Gaining an Understanding of Gender Selection

If you are considering in vitro fertilization or IVF, you may already be familiar with gender selection. The procedure allows you to select the sex of your child through PGS/NGS testing. This is a new type of technology to test the chromosomes of your embryo to determine the sex. Your results are almost 100 percent accurate. Talking about gender selection is important to help you plan your family and avoid specific disorders linked to the sex of your child. The gender of your baby is known before you conceive.

There are many reasons to have this procedure including medical considerations. You may prefer one gender above the other. A good example is if you already have a boy, you may want to have a girl as well to balance your family. Certain diseases such as muscular dystrophy are linked to the sex of the child. Although this disease is passed on through the mother, it only affects male children. You can eliminate the potential for several diseases by choosing the sex of your baby. If you have suffered the loss of a child you may want another child of the same sex.

It may be as simple as being more equipped to raise a specific gender. Regardless of your reasons, IVF is an extremely personal choice. By discussing the procedure and your options with a fertility clinic or specialist you can determine what is best for your individual needs. This will help you to prepare to raise a child. Before proceeding, you need to understand how the procedure works, the success rate and the cost. Although this procedure is not right for everyone, it can make an incredible difference for the right person.

How Does Gender Selection Work?

There are two different methods most often used to select the gender of your baby. Only one of them is accepted all over the world and offered by reproductive medical facilities. You will most likely learn about alternative options such as diet. There is no scientific backing for these options and unless proven should not be seriously considered. The reason you are able to select the sex of your child is that men and women have different combinations of sex chromosomes. Men have an XY chromosome, while women have an XX chromosome pair.

The reason sperm can be chosen is due to the X or Y chromosome. When the embryo contains either an XY or XX chromosome pair, the sex of your child can be determined. There is more to gender selection than you may realize. The preferred method to choose the sex of your child is IVF combined with preimplantation genetic or embryo testing. You may have heard this referred to as PGS or PGD. Two chromosomes determine the sex of your baby. The collective term is the sex chromosome. Female eggs cells contain the X chromosome and male sperm an X or Y chromosome.

When sperm containing the X chromosome meets the egg of the mother, the embryo will be a female with the XX chromosome. When the egg cell of the woman is fertilized by a Y chromosome sperm, the baby will be a male with the XY chromosome. You are most likely already aware when you conceive naturally, there is a 50/50 chance you will have a boy or a girl. This means in order to determine the sex of your baby, the sperm selected must contain the Y chromosome and the embryo the XY chromosome. This is the only way to ensure you have a baby of your desired sex.

Sperm Sorting

The method used to sort sperm is called sperm sorting. The basis is slightly more DNA is contained in an X chromosome than a Y chromosome. The way sperm is sorted is dependent on the method used. Sometimes the DNA is marked using a fluorescent dye. A centrifuge machine can also be used for sorting. The theory is when sperm contains the X chromosome, accurate sorting can be assured by density. This means if a fluorescent dye is used, there will be a brighter shine to the sperm. When placed in a centrifuge, the sperm will be close to the bottom.

Theoretically speaking, this method is appropriate for intrauterine insemination or IUI. Although this method can be effective, studies have shown it is not reliable. If you are interested in a method with virtually 100 percent accuracy considered to be the most advanced, it is a combination of in vitro fertilization and preimplantation genetic testing. During this procedure, a small number of the cells located in the embryo are removed through in vitro fertilization. This takes place a few days after fertilization.

The cells are then sent to a genetics laboratory for chromosomal analysis. Once a biopsy has been completed, the embryos are frozen immediately until the genetic analysis results are available. Once the results are available, you must decide which embryo will be thawed for the frozen embryo transfer. Using this method allows you to select the sex of your baby with more than 99.99 percent accuracy.

Detailed In Vitro Fertilization Steps

To ensure accuracy, in vitro fertilization is necessary. This process is fairly intensive and needs to be taken seriously. Before you proceed, you should have a basic understanding of the process and what is necessary. Generally speaking, there are four main steps.

