<http://www.washingtonpost.com/wp-dyn/articles/A62067-2004Dec13.html?referrer=email>http://www.washingtonpost.com/wp-dyn/articles/A62067-2004Dec13.html?referrer=email
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A Boy for You, a Girl for Me: Technology Allows Choice
Embryo Screening Stirs Ethics Debate
By Rob Stein
Washington Post Staff Writer
Tuesday, December 14, 2004; Page A01
Kristen and John Magill adore all three of their daughters -- 11-year-old
twins and a 5-year-old baby sister. But when they began to plan for their
next -- and last -- child, the Magills really wanted a boy.
"My husband is a 'Junior' and has a family business that he wants to
continue in the family name," said Kristen, 37, of Grafton, Mass.
So the Magills combined a family trip to Disneyland in August with a stop
at a Los Angeles fertility clinic that enables couples to pick the sex of
their babies. Kristen is now expecting twin boys.
"I'm excited," she said. "We always wanted a boy. We really wanted just
one, but we'll be happy with two."
The Magills are part of a small but growing number of Americans who are
selecting the sex of their children, using techniques developed to help
couples who are infertile or at risk for having babies with genetic diseases.
In addition to the standard in vitro fertilization procedure that Kristen
underwent, a Fairfax clinic is testing another approach that can sort
sperm by sex -- an easier and far less expensive method, albeit not quite
as reliable.
The doctors offering the services, as well as some medical ethicists who
defend them, argue the procedures make it possible for parents to fulfill
a natural desire, harm no one, and enhance the joys of parenthood and
family life.
"These are grown-up people expressing their reproductive choices. We
cherish that in the United States," said Jeffrey Steinberg, director of
the Fertility Institutes, which offers the service at clinics in Los
Angeles and Las Vegas. "These people are really happy when they get what
they want. These are heartwarming stories."
But others say the practice, which is prohibited in many countries, uses
expensive medical care for frivolous purposes, destroys some embryos just
because they are the "wrong" sex, and promotes gender discrimination.
Moreover, the critics say, the trend is a dangerous first step toward
transforming childbirth from a natural process full of surprise and wonder
into just another commodity in which a baby's features are picked like
options on a new car.
"It runs the risk of turning procreation and parenting into an extension
of the consumer society," said Michael J. Sandel, a political philosopher
at Harvard University. "Sex selection is one step down the road to
designer children, in which parents would choose not only the sex of their
child but also conceivably the height, hair color, eye color, and
ultimately, perhaps, IQ, athletic prowess and musical ability. It's
troubling."
For generations, people who wanted to choose their child's sex resorted,
fruitlessly, to old wives' tales and folklore, such as the belief that
eating more salty food or meat raises the odds of having a boy. But
techniques developed to help infertile couples and to weed out genetic
diseases have changed that -- the same procedures used to make sure an
embryo is healthy can be used to determine its sex.
So far, most of the couples doing this either suffer from infertility or
want to avoid passing on devastating genetic diseases, primarily ailments
such as muscular dystrophy that afflict boys more often than girls. Only
those who oppose creating embryos in the laboratory for any reason object
to sex selection in such cases.
But a small number of clinics have begun offering the procedures to
couples with no medical reasons -- who simply want to do the kind of
"family balancing" the Magills sought or to plan the birth order of their
children.
"The overwhelming number of couples who come in for this are couples who
have three, four, five children in one gender and come to us and say,
'Will you guarantee us the opposite?' " said Norbert Gleicher, medical
director of the Center for Human Reproduction, which has clinics in the
New York and Chicago areas. "Why shouldn't patients have the right to
choose this? It's one of the most basic rights in our society that we can
build our families the way we wish."
The IVF procedure, which costs about $10,000 to $20,000, requires women to
get hormone shots so doctors can retrieve eggs for fertilization in the
laboratory. The lab harmlessly removes a single cell from 3-day-old,
eight-cell embryos to test them. Only embryos of the desired sex are
implanted into the womb. The process is almost infallible for picking sex
and has the same overall success rate for producing a baby as standard IVF.
This approach, called PGD from its original use for "preimplantation
genetic diagnosis," has been largely banned for nonmedical use in a number
of countries, including Australia, Britain, Canada, France, Germany,
India, Japan and Switzerland. In the United States, most fertility doctors
say they refuse to do the procedure except for medical problems.
