Sex Selection and Cosmetic Genetics: Overview

Introduction

Prenatal screening for various genetic disorders has been common practice for decades. In tandem, the use of prenatal screening techniques for sex selection has grown throughout the world, raising concerns over gender bias, potential social upheaval, and moral qualms over the direction of reproductive medicine in general and of genetics in particular.

Some have argued that with the completion of the Human Genome Project in 2003 and the first whole-genome sequencing of a fetus in 2012, regular employment of cosmetic geneticsthe prenatal selection of desired genetic traitscould, in fact, become a reality. As understanding of the complex human genetic code has increased, so, too, have the possibilities for medical and social advances, particularly in the areas of prenatal genetic testing and gene editing, as well as the public fears over ethics and potential consequences.

Understanding the Discussion

DNA sequencing: The process used to determine the arrangement of A, T, G, and C nucleotide bases in an organism's chromosomes; most often refers to decoding human DNA.

Eugenics: The concept that humankind, or a particular subgroup thereof, can be improved through heredity. "Positive eugenics" historically refers to the idea that those with desirable traits should reproduce more, while "negative eugenics" refers to the idea that those with traits deemed undesirable should be prevented from reproducing.

Family balancing: Refers to sex selection in cases in which a family has a child (or children) of one sex and wishes to use fertility treatment options to bear a child of the opposite sex. This term is used primarily by fertility clinics and proponents of sex selection.

In vitro fertilization (IVF): A fertility treatment in which egg cells are surgically removed from an ovary and then fertilized by sperm cells in a petri dish or test tube; one or more resulting embryos are later implanted in the uterus.

Pre-implantation genetic diagnosis (PGD): An IVF technique in which one cell from a three- or five-day-old embryo is removed and its chromosomes analyzed to check either for genetic abnormalities or for the sex chromosomes contained within it. If selected, the remaining cells in the embryo are implanted; if an embryo is not selected, it may be donated for scientific research or discarded, at the parents' discretion.

Sperm sorting: An IVF technique in which sperm cells are chemically separated into X chromosomecarrying (female) or Y chromosomecarrying (male) groups to increase the chance of successfully conceiving a fetus of the desired sex.

History

In the late nineteenth and early twentieth centuries, elites in the United States and in Europe favored eugenic practicesefforts to promote birth among better-advantaged members of society, as well as governmental and social measures designed to prevent or reduce pregnancies among populations deemed inferior. One result in the United States was that women who had heritable conditions, came from ethnically or racially marginalized groups, were poor, or engaged in "immoral" activity, were frequently targeted for institutionalization and often underwent forced sterilization. Standardized intelligence testing and immigration restrictions were other strategies employed by eugenicists to maintain the American "genetic stock." Nazi Germany borrowed heavily from American eugenics research and sterilization practices, causing the eugenics movement to largely fall out of favor in the United States after World War II. Modern discussions of genetic selection often raise fears of a return to those kinds of state-backed eugenic programs.

Beginning in the 1950s, various methods of prenatal testing for single-gene mutations, chromosomal abnormalities, and sex-linked conditionsas well as discovering fetal sexemerged. The modern procedure of amniocentesis (removal and testing of amniotic fluid) was developed in 1956 with the specific intention of determining fetal sex. Over time, it became a standard test for a wide variety of conditions, from hemophilia to Down syndrome. Typically done between fifteen and twenty weeks, the procedure carries a small risk of harm to the developing fetus. Obstetric ultrasonography became commonplace in the mid-1960s. Ultrasound technology is considered noninvasive and allows medical practitioners to monitor the development of the fetus, including the external sex organs at around eighteen to twenty-two weeks' gestation. In 1984, chorionic villus sampling (CVS) was made available to the public. In CVS, a small amount of placental tissue is removed for analysis. Done at between ten and twelve weeks' gestation, it long represented the preferred form of genetic testing before fifteen weeks. By the 2010s, genetic testing had progressed even further to the point that a still less-invasive technique became widely accessible in which lab technicians can use blood drawn from the pregnant person to analyze some of the baby's DNA for single-gene mutations and chromosomal abnormalities. Sex selection for any reason can occur with these forms of prenatal screening.

In August 2011, the Journal of the American Medical Association reported that a woman can learn of a pregnancy and the sex of the fetus after as few as seven weeks' gestation with an over-the-counter blood and urine test. However, the authors point out that tests performed before seven weeks' gestation were unreliable. The widespread availability and affordability of this new noninvasive test worried some, who feared an increase in sex-selective abortions, particularly among populations with known gender biases.

Assisted reproductive technology (ART) also advanced significantly in the latter twentieth century and first decade of the twenty-first century. The year 1978 marked the first successful birth of an infant conceived through in vitro fertilization (IVF), and the first American IVF baby was born three years later, in 1981. From that point, especially as technological advances rendered the IVF process even more effective, the number of babies born through IVF only increased; however, the procedure also remained more costly, somewhat limiting its accessibility.