• Your first step is ovarian stimulation. This is when hormone-based medications are taken by the woman. The goal is to make the maximum number of fully developed and high-quality eggs.
• During the egg retrieval stage, the eggs are removed from the ovaries.
• Fertilization of your eggs takes place in an embryology lab, with three to seven days required for the development of the embryo.
• Your final step is embryo transfer. This is the procedure necessary to put the embryo back into the uterus of the intended parent.

Additional embryonic testing is required for gender selection. You need to allow several days to receive your results. In addition to mandating additional steps to test the embryos, two treatment cycles are necessary. During one cycle, the embryos are made and tested. The second cycle is the frozen embryo transfer cycle. This is when the uterus is prepared for the transfer of the frozen embryo. This part of your treatment is very similar to the treatment used to freeze your embryo.

In vitro fertilization is used to make your embryo before it can be frozen. Prior to being frozen, your embryo will be biopsied and sent to a laboratory to be tested.

Ovarian Stimulation

During ovarian stimulation, hormone-based medications are taken by the woman. The idea is to make as many high-quality, mature eggs as possible. In most cases, stimulation medications are taken during the second, third and fourth days of the female's natural menstrual cycle. The medication must be taken for a total of 10 days. The theory is when there are more eggs, additional embryos are created including those of the sex desired. This increases the chances of a live embryo birth of the desired sex.

Egg Retrieval

Egg retrieval is the surgical procedure necessary to harvest eggs from within the ovaries. You can expect this procedure to be performed approximately 12 days after taking stimulation medications. The actual length of time can vary according to your response to the medications and the development of the egg. Appointments will be made for bloodwork monitoring and ultrasounds to measure the process. When you consider the majority of surgeries, this procedure is fairly mild. You will not require general anesthesia, incisions or stitches.

This eliminates the need for a significant period of recovery. MAC anesthesia is used to place the patient under moderate sedation. An ultrasound is used to guide the respiratory needle through the vagina to the follicles located on the ovaries. Once the removal has been completed, the mature eggs and follicular fluid are contained in test tubes. These are immediately taken to the embryology laboratory.

The Embryology Lab

There are several main steps taking place at the embryology lab.

Isolation:

Once the eggs have been received by the lab, the follicular fluid is searched by an embryologist. Any eggs located are then isolated. The eggs are placed immediately into a nourishing media simulating the environment of the fallopian tube.

Fertilization:

Roughly four hours after the retrieval is completed, the embryos are fertilized. This is accomplished through either conventional fertilization methods or ICSI or intracytoplasmic sperm injection. This is a type of specialized in vitro fertilization.

Embryo Development:

Once fertilization is complete, the embryos are grown in a laboratory for between five and seven days. During a standard IVF cycle, embryos can be transferred after just three days during a stage of development referred to as clevage. It is only possible to conduct genetic testing on blastocyst embryos. The development generally occurs on the fifth day but can develop a little later as well.

Embryo Biopsy:

When the embryo reaches the blastocyst stage, it contains two different kinds of embryonic tissue. One of these cell groupings becomes the fetus, with the other becoming the placenta. A focused and highly specialized laser is used to perform the biopsy. During this procedure, only three to six cells are removed from the cell grouping becoming the placenta. This is referred to as the trophectoderm. The next step is quickly labelling, processing and shipping the cells to a third-party genetics laboratory to be analysed.

Embryo Freezing:

After completion of the biopsy procedure, the embryo is flash-frozen or vitrified by the embryologist. This preserves the embryo in an almost identical state to a fresh embryo. The reason your embryos are frozen is to allow enough time for genetic testing results. This has virtually no impact on your embryo quality or your chances of a successful transfer. Some evidence has suggested a frozen embryo transfer significantly increases the chances of success when undergoing in vitro fertilization.

Genetic Testing:

A third-party lab will perform your actual genetics tests. The technique used is called PGT-A or preimplantation genetic testing for Aneuploidies. This test analyses the type and number of chromosomes found in each cell. Once your chromosomal analysis has been completed, specific embryo cell groupings are labelled as XX or XY. Other basic information is included regarding the number of chromosomes contained in each cell.

This information allows you to begin preparing for your frozen embryo transfer. A thawed embryo is used with your desire sex. Having a frozen embryo transfer is a lot simpler than your first IVF cycle phase because this procedure only includes two basic steps.

