Sex Selection

Practices, Policies & Prospects

Prepared for Gender and Justice in the Gene AgeNew York, May 7, 2004Presented by Diane Beeson

Prenatal diagnosis techniques Amniocentesis

99.9% accuracy at 15-18 weeks .5-1% risk of miscarriage

CVS (Chorionic villus sampling) 99.9% accuracy at 10-13 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 $2000 + 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

technologiesIVF, 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. W10281. Available at http://ssrn.com/abstract=495787.

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