Gender by Design: Not Yet Ready for Prime Time

As someone who grew up in the 1960s, I deplore the idea that we now have technologies available to help couples select baby boys as their firstborn. I agree with John Robertson's argument that preconception sex selection (PSS) through the use of sex chromosome separation by flow cytometry only serves to reinforce sexism, while moving us one step closer to genetically engineered offspring, not to mention the potential for upsetting the sex ratio imbalance of society in general (Robertson 2001). But I also agree with him that it would be nearly impossible to outlaw this technology despite its potential social harms, given the widespread acceptance of other reproductive technologies and prenatal screening as ways to use genetic knowledge to have healthy, wanted offspring.

So what to do about this kind of reprogenetic techno-creep that's blurring the bioethical boundaries? Robertson contends that until we have hard evidence that such parental control over offspring gender is harmful to the children (and he thinks the risk of such harm is slight), we should proceed cautiously with modest regulations and minimal government oversight.

I take issue with his arguments on several points. First, we may know more than we think we know about health and behavior risks to children who are of the wanted and unwanted gender based on available epidemiological studies of planned pregnancies and birth order in naturally procreated families. For example, a comparison of individuals born fourth in a family with three other boys and those born fourth in a family with three other girls could serve as a reasonable starting point for extrapolating the impact of preferred sex, all things being equal. Mining this data for clues about how parents and children behave when gender wishes are fulfilled or disappointed could generate important information needed for the counseling and informed-consent policies that Robertson recommends to offset possible harms of PSS. Is it really possible to counsel a couple in advance to commit to the same degree of love and devotion to a child they would never have conceived except for a genetic mistake?

Second, given the still unacceptably high failure rate of PSS to ensure firstborn males (28%), the risk is greater that childbearing women and female offspring (as the unwanted gender) will suffer disproportionate consequences of the failed procedure compared to males. As an extreme example, I offer the following personal experience. In the 1980s, as a budding women's health researcher, I had the opportunity to follow the pregnancies of some of the first paid surrogate mothers in the United States (Reame and Parker 1990). In this capacity I witnessed the sad outcome of a failed gender-selection procedure performed to produce Y chromosome-enriched sperm through the "swim-up" technique. In this case, a nineteen-year-old woman contracted with a single man to undergo insemination after PSS and bear a healthy son for a fee of $10,000. The man, a twice-divorced professional with only daughters, was a member of an ethnic group that highly prizes sons. Unfortunately, the young woman gave birth to the man's third daughter, who was promptly turned over to his married sister to raise. I often wonder how this child, now approaching 20 years of age, has been shaped by the fate of her unfortunate birth arrangement. The young surrogate experienced multiple episodes of postpartum depression and subsequently volunteered for a second unpaid surrogate pregnancy with a different contracting party in an effort to overcome her sense of guilt and failure.

And that brings me to my third concern. Robertson predicts that the groups of individuals most attracted to PSS will be couples wishing for gender "diversity" in their families or those with a strong gender preference for their firstborn. I would also nominate individuals undergoing assisted reproduction, namely infertile couples, gay couples and single women seeking to postpone biological parenthood. For these persons, who have already committed to the invasive, expensive arrays of assisted reproductive technologies (ART), the additional $1,500 fee for ensuring an X or Y chromosome-enriched sperm specimen pales against the vast sums required...