Preimplantation sex selection demand and preferences among infertility patients in Midwestern United States

Abstract

Purpose To determine the demand and preferences of infertility patients for sex selection for nonmedical reasons, and to investigate the relation between these choices and their demographic and socioeconomic characteristics. Methods A cross-sectional, self-administered survey by mail was conducted at a University hospital-based fertility center of 1,350 consecutive women who presented for infertility care, to assess patient demand and preferences for sex selection. Results Of respondents, 49% wanted to select the sex of their next child for no added cost. Of these patients, 56% had no living children and 37% had children all of one sex. After adjustment for observed predictors of gender preference, we found a significant preference for a female child among women who had only sons, had more living children, or were single. Nulliparous women did not significantly prefer one sex over the other. Among parous women, those with only daughters significantly desired to select a male child, whereas those with sons significantly desired to select a female child. Conclusion There is significant demand among infertility patients for preimplantation sex selection, with a significant portion of this demand coming from patients who do not have any children or have children all of one sex.

A systematic review exploring the patient decision‐making factors and attitudes towards pre‐implantation genetic testing for aneuploidy and gender selection

“…23,24 Organizations such as the American College of Obstetrics and Gynecologists (ACOG) have issued statements suggesting gender selection is an inappropriate use of medical resources and perpetuates gender bias. 25 Despite this opposition the use of PGT for sex selection is legal in a diverse number of countries, including USA, Mexico, Thailand and Italy. Indeed, in these countries the use of embryo testing for sex selection is on the increase, with the Society of Assisted Reproductive Technology (SART) reporting that the use of PGT for gender selection in the USA increased from 9% of PGT cycles in 2005 to 22% in 2008.…”

The Israeli National Committee for sex selection by pre-implantation genetic diagnosis: a novel approach (2005–2011)

“…In an attempt to evaluate possible demographic and social implications for the balance between sexes in the event of freer and greater use of existing technologies, many studies around the world deal with the identification and analysis of trends in favoring the sex of offspring [ 1 , 18 , 23 – 25 ] and note obstetric and socioeconomic background variables as being associated with it. Regarding the former, about one-fifth of the applicants in the present study would have had to undergo IVF for other medical reasons, and might have expected this to enable their eligibility, but this did not guarantee approval of PGD.…”

“…Family size and composition have been considered a major motivator for sex-selection. Many studies, including studies in Israel [ 28 , 29 ], have indicated that in families where there are children of a single sex, and especially in cases of at least three of the same sex, there is clear preference for the other sex [ 1 , 23 – 25 , 30 , 31 ] The association between family composition and preference for offspring’s sex is not surprising given the ongoing trend of declining total fertility rate in Western countries [ 32 ], as well as in Israel [ 33 ]. An Israeli study regarding attitudes towards PGD included a survey among a population of married couples of reproductive age who were parents to at least two children of only one sex [ 29 ].…”

“…Parental age, particularly advanced maternal age and approaching menopause, has been related to a desire to proactively select the offspring’s sex [ 23 , 24 ], Among the couples in this study, maternal age or having had repeated Cesarean section deliveries (making additional deliveries risky) were noted in almost half of the requests, and most of those who reached the Committee’s decision stage with this noted as their primary reason were rejected. Among fertility clinics in the U.S., the necessity for the woman to undergo IVF or PGD for non-sex-linked medical or genetic reasons has been found to be a factor that strengthens the preference and willingness to conduct additional PGD for sex selection [ 23 ]. However, a study conducted on couples undergoing fertility treatments in Germany found that 90% of respondents ruled out the possibility of using PGD for sex selection for non-medical reasons even if the technology would be accessible to all [ 36 ].…”

Parenting in the Age of Preimplantation Gene Editing

“…It was widely assumed that the male, via his sperm, was solely responsible for the characteristics of the resulting child, and women were valued predominantly for their ability to deliver children, specifically, male children. In contrast, an American study found that patients undergoing fertility treatment expressed a slight preference for female offspring . One must be careful, nonetheless, to realize that the pursuit of information regarding fertility and the fetus is often not benign, being entrenched in a system of female oppression and marginalization.…”