Determining fetal sex brings ethical risks

Arthur Caplan

August 10, 1993|By Arthur Caplan

SINCE someone first distinguished pink from blue, one of the mysteries and joys of pregnancy has been waiting to learn the sex of the baby.

Modern reproductive technology is on the verge of making birth a bit less mysterious. It remains to be seen whether, as a result, birth will become any less joyous.

For many years medicine has had the ability to determine the sex of a baby while it is still inside its mother's womb. Ultrasound technology allows doctors to use sound waves to take pictures of the developing fetus. An experienced ultrasound observer almost always can figure out the sex by six or seven months into a pregnancy simply by looking.

Doctors also can tell the sex of a baby before it is born by using tests such as amniocentesis or chorionic villus biopsy. In using these tests, a doctor withdraws a small amount of cells from the tissues and fluids that surround the fetus and then looks in a microscope to see if there is an X or a Y chromosome inside the cells (girls are XX, boys are XY).

But tests that require the removal of cells carry slight risks of causing an abortion, so they almost never are used simply to determine sex. And, even though you can know your little bundle of joy's gender even before the stork has dropped the bundle, there is nothing you can do, short of ending the pregnancy, if you're not happy.

That is about to change. There are now 57 clinics in the United States, along with eight in other countries, that are offering a technique allowing would-be parents to pick their baby's gender. A Montana-based company, Gametrics Limited, has patented a process that uses artificial insemination to increase the odds of having a boy or a girl.

The key to the technique involves having sperm swim through a test tube filled with a specially prepared gel. The sperm that make it to the bottom are more likely to have a Y (male) chromosome. So, depending on what the parents want, the woman is artificially inseminated with sperm from the top or the bottom of the test tube.

The technique is not new. The founder of Gametrics, Ronald J. Ericsson, first reported on his sperm separation technique in 1973. But others have had a hard time replicating Mr. Ericsson's results.

Mr. Ericsson and two colleagues, Ferdinand Beernink of the East Baby Fertility Group in Berkeley, Calif., and W. Paul Dmowski of Chicago's Rush Medical College, recently reported the technique had worked well in a large number of births at a variety of clinics.

At the 65 Sperm Centers franchised to offer Mr. Ericsson's technique, couples beat the roughly 50-50 odds associated with making babies the old-fashioned way. Those who wanted a boy were successful in 749 out of 1,034 births. That is a 72 percent success rate. Mr. Ericsson and his group reported similar success rates for those seeking girls: 133 out of 193 pregnancies produced girls, a success rate of 69 percent.

There are lots of reasons why people might want to select their babies' sex. Some of them make a great deal of moral sense. Certain diseases, such as hemophilia, are linked to sex. Couples who know they are at risk of having a child with a sex-linked genetic disease could prevent a good deal of suffering and premature death by picking their baby's gender.

The technique also might help some couples who now have more children than they really want in the hope that the next one will be a different sex from those they already have.

But other reasons for sex selection are not morally commendable. In many societies, such as China and India, there are strong cultural biases against females. The bias is so strong that some experts believe thousands of female babies are killed each year in China.

In the United States, preferences for boys over girls do not appear to be as strong. Various surveys of married men and women over the past 20 years show that there is a small preference for boys over girls for the first child. However, when a couple already has a boy, there is a very strong preference that the next child be a girl.

Americans have spent a great deal of time arguing about whether women ought to be permitted to serve in combat or work as firefighters and in other occupations.

Medical science is about to put our talk of equal opportunity and gender equality to a much more severe test. If we can live up to our rhetoric and really value men and women equally, then sex selection will only enhance the joy of having a baby. But if gender prejudice is still deeply rooted in society, then removing the mystery about the sex of our offspring will be no cause for joy.

Arthur Caplan is director of the Center for Biomedical Ethics at the University of Minnesota.

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