BACKGROUND: Preconception sex selection for non-medical reasons raises serious moral, legal and social issues. The main concern is based on the assumption that a freely available service for sex selection will distort the natural sex ratio and lead to a severe gender imbalance. However, for a severe gender imbalance to happen, at least two conditions have to be met. First, there must be a signi®cant preference for children of a particular sex, and second, there must be a considerable demand for preconception sex selection. To ascertain whether or not these two conditions are met, we have conducted a survey in Germany. METHODS: As a representative sample of the German population, 1094 men and women aged 18±45 years were asked about their gender preferences and whether or not they could imagine selecting the sex of their children through ¯ow cytometric separation of X-and Y-bearing sperm followed by intrauterine insemination. RESULTS: 58% of respondents stated that they do not care about the sex of their offspring. 30% wish to have a family with an equal number of boys and girls. 4% would like to have more boys than girls, 3% more girls than boys, 1% only boys and 1% only girls. For ®rst-borns, however, there is still a preference for boys over girls. While 75.6% claimed to have no gender preference, 14.2% would like their ®rst child to be a boy and 10.1% would like their ®rst child to be a girl. Whereas 6% could imagine taking advantage of preconception sex selection, 92% found this to be out of the question. Even in the hypothetical case that a medication for sex selection were ever to become available, 90% stated that they would not want to use it. CONCLUSION: Given that a majority does not seem to care about the sex of their offspring and only a minority seem to be willing to select the sex of their children, a freely available service for preconception sex selection for non-medical reasons is rather unlikely to cause a severe gender imbalance in Germany.

Objective: Preconception sex selection for nonmedical reasons raises important moral, legal, and social issues. The main concern is based upon the assumption that a widely available service for sex selection will lead to a socially disruptive imbalance of the sexes. For a severe sex ratio distortion to occur, however, at least two conditions have to be met. First, there must be a significant preference for children of a particular sex, and second, there must be a considerable interest in employing sex selection technology. Our objective was to ascertain such demand and preferences among the United States general population. Design: Cross-sectional web-based survey. Setting: United States general population. Patient(s):One thousand one hundred ninety-seven men and women aged 18 to 45 years. Intervention(s): None. Main Outcome Measure(s): Web-based questionnaire assessing preferences for sex of children and demand for preconception sex selection for nonmedical reasons. Result(s):Eight percent of respondents would use preconception sex selection technology, 74% were opposed, and 18% were undecided. If the sex selection process was simplified to taking a pill, 18% would be willing to use such a medication, 59% were opposed, and 22% were undecided. In terms of gender choices, 39% of respondents would like their first child to be a son, 19% would like their first child to be a daughter, and 42% had no preference. Overall, 50% wished to have a family with an equal number of boys and girls, 7% with more boys than girls, 6% with more girls than boys, 5% with only boys, 4% with only girls, and 27% had no preference. Conclusion(s): Preconception sex selection technology via sperm separation is unlikely to be used by the majority of the United States population and is unlikely to have a significant impact on the natural sex ratio. (Fertil Steril 2006;85:468 -73.

Preconception sex selection for non-medical reasons raises serious moral, legal and social issues. The main concerns include the threat of a sex ratio distortion due to a common preference for boys over girls, the charge of sexism, the danger of reinforcing gender stereotypical behaviour in sex selected children, and the fear of a slippery slope towards creating designer babies. This paper endeavours to show that none of the objections to preconception sex selection is conclusive and that there is no justification for denying parents the right to choose the sex of their prospective children.

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In its recently published report 'Sex Selection: Options for Regulation', the Human Fertilisation and Embryology Authority (HFEA) concluded that sex selection for non-medical reasons should not be permitted in the United Kingdom. The HFEA's recommendation to ban sex selection for any but the most serious of medical reasons clearly reflects the majority view of UK citizens. Notwithstanding the general moral consensus against non-medical sex selection, the HFEA's approach to social policy needs to be criticised for betraying the commonly held presumption in favour of liberty.

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BACKGROUND: In its recent report 'Human Reproductive Technologies and the Law', the House of Commons' Select Committee on Science and Technology called for greater efforts to establish the potential demographic impact of sex selection across all sectors of UK society. Given the well-known preference for boys over girls among some communities, there is concern that a readily available service for social sex selection may upset the balance of the sexes. Of particular interest are the gender preferences and the demand for sex selection among Pakistanis. METHODS: We conducted a social survey on gender preferences and potential demand for preconception sex selection among 301 pregnant women in Karachi, Pakistan, using a self-report questionnaire consisting of 14 questions. RESULTS: About 41.5% wish to have a family with an equal number of boys and girls; 3.3% would like to have only boys, 1.0% only girls, 27.6% more boys than girls and 4.3% more girls than boys, and 22.3% stated that they do not care about the sex composition of their family. Whereas 6.3% could imagine employing cytometric sperm separation for social sex selection, 76.1% could not and 17.6% were undecided. About 27.2% felt that social sex selection ought to be legal, 48.8% thought it ought to be illegal and 23.9% were undecided. CONCLUSIONS: Although Pakistani women do show a statistically significant preference for boys over girls, the number of women willing to subject themselves to cytometric sperm separation appears to be too small to cause a severe imbalance of the sexes. However, further research among British citizens of Pakistani origin is needed to establish whether sex selection poses a serious threat to the sex ratio of UK communities.