Pick a gender and start a controversy
By Beth Whitehouse
Newsday
July 14, 2004
Up until now, Sharla Miller's life could pretty much be titled "My Three
Sons." Nature dealt her boy after boy after boy. Anthony arrived 12 years
ago. Then came Ashton, now 9, and finally Alec, 5.
Miller loves her sons. But they are boys.
"They fish and hunt and do all that stuff with their dad," Miller says. "I
go along, not necessarily enjoying it, but to be part of the family."
So when she decided she wanted another child, Miller didn't take any
chances.
She and her husband, Shane, visited a California fertility clinic for a
process called preimplantation genetic diagnosis. Several medical
procedures and $25,000 later, Miller indeed got what she had wished for,
times two. She is due to deliver twin girls July 21.
"I just couldn't get it out of my system that I wanted a daughter," says
Miller, 33, of Gillette, Wyo. "I just felt that our chances were slim to
none. I could end up with 25 sons and not one daughter."
The desire to influence the gender of offspring dates back through the
ages. Today there are more cutting-edge, reliable options to chase the
dream. The procedure's gender accuracy, for instance, is almost 100
percent guaranteed.
But the options are not simple. And, although they bring joy to the new
parents, they also raise ethical questions.
The two newer methods of gender selection include the procedure, which
many doctors have begun offering only in the past couple of years, and
Microsort, undergoing a federal Food and Drug Administration trial for
accuracy and safety.
For the procedure, a woman must first go through in vitro fertilization,
in which eggs are surgically extracted from her ovaries and fertilized in
a petri dish. Then, doctors test the embryos and implant only those of the
desired sex. But the procedure was developed to detect genetic and
chromosomal disorders; its use for gender selection is very controversial.
Microsort involves sorting sperm and then inseminating the woman with
sperm stacked to create a boy or a girl. It's less controversial because
it's done before conception and doesn't necessarily create excess embryos,
but it's also less accurate. So far, 90 percent of couples who wanted
girls got them. The success rate for boys is lower, at 77 percent,
according to Microsort reproductive endocrinologist Keith Blauer.
Some people are even combining the two procedures, using sorted sperm to
fertilize the eggs in the petri dish in the hope that, when tested, most
of the embryos will be of the desired sex.
The worries
Though the number of couples seeking to influence gender is small, and
most programs offering gender selection require that participants already
have a child of the opposite sex to stave off a population imbalance,
critics worry that, if the technology takes off, it will be hard to
enforce such a rule.
Critics contend gender selection opens the door to a frightening brave new
world of designer babies -- in which couples can select embryos based not
only on gender, but height, weight, eye color and even IQ.
The day is coming, some doctors say, when Microsort will be more widely
used, provided the studies back up the technology. The technique is
relatively uncontroversial among scientists.
"You're separating sperm," says Dr. Daniel Kenigsberg, director of Long
Island IVF. "It's not like you're making embryos."
The preimplantation procedure, on the other hand, indeed makes embryos. So
when couples who are perfectly fertile -- not prone to miscarriage, not
carriers of a debilitating disease -- ask for the procedure to select the
sex of their babies, the debate gets more involved.
The Millers, for instance, still haven't decided what to do with the four
healthy female embryos and seven healthy male embryos that they have
frozen. If they don't use them, they can discard them, which some people
believe on religious or moral grounds is a violation of human life. They
can give them to another couple or donate them for research.
Society needs discussion
Society needs to have a serious discussion about the issue of gender
selection, doctors and ethicists say. The major medical associations have
come out with recommendations, basically supporting pre-conception
interventions while discouraging the use of elective post-conception selection.
The recommendations bother doctors such as Norbert Gleicher of the Center
for Human Reproduction, with offices in Manhattan and Chicago. He says he
would like to offer elective preimplantation for family balancing but
isn't willing to go against the guidelines of the American Society of
Reproductive Medicine.
Argues Gleicher: "It is not ethical in our opinion to say to a patient,
'You can choose to use a technique that has a very significant error rate,
but you cannot choose to use a technique that is virtually 100 percent
accurate. You can only use the lousy technique.' "
The recommendations please doctors such as Kenigs- berg, who is against
the preimplantation method being used for elective gender selection.
Kenigsberg labels doctors who do the procedure "entrepreneurs. . . . And
that's basically a pejorative term," he says. "I can do [the procedure]
for gender selection. There's nothing stopping me, and I would probably
double my income. If the field doesn't restrain itself, there's going to
be some really ugly stuff down the line. At some point, the technology can
get ahead of society. Then, at some point, you are risking a backlash."
Some critics worry that the procedure or Microsort may be shown to have
side effects.
The oldest child born after the preimplantation procedure is 14; so far,
the children studied have shown no ill effects, says Dr. Mark Hughes at
Genesis Genetics Institute in Michigan. No central registry tracks how
many such babies there are, says Hughes, who would like to see a
full-fledged U.S. study.
Even so, it would take a generation to get results, says Dr. Richard Scott
of Reproductive Medicine Associates in Morristown, N.J.
"Like all things in medicine, people who do it first assume a certain
amount of risk," he says.
Marcy Darnovsky is the associate director of the Center for Genetics and
Society, a nonprofit research and public-affairs organization in Oakland,
Calif. She says gender selection could lead to a "slippery slope" of
customizing offspring in more ways than just their gender.
Research has shown that taller people command more power and money, she
says. It also shows that, in our culture, if most people could choose,
they would have a son first, then a daughter, she says. "Experts fear we'd
be creating a nation of little sisters," Darnovsky says.
And because birth-order studies show first children are more successful,
could we be heading toward a nation of tall, powerful men and more docile
women? she asks. "This stuff is always full of unintended consequences."
Beth Whitehouse is a reporter for Newsday, a Tribune Publishing newspaper.
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