Abstract and Introduction
Abstract
This Task Force document revisits the debate about the ethics of sex selection for non-medical reasons in the light of relevant new technological developments. First, as a result of improvement of the Microsort® flow cytometry method, there is now a proven technique for preconception sex selection that can be combined both with IVF and IUI. Secondly, the scenario where new approaches that are currently being developed for preimplantation genetic screening (PGS) may lead to such screening becoming a routine part of all IVF treatment. In that scenario professionals will more often be confronted with parental requests for transfer of an embryo of a specific sex. Thirdly, the recent development of non-invasive prenatal testing based on cell-free fetal DNA in maternal plasma allows for easy and safe sex determination in the early stages of pregnancy. While stressing the new urgency that these developments give to the debate, the Task Force did not come to a unanimous position with regard to the acceptability of sex selection for non-medical reasons in the context of assisted reproduction. Whereas some think maintaining the current ban is the best approach, others are in favour of allowing sex selection for non-medical reasons under conditions that take account of societal concerns about the possible impact of the practice. By presenting these positions, the document reflects the different views about this issue that also exist in the field. Specific recommendations include the need for a wider delineation of accepted 'medical reasons' than in terms of avoiding a serious sex-linked disorder, and for a clarification of the legal position with regard to answering parental requests for 'additional sex selection' in the context of medically indicated preimplantation genetic diagnosis, or routine PGS.
Introduction
Sex selection can be performed at three stages: preconception (selective fertilization with enriched fractions of X- or Y-bearing sperm), preimplantation (selective transfer of male or female embryos) and prenatal (sex-selective abortion). Sex selection for medical reasons (to avoid the transmission of disease to a next generation) is widely regarded as acceptable. However, sex selection for non-medical reasons (because of a sex preference that the prospective parents would want to see fulfilled) has been the subject of recurrent ethical and public policy debate in many countries. The Task Force has briefly discussed this issue in its earlier document on preimplantation genetic diagnosis (PGD) (Shenfield et al., 2003). This new document revisits the debate about allowing or not allowing sex selection for non-medical reasons in the light of recent technological developments.