"My job is to help people make healthy babies, not help people design
their babies. Gender is not a disease," said Ralph R. Kazer, a
Northwestern University fertility doctor. "We would rather spend our time
helping people who want to have babies who can't have babies."
With scientists rapidly identifying genes for various human traits, the
potential for tailoring children in many other ways is becoming
increasingly possible, critics say.
"It is the first step towards the concept of a designer baby," said George
Annas, a Boston University bioethicist. "If you don't draw the line at
disease, where do you draw the line? If gender is okay, it's hard to say
any other characteristic we might be able to select in the future is
off-limits."
But the doctors doing the procedures and independent experts say science
is not even close to allowing parents to pick other traits -- and in all
likelihood never will be.
"The overall concern that we have one foot over the edge of the slippery
slope is overstated because of the limited role that individual genes play
in complex human traits," said Kathy Hudson, director of the Genetics and
Public Policy Center at Johns Hopkins University. "There are real
biological limits to how much control you can have over the
characteristics of your offspring."
Nevertheless, research that her center will release next month found 60
percent of Americans are uncomfortable with sex selection for nonmedical
reasons. "The use of a technology to fulfill parental desires is viewed as
vain, capricious and frivolous," Hudson said.
The sperm-sorting approach being tested by the Genetics & IVF Institute of
Fairfax sidesteps some of these concerns because it does not require
scientists to create embryos in the lab and the process can select no
traits other than sex.
Originally developed for livestock breeding, the MicroSort technique can
sort male-producing sperm from female-producing sperm because the latter
carries slightly more DNA. A woman can then be artificially inseminated
with the sperm for the sex she wants.
The clinic is offering the procedure -- for about $2,800 to $4,000 per
attempt -- at its Northern Virginia headquarters and a new center in
Laguna Hills, Calif., for a study aimed at winning Food and Drug
Administration approval. Several thousand couples have used it and more
than 400 babies have been born, producing boys with about 75 percent
accuracy and girls with 90 percent, said David Karabinus, scientific
director of the MicroSort unit.
"For someone that really has a desire for that little girl or that little
boy . . . this is a very, very important and useful technology," he said.
But critics say both techniques allow parents to discriminate on the basis
of sex, and they point to countries such as India and China, where a
preference for boys has led to abortion of female fetuses and abandonment
of baby girls, creating a shortage of women.
"It is clear that sex selection targets women," said Alfonso Gomez-Lobo, a
philosophy professor at Georgetown University. "From an ethical point of
view, all of this is quite unacceptable."
Because MicroSort is not 100 percent reliable, critics fear it may lead to
the selective abortion of fetuses, particularly females.
"If you ask couples coming in what they will do if they get the wrong sex,
these couples say very frankly they will terminate the pregnancy," said
Mark V. Sauer, director of the division of reproductive endocrinology at
Columbia University. "I don't want to be a party to that."
Proponents counter that there is no bias against girls in the United
States. In fact, American couples are just as likely, if not more likely,
to want a girl.
"We get roughly the same number of parents coming in who will request a
boy as will request a girl," said David L. Hill, scientific director of
the ART Reproductive Center in Beverly Hills, Calif. "It's not as if
everyone is coming in wanting a male."
At MicroSort, 75 percent of parents have been seeking girls, Karabinus
said.
Still, concern remains about the possibility of more subtle, emotional
consequences. What happens in cases where, after paying thousands of
dollars and suffering months of discomfort and inconvenience, parents are
bitterly disappointed by a baby of the "wrong" sex?
"Consider the father who wants a boy in the hope of having as a son the
athlete he had never been. Suppose the son isn't really interested in
sports," Sandel said. "What sorts of expectations will burden a child who
was designed with certain purposes in mind?"
These kinds of questions raise fears that the increasing ability to
control and commercialize childbearing will fundamentally transform parenting.
"This is . . . a threat to the core value of parenthood that is usually
expressed by the commitment to unconditional love," Gomez-Lobo said. "Our
children should not be the result of our desires. We should love them as
they are, not as we wanted them to be."
For their part, the Magills are looking forward to introducing their
daughters to their little brothers.
"It's a good thing this is out there and available," Kristen said. "I
don't think it's for everybody -- it takes money and patience and
everything. But we felt like it was worth it. I'm sure having boys will be
a different experience."
© 2004 The Washington Post Company
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