Sex Selection: Choice and Responsibility in Human Reproduction

This is the title of the latest public consultation exercise from the Human Fertilisation and Embryology Authority (HFEA).  It is asking whether embryo sex selection techniques should be made available for non-medical purposes.  The public was last consulted on this issue in 1993, when such non-medical sex selection was rejected.

Sex Selection - The Methods Used
Sex selection of children is not new.  Some societies, for example, especially in India and China, currently practise it by infanticide – that is, they kill their newborns, usually girls, within the first few days of their birth, either deliberately by smothering or poisoning them, or by simple abandonment.  That is horribly crude, but effective.  Other societies use the less primitive method of ultrasound scanning to determine the sex of the unborn child and then use abortion to ‘get rid of it’.  That is a rough and ready, process but it works, mostly.

Now, we, in the West, have become far more sophisticated.  We can use techniques like preimplantation genetic diagnosis (PGD), or sperm sorting.  PGD is a fairly recent development in a series of methods used to check on the health of the unborn – it joins amniocentesis and chorion villus sampling in seeking out those with genetic abnormalities that may lead to disability, who are then typically destroyed by abortion.  All three methods are part of the ‘search and destroy’ mentality of prenatal screening.  The newcomer, PGD has to be used in combination with in vitro fertilisation – one cell from an early human embryo is removed, sent for chromosomal analysis and if it fails the quality control test, that is, it is of the unwanted sex, then the rest of the embryo is simply squashed.

Sex Selection - The Previous Consultation
In 1999, the HFEA held a public consultation exercise on the use of PGD.  The FIEC responded – the full text can be read at <>.  The following is one pertinent paragraph from that response.  The fear expressed in the penultimate sentence is now upon us, big time.

The Slippery Slope Argument
In some bioethical circles this is a much-maligned concept; we disagree.  We remember the legal changes made in the 1967 Abortion Act, which gave permission, under limited circumstances, to women seeking termination of their pregnancies.  That initial permission has since become an expectation with hundreds of thousands using the poorly-defined grounds.  Legalisation creates a demand.  Furthermore, the Human Fertilisation and Embryology Act (1990) initially appeared to be the basis for strict regulation in some areas.  Yet, additional techniques, some novel, if not bizarre, circumstances, a lack of public awareness and an inability to legislate for a fast-moving technology from a clear and solid ethical framework have shown this piece of legislation to be repeatedly ineffective.  We fear the same for PGD.  Once approved it will be impossible to maintain boundaries.  It will be impossible to define “severe” and “significant” with respect to genetic disorders.  “Severity creep” will undoubtedly occur.  And whose assessment of severity will count?  It clearly will not be the patient’s, so will it be the doctor’s, the parent’s, or society’s?  Within a few years screening for more and more potential diseases, as well as sex determination, will be widespread with the consequence of more and more genetic discrimination.  Eventually, other genetic aspects, such as behavioural disorders, that commissioning parents find unacceptable will also have to be included in such testing.

The upshot of that 1999 consultation was that, despite the opposition by many, Parliament approved the use of PGD in the UK for medical reasons, such as the avoidance of X-linked diseases, like haemophilia and Duchenne’s muscular dystrophy.

So sex selection, via PGD, is already happening in a limited way, but it could soon be on a grander scale.  This is because of the advent of a new technique for sperm sorting – it is the cause of the latest bioethical commotion.  But sperm sorting itself is not new.  In 1993, it was brought to this country by the London Gender Clinic.  However, its technique was not very efficient, about seventy per cent, and expensive, about £650 a go.  The Clinic closed down fairly rapidly.

Sex Selection - The New Challenge
Enter MicroSort - this is the new, more reliable and cheaper method of sperm sorting.  It has been pioneered by The Genetics and IVF Institute in Virginia.  This Institute has helped at least 300 couples choose the sex of their babies before fertilisation.  And apparently six UK couples have already gone to Virginia to have either a boy or a girl of their choice, well almost - MicroSort is claimed to be ninety-one per cent accurate.

The two genes that determine a child’s sex come from the mother’s ovum (which is always an X chromosome) plus the father’s sperm (which can be either an X or a Y chromosome).  If the ovum is fertilised by an X-carrying sperm, the result will be a daughter.  If a Y-carrying sperm fertilises the ovum, a son will be conceived.  Sperm sorting works because the possession of an X or a Y chromosome affects the amount of DNA that a particular sperm contains.  On this basis, 'male' and 'female' sperm can be separated because the latter are 'heavier', or they can be sorted with the aid of a fluorescent dye and a laser.  Either a son or a daughter can then be ‘created’ using the appropriate X or Y sperm.

With the imminent arrival of MicroSort, and other similar procedures, into the UK, the HFEA has arranged this latest consultation to consider the rights and wrongs of selecting the sex of future children for non-medical reasons.  It often goes under the euphemism of ‘family balancing’.  A couple already have two sons, why can they not be guaranteed a daughter next time round?  Currently, there is nothing to stop MicroSort, or similar methods, being used in the UK.  The 1990 Human Fertilisation and Embryology Act covered aspects of assisted reproduction using only frozen or donated sperm, but not fresh sperm.  Does the law need changing?

If we already allow sex selection on medical grounds, then why not on non-medical grounds?  Do these techniques declare that the disabled are inferior people?  If used in conjunction with IVF, what happens to embryos of the ‘wrong’ sex?  Is this a further step down the eugenics road?  Is choosing the sex of children who do not yet exist a weird enterprise?  Does it amount to control and design, rather than nurture, by parents?  Is it not blatant sex discrimination?  These are the sorts of questions that need to be considered.

Sex Selection - What Do You Think?
So this is your chance to make your mind up and respond to the HFEA document.  This is what responding to the culture of death is all about!  The HFEA Consultation Document can be found at <>, click on ‘Consultations’.  Then you have a choice of either the whole 39-page Document plus the questionnaire (in pdf), or just the online questionnaire.  It will take only about two hours to read the full Document and begin to think about the issues.  A good strategy might be to then discuss it with others from your fellowship, either formally, or informally.  Then there are a mere eight questions to answer.

You have until 22 January 2003 to reply.  This is an excellent opportunity to clarify your thinking and formulate a coherent response.  Just imagine what would happen if all FIEC churches and a few hundred individual Christians replied – the HFEA would be taken aback.  If you sit on your hands, nothing will change.  So, go on, go on, go on!