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Norbert Gleicher, M.D.
Chairman, Centers for Human Reproduction;
Editor, Journal of Assisted Reproduction & Genetics
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YES
In-vitro fertilization has been used for more than a decade with close to 100% success in selecting sex to avoid sex-linked genetic diseases that express only in males, such as muscular dystrophy and hemophilia. However, sex selection for non-medical reasons was considered unacceptable until May, when the American Society for Reproductive Medicine (ASRM) released a position paper that accepted it when using sperm-sorting, which is only 70% to 85% effective. Based on this decision, the Centers for Human Reproduction opted to make IVF available to select the sex of embryos. It seemed unethical to offer patients an inferior technology when a superior technology is available.
With IVF you sex every embryo and implant only the embryos of the chosen gender, a procedure that is almost 100% accurate. When we informed the chairman of ASRM’s Ethics Committee of our plans, he supported us in a letter. But with the publicity that followed, ASRM retracted its opinion. It plans to revisit the issue. There are some good reasons for sex selection. People have the right to make responsible decisions.
It’s true that psychedelics did not live up to the “magic bullet” claims of early proponents, and one dose will not often result in a miracle cure. But research with LSD on alcoholics by Kurland et. al. showed significantly increased sobriety in the experimental group at six-month follow-up, though increased sobriety was only a nonsignificant trend at 12 and 18 months. Nevertheless, these are impressive results from a single LSD dose.
If a family has three boys and wants a girl, who am I to say it is not appropriate to choose the gender of their next child? Critics are misleading when they talk about a slippery slope. There’s a difference between giving someone the opportunity to choose the gender of his or her child and choosing somebody’s eye color or IQ. If we don’t offer reliable sex selection, then we are taking an absolutely unacceptable position for our profession. I am concerned about offering the public snake oil when we have good medicine available.
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Zev Rosenwaks, M.D.
Director, Center for Reproductive Medicine and Infertility, Weill Medical College of Cornell University and New York-Presbyterian Hospital
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YES
Sex selection has recently become the center of a vigorous professional and public debate.
There are compelling reasons for sex selection, gender-linked diseases principal among them. I am, however, disturbed when a couple elects preconception (sperm sorting) or preimplantation genetic diagnosis (done in conjunction with in-vitro fertilization) solely to satisfy their desire for a boy or a girl. There is no question that sex selection is a valuable tool for therapeutic purposes. It may be medically reasonable for patients who need IVF to conceive to request sex selection for nonmedical reasons-if society deems it also ethically reasonable. Given the deeply rooted gender preferences found in cultures, making sex selection readily available is a de facto gamble with the natural balance between the genders.
If we unconditionally sanction sex selection, we may be inadvertently endorsing gender preferences around the globe. While that delicate ratio of boys to girls in North American is unlikely to be disturbed, there is no guarantee it won’t be upturned elsewhere. Furthermore, sex selection is not risk-free, especially when PGD is the means of determining gender. Even though IVF is relatively safe, the potential for problems is inherent in the treatment, as it is with any course of medicine. IVF is a medical procedure and as such should not be used solely for social ends. If there is no infertility and the offspring is not vulnerable to certain genetically transmitted diseases, then even the minimal risk of these procedures is too high. IVF is a medical procedure and, as such, should not be used solely for social ends.
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