About one out of five couples who come to HRC Fertility, a network of fertility clinics in Southern California, doesn’t need help getting pregnant.

Instead, they come for what is called family balancing, or nonmedical sex selection.

“They usually have one, two or three children of one gender” and want their next child to be of the other sex, said Daniel Potter,medical director of HRC Fertility, which includes nine clinics.

Women who want to select their baby’s sex undergo the costly and cumbersome process of in vitro fertilization (IVF) to create embryos that are also genetically tested before being implanted. Although the testing, broadly referred to as preimplantation genetic diagnosis, or PGD, is often used to test for genetic diseases, it can also identify the sex of the embryos. The IVF/PGD process can cost as much as $15,000 to $20,000 a cycle and isn’t covered by many insurance plans.

“The growth part of our practice at this point is in fact the segment of the population that technically doesn’t have fertility problems,” which includes same-sex couples and couples with genetic diseases, Dr. Potter said.

Nonmedical sex selection is a controversial practice legal in only a few countries, including the U.S. and Mexico. Medical organizations and fertility specialists are split on the issue. No agency tracks the numbers of procedures performed.

Family-balancing services are advertised prominently on many clinics’ websites. Some clinics, including HRC Fertility and Fertility Institutes, which has offices in Los Angeles, New York and Mexico City, say they are seeing growing demand for the services, particularly from foreign couples.

Other fertility experts say it is a niche practice marketed only by a handful of clinics.

A 2008 study in the journal Fertility and Sterility found in an online survey that among U.S. clinics that offered PGD, 42% would do it for nonmedical sex selection. It was performed in 9% of PGD cycles reported in 2005, according to the survey.

In June the American Society for Reproductive Medicine, a professional organization of fertility experts, issued a position paper saying practitioners are under “no ethical obligation to provide or refuse to provide nonmedically indicated methods of sex selection.”

But the ethics committee of the American Congress of Obstetricians and Gynecologists, which represents women’s health-care providers, reaffirmed last year a committee opinion opposing the practice of sex selection for personal and family reasons.

Dr. Daniel Potter, medical director of HRC Fertility, which has nine clinics in Southern California, says about half of the patients he sees for nonmedical sex selection come from abroad. In September he plans to travel to Australia for reunions with about 60 families he helped to select their children’s sex. PHOTO: SOLENT NEWS AND PHOTOS

“We don’t want people to use technology that’s really intended to help couples with medical needs for nonmedical reasons,” said Sigal Klipstein, head of the ACOG ethics committee. She said IVF is considered a very safe procedure with minimal risks. But as with any medical procedure there is a low risk for bleeding and infection, as well as overstimulation of the ovaries.

Dr. Potter, of HRC Fertility, says about half of the patients he sees for nonmedical sex selection come from abroad. In September he plans to travel to Australia for reunions with about 60 families he helped to select their children’s sex. Last year he visited families in London and he is also planning a trip to China.

Katie Kanavan is one of the Australian patients he plans to reunite with. The 33-year-old traveled from her home in Melbourne to Dr. Potter’s clinic twice to undergo IVF/PGD. She already had three boys, who had all been conceived naturally. She and her husband wanted to ensure their next child was a girl. Nonmedical sex selection has been banned in Australia for about 10 years.

“We wanted to give our boys a sister and we wanted to have a daughter as well,” she said.

Katie and Stuart Kanavan of Melbourne, Australia, had three boys and wanted to ensure the next one was a girl. From left, Lachlan, Katie, Daulton (sitting), Charlie (standing), Stuart and Ruby-Rose, who is now 2 years old. The Kanavans traveled to the U.S., where nonmedical sex selection is legal. PHOTO: KANAVAN FAMILY

The couple spent about $50,000 on two cycles of IVF/PGD and travel expenses, including living in the U.S. for nine weeks. “It was a pretty big gamble for our family,” Ms. Kanavan said. “We saved a lot. We did take money out on our mortgage.”

They now have a 2-year-old girl, Ruby-Rose. “We’ve completed our family,” Ms. Kanavan said. “I’d do it in a heartbeat again.”

Arthur Caplan, director of the division of medical ethics at New York University School of Medicine, said family balancing can become a smoke screen for families who want boys. “When you are treating the fertile in order to produce something that they prefer as opposed to a disease, I do think you’re really opening the door to a potential slope toward eugenics,” Dr. Caplan said.

(Some fertility clinics that offer the services say they get more requests for girls than boys, or the requests are about even.)

David Kaufman, a program director for the National Human Genome Research Institute—a division of the National Institutes of Health—doesn’t expect a trend to emerge for designer babies. Unlike sex selection, genetic testing of embryos for other traits is much more complicated because most of them are governed by multiple genes. “In most cases we don’t even know all the genes and even if we did you’re pretty unlikely to produce an embryo with the perfect combination of all those genes,” he said.

Nearly 90% of patients seen at the Fertility Institutes’ three centers have no fertility problem and come for family balancing, said Jeffrey Steinberg, the medical director. The centers are known for sex-selection services and impose no restrictions, even for a woman’s first pregnancy, he said.

Joel Batzofin, medical director of New York Fertility Services in Manhattan, said about 20% of its patients come for sex selection. Nearly a third of them come from abroad.

“If people want to avail themselves of the technology, why not?” Dr. Batzofin said. “They’re not hurting anyone. They’re paying for it. [The American Society for Reproductive Medicine] thinks that it’s OK.”

Other centers see less demand. Jamie Grifo, program director of the New York University Langone Fertility Center, says when patients hear what is involved in the sex-selection procedure and what it costs, very few choose to go that route. “We’re doing more of it in the patients who have to do IVF to get pregnant in the first place,” he said.

Elena Trukhacheva, a fertility specialist and vice president of Reproductive Medicine Institute, which has six offices in the Chicago area, said roughly 5% of her patients come for nonmedical sex selection and she hasn’t seen a noticeable increase in interest.

All patients at Reproductive Medicine Institute receive extensive counseling on IVF, Dr. Trukhacheva said. There might be a slight increase in risk for breast and ovarian cancers, she said, but most likely only if a patient goes through multiple IVF cycles. There is also a very slight increase in risk for having a child with certain disabilities.

The increased risk for birth defects is likely caused by parent’s infertility and age more than from the IVF procedure, Dr. Trukhacheva said. “But we can’t tell the patients that the procedure is risk-free.”

source: wsj.com By SUMATHI REDDY



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