Pre-implantation genetic diagnosis (PGD) was developed in the 1980s and 1990s as a means of testing embryos for genetic disorders prior to the implantation stage of IVF procedures. Its use in determining the presence or absence of such genetic disorders as cystic fibrosis and Tay-Sachs eventually led fertility clinics to offer PGD services for nonmedical reasons beginning in late 2001. Six years later, genetic markers that influence skin, eye, and hair color in people from Iceland and the Netherlands were identified by Icelandic researchers. The authors of this study pointed out that testing for these traits will only provide a certain level of probability that a child will have blond hair or green eyes, not an absolute guarantee. The authors also stated that they "vehemently oppose the use of these discoveries for tailor-making children." Proponents of sex selection and cosmetic genetics have argued that parents should be allowed such choices as a matter of individual freedom, while critics have asserted that sex selection reinforces sexist gender norms and that further cosmetic genetic choices would exacerbate existing societal ills.

Along with using PGD to select embryos for their own individual health came the idea of selecting for children who could help treat an older sibling affected by a genetically related disorder. The first such tissue-matching child was conceived in the fall of 2000. In 2004, PGD was first used to select embryos to treat older siblings with disorders often genetic in origin such as blood or metabolic conditions.

Left to nature, the number of boys born in a given population will slightly outnumber the number of girls. According to a Guttmacher Policy Review report issued in 2012, China and India had growing disparities in their sex ratios, particularly in late-order births, meaning those born after the first child. In India, for instance, census records for 1981 showed a ratio of 962 female children for every 1,000 boys; thirty years later, in 2011, the ratio was 914 girls to every thousand boys. Both China and India have long-standing cultural preferences for sons, and many opponents of sex selection have pointed to the dramatic shifts in sex ratio in these countriesand the potential long-term consequences of these changesas a reason to outlaw sex-selection practices. In fact, in the mid-1990s, the Pre-Natal Diagnostic Techniques Act was implemented in India, making it illegal to identify and disclose the sex of a fetus. However, it appeared that implementation of this law had not been successful in balancing the sex ratio in India.

As selecting for genetic traits such as fetal sex continued to occur after natural conception, abortion remained a dominant means of selection. By 2009, over thirty countries, predominantly in Europe and the Asia-Pacific region, had implemented legislation barring social (that is, nonmedical) reasons for sex-selective abortions; choosing to terminate a pregnancy that may result in a child with a sex-linked disorder was still allowed. A handful of other nations prohibited sex-selective abortions outright.

Efforts at similar bans in the United States met with mixed results. Although abortions became legal nationwide in the United States with the landmark 1973 Supreme Court ruling in Roe v. Wade, the circumstances under which abortion may be performed, and how it may be performed, remained widely controversial. In 2008, Arizona congressman Trent Franks sponsored the Susan B. Anthony and Frederick Douglass Prenatal Nondiscrimination Act (PRENDA), which sought to outlaw sex-selective and race-selective abortions throughout the United States. He reintroduced the bill in 2011, but it failed to gain a majority in May 2012. (It should be noted that while sex-selective abortions have been documented in the United States, so-called race-selective abortions largely have not.) In light of the lack of federal legislation on the matter, several state governments took up measures to prohibit sex-selective abortion within their respective borders. According to the Guttmacher Institute, by 2023 legislation banning sex-selective abortions had passed and been put in place in eleven states, with Arkansas having done so in 2017.

Jeffrey Steinberg, owner of Fertility Institutes, stirred up global controversy in 2009 when he announced that his New York and Los Angeles clinics would not only help prospective parents choose their children's sex, but would enable them to select embryos for such traits as eye and hair color. In the face of harsh criticism, Steinberg initially backed down.

Many speculated that the increasing ease and decreasing cost of genome sequencing could lead to advances in personalized medicine. In the summer of 2012, researchers at the University of Washington were successful in sequencing an entire fetal genome for the first time. The breakthrough raised the possibility that an increasing number of genetic mutations would soon be uncovered in prenatal screening, for good or ill.

Sex Selection and Cosmetic Genetics Today

Although regular embryonic selection on the basis of cosmetic preferences was still not a known reality in the United States into the 2020s, with many continuing to argue that the genetics involved with such traits as height, hair color, etc. remained too complex to allow for accurate prediction and selection, discussion of its potential implications abounded. At the same time, further advances in embryonic genetic screening and testing raised concerns about the potential to go too far in trait selection. In the early 2020s, scientists had begun to introduce preimplantation genetic testing for polygenic diseases which, though still considered more of a probabilistic risk assessment than an exact guarantee, aimed to go beyond traditional testing to screen for more complex diseases and traits involving multiple genes. While some companies specifically restricted this type of testing to disease prevention, many saw this development as another that might allow for people to become more selective with cosmetic traits as well. Additionally, the existence of some fertility clinics offering and even promoting embryonic sex and/or cosmetic trait selection fueled further debate. By the 2020s, Steinberg's Fertility Institutes had made sex selection through IVF and PGD services a main focus of its practice, actively encouraging parents' right to pursue family balancing, and offered eye color selection. At this point, research into making the technique of sperm sorting for sex selection more effective was also ongoing. With all techniques and the perceived associated potential for prenatal selection of sex and desired genetic traits, discussions also continued to include racial stigmatization and financial and demographic inequities in the accessibility of such technological services.

Sex-selective abortion was additionally still discussed, particularly after the 2022 Supreme Court decision that overturned Roe v. Wade. Abortion rights activists who had protested bans on sex-selective abortions expressed concerns not only about states subsequently implementing total abortion bans but still others that had not done so before using the decision to impose abortion restrictions related to such aspects as sex selection.

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