1. Uterine Lining Development:

During an IVF embryo transfer, ensuring the uterus is prepared optimally for the embryo implant into the lining of the uterus or the endometrial lining is extremely important. Although a frozen embryo transplant is possible without any medications, the medical community highly advises progesterone and estrogen for the woman for a specific time period both before and after the embryo has been transferred.

2. Frozen Embryo Transfer:

An embryo transfer requires genetically tested embryos for the gender to be determined. An embryo confirmed to be your desired sex is removed from cryo-tanks. The tanks contain liquid nitrogen. After your embryo has been thawed, it is loaded into a transfer catheter of a medical-grade and passes through the cervix and vagina to reach the uterus prior to being expelled. The parent is now considered pregnant. The growth of the embryo results in a foetus with the desired sex of the parents.

The Costs of Gender Selection

There is a lot of variation in cost due to the different fees involved. Your average cost in Northern Cyprus is about EUR 6000. This can increase or decrease depending on the country you are living in. The fees to determine the sex of your baby are divided sometimes into two different categories. The first are fees for a fertility clinic biopsy. You pay this fee to have your embryonic tissue biopsy prepared then sent to a genetics laboratory to be analysed. The genetic lab is your second fee. You must pay to have your embryonic cells tested to determine the sex of the individual embryos.

If you decide to have in vitro fertilization, the cost varies and includes several components. The components required for the procedure are detailed below.

Monitoring:

This process observes the egg and follicular development while in vitro fertilization is taking place to make certain your procedure is properly timed and safe.

Base IVF:

The majority of your expenses related to the procedure are included in a base in vitro fertilization package.

Frozen Embryo Transfer:

This is a specific kind of embryo transfer. The embryos you have had frozen are transferred to the uterus of the woman once thawed. The embryos need to be frozen due to the length of time necessary to receive genetic testing results. Your results show the sex of your embryos. Once you have your results, your embryo is thawed and transferred.

Medications:

Medications are required for the woman for the production of multiple eggs. The more eggs you have, the greater the chance one of them will be the sex you desire whether male or female.

You may be charged an additional fee by some facilities including ICSI or intracytoplasmic sperm injection. This procedure is necessary for many women.

Once all of the separate charges are totaled, your cost is generally between EUR 6000 - 10'000 per cycle in Europe and USA USD 27'000+. This depends on the facility, lab, country and procedures performed.

Ethical Considerations

There are ethical concerns regarding gender selection. One of the most common is what happens to the embryos you do not use. Regardless of the type of procedure, this has always been an ethical dilemma. If you decide to have in vitro fertilization, you must decide what will happen to your unused frozen embryos before beginning the process. One of your options is keeping your extra embryos frozen in case you decide to extend your family in the future. You can also donate them to another couple, to research or ensure they are nonviable by allowing them to be thawed.

One of the most common recommendations is donating them to another couple. Keep in mind, whatever you decide to do is your choice alone. If you decide to donate your embryos, the couple may reimburse a portion of your in vitro fertilization expenses. Preimplantation gender screening is another social concern due to the history of both India and China. Until 2015, China enforced a rule limiting couples to just one child for 35 years. Many couples decided on abortion when learning the pregnancy was female. The result is an imbalanced population.

There are no longer enough women in China for the men to marry. This does not mean choosing the sex of a baby will result in a gender imbalance in the country, but the potential should be considered. Another concern is gender devaluation. Some people believe if the gender of a child can be chosen, one sex will be preferable over the other. According to a recent study, parents choosing one sex over another are not sexist and do place more value on one sex. According to psychologists, there are substantial differences between raising male and female children.

This means many couples want the opportunity to raise a male and female child. Gender selection often becomes a consideration after a couple has two or three children of the same sex. Many consider the final ethical dilemma preposterous. Others believe in the future, genetic screening has the potential for abuse. The theory is as science advances and technology continues to develop, it may become possible for specific physical characteristics to be detected.

This could mean children are chosen according to hair or eye color resulting in designer babies. At this point in time, no technology has been developed or is in known development to make this practice possible. It is not possible to identify a specific gene for artistic or musical talent or athletic ability.

Most Common IVF Questions for Discussion

Q: What is in vitro fertilization and how does the process work?

