Q&A: Controversy: Gender selection via preimplantation genetic diagnosis: ethical pros and cons of the controversy

Yes. It's not sexist, and if choosing gender is acceptable before fertilization, why not after, too?

BY NORBERT GLEICHER, MD

When in 2001 the Ethics Committee of the American Society for Reproductive Medicine (ASRM) for the first time concluded that elective gender selection, under some circumstances, could be considered ethical,¹ the consequences may not have been all that obvious at first. Up to that point, elective gender selection had been-nearly universally-considered unethical. A small community of practitioners who had offered rather nebulous sperm-sorting techniques were largely perceived to be outside of the professional mainstream and weren't taken too seriously.

By that time, an even more effective gender selection technique had been in use for many years. Preimplantation genetic diagnosis (PGD) allows for the chromosomal evaluation of embryos, and therefore, for the selection of embryos by gender prior to transfer into the uterus. Even compared to the newly developed sperm-sorting technique mentioned above, PGD was a much more accurate gender selection technique that had been in clinical use for years for avoidance of sex-linked diseases.⁵ Because PGD was being used for medically indicated purposes, it never raised serious ethical questions within the scientific community. But because all forms of elective gender selection prior to ASRM's announcement1 were considered unethical, PGD was never considered for such a purpose.

The Ethics Committee's announcement that, under certain circumstances, elective gender selection may be ethical changed all of this.¹ The issue was no longer whether all elective gender selection was ethically unacceptable but whether some techniques were, and others were not.

ASRM's Ethics Committee differentiated between prefertilization (i.e., sperm sorting) and postfertilization (i.e., PGD) techniques of elective gender selection, assigning different gravitas to these two options by finding prefertilization gender selection ethically acceptable but not the postfertilization technique.^1,4 In making this assessment , the ASRM parted ways with the American College of Obstetricians and Gynecologists (ACOG)⁶ and some international bodies^7,8 that still oppose all forms of elective gender selection as unethical. We consider all of these ethics opinions deeply flawed, and the following analysis will show why.