How To Have a Boy

The PGD Procedure

Want to have a boy?

WARNING: I am not a Medical Doctor. This information is for informational purposes only.

HOW TO SELECT THE SEX OF YOUR BABY !

Right or Wrong ?
The ethics of PGD for sex selection.

PGD is emotionally a very touchy area, because not only are we dealing with human embryos - the very start of new life , but we are studying their basic blueprint - their genes - the stuff of which humanity is made. Obviously, this is likely to cause people to take very strong views on what is right and what is wrong - so that they start thinking with their hearts rather than their heads
! A familiar refrain is we shouldn't be doing any of this because scientists are becoming too big for their boots - they are trying to play God by tinkering with the genes , and it is far better that they leave this entire field well alone, since we will never be able to understand any of it - it is beyond human wisdom. This is a common knee-jerk reaction, which precludes further rational
debate.

The other view point is - Why not ? If man can improve on Nature, then why should he not try ? After all, building a house is simply man's way of improving on nature - and if we can improve man himself, then why not ? Seen in this light, then studying the molecular genetics of the human embryo would be the ultimate goal of all medicine. Of course there are bound to be worries and concerns - but this was true even when the first caveman discovered fire ! We have to learn to live with change and progress !

After all, why do we encourage mothers to get antenatal care ? Why do we advise them not to smoke or drink during their pregnancy ? To help them to have a healthy baby of course ! Avoiding negative influences is the heart of good preventive medicine. This is simple common sense and is not controversial. Similarly, if you can help a patient to have a healthy baby by
using PGD to select only the healthy embryos, then why not ? In the past, doctors used to treat adults. In the beginning of the 20th century, we started treating children, and the field of pediatrics was born. We can now treat the fetus - and the future patient of the 21st century will be the embryo - this is a logical progression !

In principle, PGD can be used for non-controversial " medical " indications - such as screening for aneuploidies, to prevent trisomy 21 ( Down's syndrome ) . Let's take an embryo diagnosed as having trisomy 21 using PGD. Most doctors would be very comfortable not transferring this embryo into the uterus, as they feel that a baby with Down's syndrome is mentally handicapped, and their quality of life may not be optimal. However, may right-to-lifers would vociferously protest against this, and object to discarding embryos just because they have an extra chromosome, the argument being, don't these children also have a right to life ? While many doctors would have little or no ethical qualms about "discarding" an embryo with trisomy 21,
In a pluralistic society, you should have the wisdom to appreciate that there may be others who have a different point of view - and you should be tolerant enough to accept their viewpoint as being equally legitimate ! Thus, there are no "right" or wrong answers - and none of this is simply a matter of applying "common sense' either !

If we allow people to choose when to have babies; how many to have; and even to terminate pregnancies if they inadvertently get pregnant, then why not allow them to select the sex of their child, if it is possible ?

The basic purpose of technology is to give Man more control over his destiny than he has had in the past. Of course, how he uses this technology is difficult to predict. But , in all fairness, we need to give due credit to people's intelligence, and allow them to make their choices for themselves, rather than presume that only medical professionals ( or politicians or lawyers) have the requisite sense to decide what is best for everyone else. I feel this is a very arrogant attitude which professionals take - yes, it's okay for you to do this or that, but not okay to do this!

We should allow patients freedom to choose for themselves - medical technology should empower them with choices they can make for themselves ! Of course, patients may make decisions you may not be comfortable with - in which case, you can choose to refer them elsewhere, and not participate in their medical care. This is fine too. But to deprive them of treatment options is not fair. This just creates blackmarkets and engenders unethical practises making matters even worse ! Far better to have an "open" system which is quality controlled and reliable because it is performed ethically ! This is why the introduction of legal abortion was such a major step forward for women's health.

A common criticism against PGD for sex selection is that it will cause an unbalanced sex ratio. In reality, PGD will allow couples to balance the sex ratio in their families, rather than unbalance it ! For example, take a couple with a baby girl, who want to have a second baby. If they leave things upto chance, half of them will have a second baby girl - causing unbalanced intrafamily sex ratios ! PGD will allow them to make sure that they have a balanced sex ratio in their family, if they so desire.

What will the effect be on the population level ? The argument that " women will get wiped out in a few generations "- because of skewed sex ratios produced by selection pressure for boys only holds little water.

It is based on highly distorted figures which are used to create a sensationalistic impact by presenting them out of context. A very commonly quoted study is one which showed that out of 1000 aborted fetuses, 999 were female. However, it is important to not lose sight of the real denominator - the total number of boys and girls in these families.

Of couples who choose to go through sex determination , the vast majority have at least 1 or more ( often 3-4 girls) before they decide to take matters in their own hands - they have got fed up of leaving everything upto chance ! Thus, if you consider 1000 couples who go through fetal sex determination, they already have 2000 or more girls in these families. These couples are not
representative of the population , and therefore extrapolating these figures to the entire opulace makes absolutely no sense !

Let us consider a thought experiment. Let us take 2000 couples who have 1 girl each, and who choose to go through fetal sex selection, because they want to have a baby boy. The sex ratio now is 2000 girls: 0 boys. Of these 2000 women, 1000 fetuses will be male, and 1000 will be female. Now , if they had not gone through a sex determination procedure, at the end of this
pregnancy, there would be 500 more boys and 500 more girls, so that now there would be 2500 girls and 500 boys amongst these couples, so that the sex ratio is 5 girls: 1 boy. If the couples who had female fetuses aborted these, there would be only 500 more boys ( and no more girls) , so that now there would be 2000 girls and 500 boys - giving a more balanced sex ratio in
these families of 4 girls: 1 boy ! By aborting the female fetuses, they are actually helping to correct the unbalanced sex ratios ! However, a reporter describing the activities of this clinic would simply say that 500 female fetuses were aborted ; and then go on to wax eloquent about the misuse of medical technology , which may cause the "girl child" to disappear if not adequately controlled - without considering the true background of the couples at all !

Let's consider a couple who already has one baby girl and wants only one more baby to complete their family. If they would like to have a balanced family, and want to have a boy, and if we have the technology to fulfill it, then why not use it ? Some people may consider this "overkill" - but isn't it upto each couple to make up their own mind ?

References

1. Joe Leigh Simpson and Sandra Ann Carson. The reproductive option of sex selection . Hum Reprod 1999 14: 870-872.

2. Carson, S.A. Sex selection: the ultimate in family planning. Fertil. Steril. 1988 50, 16?19.

3. K Dawson and A Trounson . Ethics of sex selection for family balancing. Why balance families?
Hum Reprod 1996 11: 2577-2578.

4. P Liu and GA Rose . Sex selection: the right way forward . Hum Reprod 1996 11: 2343-2345.

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