-causing gene on his X chromosome. Unlike a girl, he only has one X chromosome, so the mutation will not be masked. The boy will therefore be affected by the disease.

Sex selection can be used to help these families avoid having boys, thus removing the risk of having a child with one of these disorders.

Some people, including some Christians, argue that there is a critical difference in the ethics of employing sex selection for either social or medical motives. Others believe that choosing the characteristics of your offspring is always wrong.

UK Legislation
In the UK, the Human Fertilisation and Embryology Act, 1990, determines that any medical technique involving embryos must occur in licensed clinics. This restricts the use of techniques like PGD. But techniques that use artificial insemination to introduce selected sperm to the woman’s vagina or uterus, fall outside the scope of the Act.

Making Choices

People tend to line up in one of three camps when considering sex selection. Some say that selection for social and medical motives is an exciting extension of medical technology’s ability to extend our control over life.

Others argue that choosing the sex of your child for social reason is always wrong because it is an example of consumerism and commodification of human life. However, they would be prepared to use sex selection for medical reasons. A third group consider that any use of sex selection would be an unethical use of medical technology.

To understand these different viewpoints we need to study some areas of the debate. Deciding what you think about the use of sex selection will shed light on your hopes, fears and attitudes to human life.

Methods of Selecting Children of The Right Sex

Sperm Sorting
Sperm contain either an X or a Y chromosome. X chromosomes are larger than Y chromosomes, so on average, sperm carrying X chromosomes are marginally heavier than those with Y chromosomes.

Various methods use this difference to sort male and female sperm. Because this process is not regulated by law it is difficult to establish the validity of claims made by different clinics, but the technique certainly increases the chances of having a child of the sex of your choice.

Some new, more hi-tech methods now fix dyes to either the X or Y chromosomes inside the sperm. The sperm then travel though a flow-cytometer that sorts them one at a time. Users claim success rates as high as 91% in selecting females and 76% for males. pregnancy rates are comparable with standards fertility procedures.1

During many forms of fertility treatment it is possible to remove a cell from a few-day-old embryo and subject it to genetic tests. This pre-implantation genetic diagnosis (PGD) can easily dtermine the sex of the embryo. Only embryos of the desired sex are placed in the woman’s uterus.

The crudest form of selection is to wait for the baby to grow large enough for visual examination to determine the individual’s sex. This can now include an ultrasound scan while the baby is in the womb. Unwanted babies are then aborted, abandoned, or treated in a way that brings their lives to an end.

Health or ‘type’?
Arguments in favour of sex selection are frequently phrased in terms of benefit to those born, saying that the technology ensures that any children born will benefit. This can be in terms of providing a more balanced family or avoiding certain genetic disorders.

Opponents of selection point out that in reality, parents are not helping a child to live a healthy life, but choosing the type of child they wish to be born. This is a radical departure form any previous treatments.

For example it is different from a woman’s decision to take folic acid to prevent her baby developing spina bifida, or having a rubella vaccination to ensure that any baby can’t be damaged by her catching the disease while pregnant. Both of these maximise the chance of any future children being born free from illness, rather that preventing individuals of a certain type being conceived or born.

Similarly sex selection is subtly different to contraception. Both technology give people an element of control over their offspring, but contraception limits the number of children, without choosing between types of children.

Selecting offspring on the basis of health also begs two question; what is health? and, what is normality? People’s concepts of health and normality differ. On occasions the notion of health has been challenged when parents with a type of dwarfism called achondroplasia and others with genetic forms of deafness have asked to use genetic techniques to select children with the same conditions. For them, it is perfectly ‘normal’ to be either four feet tall, or be unable to hear.

Read more: Sex Selection (Part 2-end)

Christian Medical Fellowship (CMF) Files No. 21, 2003