A: IVF is the most common and effective practice for infertility treatment across the globe. In addition to being an option for gender selection, this procedure is performed when a woman is unable to conceive with standard methods.

Q: Is in vitro fertilization painful?

A: No, but you may feel a little minor discomfort during one of the steps necessary for the procedure. Experiencing anything more than minor discomfort is rare. The majority of medications for fertility are administered with an injection. Due to advancements in technology, these injections are much easier to administer than those given just a few years ago. You should not experience any pain during egg retrieval either. Your eggs are removed from your ovaries during a surgical procedure. The needle used is very small, goes through the top of your vagina and into your ovaries.

Both your IV and sedation will be monitored extremely closely by an anaesthesiologist. The entire procedure requires 30 minutes or less and you should not feel any discomfort or pain. During the day of your procedure, you may experience a little minor cramping. In most cases, any cramps are gone the next day. There is a possibility you will experience some pressure or fullness because your ovaries are expanded due to ovarian stimulation. This can last for several weeks.

A thin, flexible and very soft catheter is used to transfer the embryo directly into your uterus. You will receive an abdominal ultrasound to make certain the embryo is placed in the best possible location by the tip of the catheter. This ensures your embryo has been implanted correctly. It is rare to experience any discomfort or pain during this procedure. Many women have compared the way it feels to getting a pap smear.

Q: How much time is necessary to become pregnant with in vitro fertilization?

A: You need to allow approximately two months to complete an in vitro fertilization cycle. Younger women below the age of 35 generally become pregnant with only one egg retrieval cycle and embryo transfer. Unfortunately, there is no way to guarantee how long it will take for you to become pregnant. If you are not pregnant with the sex of your choice after your first cycle, the chances are good you will be successful after one or two more cycles.

You have to consider a lot of different factors to determine your chances of becoming pregnant. This is the reason understanding the procedure and asking questions are so important. Every facility has a slightly different success rate. Part of this is attributed to patient characteristics, age and individual patient care. Prior to choosing the right facility for your needs, you should consider when the facility was established, the experience of the staff, whether or not your question have been answered to your satisfaction and if you feel comfortable.

The Bottom Line

One of the most important choices you can make is whether or not you want to select the gender of your child. The other is if you want IVF as part of the process. Although there are a lot of good reasons to desire one sex over the other, you should not make any decision lightly. Before you make a final decision, it is a good idea to consider the pros and cons.

The pros include

The Ability To Plan Your Family:

You may only want a specific number of children or you're firstborn to be of a certain gender. When you have the ability to select the gender, you are able to plan your family.

Genetic Disorders:

You may have a history of gender-specific medical conditions in your family that can be passed on to your children. By selecting the gender of your baby, you can eliminate the possibility of passing down these types of conditions.

Taking Care of Your Children:

You may only want to have one or two children to make certain you have the capacity and finances to raise them properly and ensure they receive a good education. In this instance, you may want one child of each sex or just one child of a specific sex.

Preferred Genders:

If you have a preference for one gender over the other, choosing the sex of your child makes sense. If you already have several children of the same sex, it is only natural to want to have a child of the opposite sex. When you are content with the gender of your children, you will receive more enjoyment raising them resulting in a much happier family.

Preparing For a New Baby:

Knowing the gender of your child in advance allows you to prepare better. You know how you want your nursery decorated, which color scheme you prefer to use and the type of clothing you need to purchase. If you already have a child of the same gender, you can keep their old clothing and toys to pass down to your new baby.

The Loss of a Child:

If you have suffered the loss of a child, having another baby of the same gender can help with your recovery. Although nothing can take the place of a lost child, a baby of the same sex often decreases grief and gives you the ability to move forward with your life.

The cons include

Ethics and Morals:

Some people believe choosing the sex of a child breaches morals and ethics. You must decide if you share this belief before you proceed.

Considering the Future:

You need to consider that having a child of your desired sex does not mean everything will work out exactly the way you planned. If you want a boy because you are interested in sports, he may not be athletic. By the same token, some girls excel in sports and athletic abilities.

The Expense:

One of the biggest drawbacks to choosing the sex of your child is the expense. You must have the finances necessary to complete the procedure and raise your child.