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Choose Your Baby's Gender

Clinics Around the Country Starting to Offer Gender Selection; Ethical Questions Abound

BY ROBERT KUMPEL

Self-described as the largest gender-selection program in the world, The Fertility Institutes, led by Dr. Jeffrey Steinberg, uses in-vitro fertilization to deliver made-to-order babies for parents who don't want to leave anything to chance. "If they want a boy, we give them only boys, and if they want a girl, we give them only girls. It's got to work. We're coming up on 2,500 cases and it's never gone wrong."

Steinberg, 54, operates clinics in Los Angeles, Las Vegas, Guadalajara, and is preparing to open in Manhattan. After his fellowship at Unive, Steinberg applied his obstetric and gynecological know-how to modern genetic technology to give parents what they wanted. "We know of course that sperm makes the difference. Men carry half X and half Y sperm and women carry only X eggs, so it's the guy that determines the gender. We've been doing gender selection for over 50 years, and for 45 years it was worthless. All the efforts until about five or six years ago have been towards trying to separate out the sperm so that if you get the right sex sperm, you get the right sex baby. But the results were really marginal."

The biggest change came eight years ago when MicroSort, a genetic engineering process for developing superior farm animals, was licensed by the U.S. department of agriculture. Using technology which allows "sorting" by separating Y and X chromosome-bearing sperm, Steinberg greatly increased the probability of gender selection for his in-vitro-fertilization patients, but it still didn't satisfy them all. "They'd have about 70 percent [accuracy] on males and 85 percent on females." To increase the odds of getting the boy or girl desired, Steinberg uses a technique called "embryo biopsy."

An embryo biopsy consists of taking one of eight cells from an embryo, a process Steinberg insists does not hurt the embryo. The one cell contains the genetic information needed to identify the gender. Only embryos of the desired gender are then implanted in the mother. The process of embryo biopsy did not start, however, as a means of determining gender.

"Based on our ability to take care of the embryos so well, people started to ask, 'What if we carry a genetic disease? Is there any way you can check that embryo before you get it back to us and check it for a genetic disease?' Finally, it got to the point where there were people who had five boys and wanted a girl, or vice versa and they asked if we could [identify the gender] for them. We went to the American Fertility Society and asked for permission. It took them two years before they came back and said, 'No, we don't think you should do this.' So we countered by saying, 'Wait a minute! You had no problem with us separating sperm out with basically a 50-50 chance, how can you have a problem with something that gives us a 100 percent chance?' So they went back into committee and six months later came back and said, 'You're right. We don't encourage this, but at the same time, we won't prohibit it.'"

Steinberg says he receives nearly equal requests for boys as for girls. He describes his average patient as "about 34 years old, has three children who are opposite sex of what they are requesting, is totally fertile, and they just want what they want. They are usually upper-middle class or upper class. And they are extremely motivated. Nothing is going to stop them from getting that baby. If the woman calls to make the appointment, they usually want a daughter. If the man calls, they want a son."

Many fertility specialists will not allow first-time parents to pick the gender of their baby, but Steinberg will. "The occasional first-time patient that comes in and wants a baby of one gender doesn't bother me. In a way, I think we're sort of helping achieve gender balance."

Initially concerned about contributing to a societal gender-imbalance, the equality of gender requests soon put Steinberg's mind at ease. "Ninety eight percent of the patients are doing this for family balancing," he says. "If 98 percent were coming in for first babies, and they were all selecting boys or all selecting girls, I'd be a little edgy about it."

As a Jew, albeit "not devout", Steinberg says that he doesn't impose his ethics or morals on other people. "If I did that, then I really shouldn't be in obstetrics or gynecology, because people face tremendous dilemmas every day, and you have to respect the patient's feelings. There are people who will not terminate life-support, and that's their choice. Now if there's something that's way out in left-field, I'll reject the patient." Some of the "left-field" parents Steinberg has rejected have included a couple who wanted triplet boys and the parents of a rebellious teenage girl who wanted another daughter "who would be better".

Even though Steinberg did not discuss his personal ethics, he was frank about where his unused embryos go. "The same thing happens as with standard in-vitro fertilization. It's been a dilemma for 25 years. You can freeze your embryos for future use for yourself or someone else, or donate them for research. The most common destiny of the embryos is donations to stem-cell research."

Unlike abortion specialists, Steinberg doesn't have to face protesters at his clinics, but he recalls one incident that happened early in his career. "It was 30 years ago, when I was walking outside of my office in the San Fernando Valley. I had been on the news, because we brought Louise Brown over [from Britain], the first [in vitro fertilization] baby. Someone left a note on my windshield that said, 'Test tube babies have no soul.' That was 30 years ago and there's been nothing since.

"It was new and people were afraid of it. Now I go to my kid's school, and half the kids there are IVF kids. With time, people will be more accustomed to this and it won't be so scary."

New York is considered by some to be America's high-tech baby capital, but Steinberg, who is opening a clinic in New York this autumn, does a brisk business at all of his clinics. Many of his clients come from foreign countries, especially Canada, where gender-selection IVF is illegal. "Toronto is a huge market for us. In one day, I can see people from seven different countries. In fact, the reason we're going to New York is to serve Europeans. That will cut five hours of flight time for them."

And even if the amount of boys versus girls selected is 50-50, Steinberg has noticed cultural tendencies in gender selection. "Canadians like girls, Chinese like boys, India likes boys, Peru likes girls, Chile likes boys -- it's just an amazing thing. Wecompiling statistics for what ought to be an interesting study."

Steinberg's practice is rare in that he is one of the few gender-selection doctors who will allow first-time parents to choose the gender of their baby. Most physicians in his subspecialty will only perform this service for parents who already have a child of the opposite gender for "family balancing." In the July 17 New York Observer, Dr. Masood Khatamee, a gender-selection physician in Manhattan's "baby-belt" discussed the ethics of family balancing. "We have a criteria, and that is that we don't offer gender selection to a couple for the first time. They have to have one or the other gender of child. This assures that the natural balance between the sexes is not disturbed."

In the same Observer story, "Joy", a "MicroSort Mom", said that it was her relationship with her mother that led her to want a daughter so badly. "I was very close with her," she said, "and then she passed away. So most of the people who know me are like, 'You're completely trying to replace the relationship with your mother, and maybe they're right -- but I have the money, so I'm going to do it."

Jennifer Merrill Thompson, another gender-selecting parent and author of Chasing the Gender Dream (Aventine Press), told the Observer that having a girl offered her a different kind of relationship than she could enjoy with her two sons. "I am trying not to favor her," said Ms. Thompson of her four-year-old daughter. "But ... I feel like she likes more of the same things I like, and we have more in common than I might have with one of my boys."

One San Diego clinic, The Fertility Center of California, located in the College Area, does offer sex-selection for in vitro parents, but the office manager, CiCi, refused to speak on the record. When asked if any patients would like to share their experiences, she, like officials at some 50 other clinics around the country, replied that she could not violate doctor-patient privilege by referring patients for interviews.

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