What is the appropriate response to a couple undergoing In Vitro Fertilization (IVF) who request gender selection for a baby boy?

Gender Selection for Non-Medical Reasons in IVF

You should decline to perform non-medical sex selection and explain that this practice is ethically controversial and not supported by major reproductive medicine guidelines for social preferences alone.

Ethical Framework and Professional Guidance

The most recent guideline from the American Society for Reproductive Medicine (ASRM) explicitly states that practitioners are under no ethical obligation to provide nonmedically-indicated sex selection 1. Multiple international normative documents argue against social sex selection, citing concerns about gender discrimination, preference for male offspring, and eugenic implications 2.

Key Ethical Concerns

The practice of selecting embryo sex for social reasons raises several fundamental issues:

• Gender discrimination: Social sex selection can encourage gender bias and preference for male offspring, particularly in cultures with strong gender preferences 2, 3
• Child welfare: Selection based on sex alone may affect expectations placed on the child and limit their open future 2
• Societal impact: Widespread use could affect population sex ratios and reinforce gender stereotypes 3
• Resource allocation: Using expensive reproductive technology for social preferences rather than medical needs raises justice concerns 4, 3

Appropriate Clinical Response

Your response should be Option A with additional counseling: Explain that non-medical sex selection is not offered at your facility due to ethical concerns, and provide comprehensive genetic counseling about appropriate uses of preimplantation genetic testing.

What to Communicate to the Couple

• Preimplantation genetic testing (PGT) is ethically justified for preventing serious sex-linked genetic diseases, not for social preferences 2, 1
• Many professional societies and countries have policies restricting or prohibiting non-medical sex selection 2
• The couple should understand that sex selection for family balancing or cultural preferences does not meet medical criteria for PGT 2

Counseling Approach

Provide non-advocacy counseling that respects reproductive autonomy while explaining limitations 2:

• Acknowledge their request and desire for a male child
• Explain that PGT technology is reserved for medical indications, particularly prevention of serious genetic diseases 2
• Discuss that selecting against healthy embryos based solely on sex would involve discarding viable embryos without medical justification 2
• Inform them that this is not a legal issue in most jurisdictions but rather an ethical policy decision by the clinic and professional societies 1

Medical Indications Where Sex Selection IS Appropriate

Sex selection through PGT is ethically acceptable in specific medical contexts 2:

• X-linked genetic diseases: Selecting male embryos to avoid transmission of serious X-linked conditions (e.g., Duchenne muscular dystrophy, hemophilia) 2
• Mitochondrial DNA disorders: Transferring only male embryos to prevent transgenerational transmission of maternal mitochondrial disease 2
• Sex-linked cancer predisposition: In rare cases where sex significantly affects disease penetrance 2

Why Referral (Option B) Is Inappropriate

Simply referring to another facility without explanation:

• Abdicates your professional responsibility to provide ethical guidance 2
• May give false hope that another facility will perform the procedure
• Misses the opportunity for proper genetic counseling about appropriate reproductive options 2
• Does not address the couple's underlying concerns or provide education

Documentation and Policy

• Clinics should have clear written policies regarding sex selection that are made available to patients 1
• Document the counseling session thoroughly, including the couple's request and your explanation of clinic policy 2
• Ensure informed consent processes protect couples from feeling pressured and fully explain limitations of PGT technology 2

Common Pitfalls to Avoid

• Don't simply state "it's illegal" unless it actually is in your jurisdiction—in many places it's a matter of professional ethics and clinic policy, not law 1
• Don't be judgmental about cultural or personal preferences, but remain firm on ethical boundaries 2
• Don't offer false hope by suggesting they might find another provider willing to do this, as most reputable centers follow similar ethical guidelines 2, 1
• Don't forget that couples undergoing IVF are emotionally and financially vulnerable and require sensitive, comprehensive counseling 2