I-26: Considerations for PGD Applications inElective Human Embryo Sex Selection

The promise of medical innovation has long evoked social commentary, particularly when personal reproductiveautonomy may be impacted. Development of the oral contraceptive, effective and safe surgical sterilization, and later IVF and ICSI are among the revolutionary developments where initial reaction was dubious, but eventually, each was accorded mainstream status as clinical experience accumulated. Debate about the moral and social implications of these treatments accompanied their introduction into the medical marketplace. This pattern appears to be repeating itself as preimplantation genetic diagnosis (PGD) is used specifically for elective sex selection of human embryos. As with prior challenges in reproductive medicine, developing meaningful “guidelines” for this latest controversy has proven to be a contentious task. Indeed, the progression of ethics committee reports from the American Society for Reproductive Medicine seems to echo the ambivalence within society at large regarding this issue. Sex selection claims have been based on sperm sorting, while flow cytometry and especially PGD have facilitated this selection at the gamete and embryo stage, respectively. Yet, patient demand, market forces and practitioner considerations associated with the application of PGD for this have not received much formal study. Increased physician familiarity with PGD is a welcome trend, and clinicians should prepare for important questions from patients about the risks and benefits of this technology.While the advances of PGD are relatively new, the desire for sex selection is not. Those who contemplate offering PGD for this purpose should first clarify their own personal moral position, and then evaluate each clinical circumstance on a case-by-case basis. This approach is consistent with the policy that IVF patients should have full access to PGD for elective sex selection, but that physicians should first use “moral suasion” to promote offspring sex by chance, even when modern reproductive technologies could be applied to influence the outcome. While some clinicians and policy makers may find the use of PGD for elective embryo sex selection problematic, regulatory measures mandating its elimination would be even more worrisome and objectionable. Since a resolution satisfactory to all interested parties is unlikely to be achieved, continued multidisciplinary study as proposed by professional organisations seems appropriate.