Several times over the past few months, a small but striking ad from a Virginia-based fertility clinic has appeared in the Sunday Styles section of The New York Times. Alongside a smiling baby, its boldface headline asks, "Do You Want To Choose the Gender Of Your Next Baby?"

If so, the ad continues, you can join "prospective parents…from all over the world" who come to the Genetics & IVF Institute (GIVF) for an "exclusive scientifically-based sperm sorting gender selection procedure." The technique, known by the trademarked name MicroSort, is offered as a way to choose a girl or boy either for the "prevention of genetic diseases" (selecting against the sex affected by an X-linked or Y-linked condition) or for "family balancing" (selecting for a girl in a family that already has one or more boys, or vice versa).

GIVF has been promoting MicroSort on its website for several years, and a few other fertility clinics offer other "family balancing" methods online. But the MicroSort ads in The New York Times represent a bolder and higher-profile approach. They mark the first time that high-tech methods for sex selection, and their use for clearly social purposes, have been openly marketed in a mainstream US publication.

Two years ago, when newspapers aimed at Indian expatriates in the United States and Canada carried fertility clinic ads for sex selection, The New York Times covered the event as a news story (3). The article included hard-hitting criticism from Indian feminists in the United States, and discussed the hugely skewed sex ratios in South and East Asia (some demographers estimate as many as 100 million "missing girls") that are the result of female infanticide, neglect of girl babies, and prenatal diagnosis followed by sex-selective abortion. It noted that the sex-selection ads would be illegal in India, and reported that one of the publications dropped them after controversy erupted.

The New York Times has also covered other aspects of the debate about sex selection. To date, however, it has taken no note of the MicroSort ad campaign. Nor have other newspapers.

The marketing tactics

GIVF's ads note that MicroSort sperm sorting is currently "investigational," and is being used in the context of an FDA clinical trial. But the company is marketing the procedure with a classic consumer come-on: It promises "FREE MicroSort for qualifying patients" who sign up for either its "Donor Egg" or "Preimplantation Genetic Diagnosis" program. GIVF repeats the offer in a pop-up ad on its MicroSort website, where another smiling baby sits in front of a pink-and-blue double helix (4).

Both egg "donation" and PGD (in which embryos are produced outside the body, and then screened and selected for genetic characteristics) require that women undergo an invasive egg-harvesting procedure. Sex selection via sperm sorting is usually accomplished by artificial insemination, and so doesn't require egg harvesting or in vitro fertilization. GIVF's offer can thus be read as luring women to undergo riskier (and in the case of PGD, more expensive) procedures.

The MicroSort story

The technology behind MicroSort was developed in the late 1980s by a government scientist at the US Department of Agriculture for use in producing livestock. In 1992, USDA granted GIVF founder Dr. Joseph Schulman an exclusive US license to apply the method in humans for the patent's full 17-year life. The first MicroSort baby was born in 1995.

GIVF now has established relationships with dozens of "physician collaborators" in the US and six other countries, who ship semen samples to GIVF for sorting and freezing. In October 2002, GIVF launched a second MicroSort lab, in partnership with the Huntington Reproductive Center in southern California (5).

GIVF's Schulman is not only a technical and entrepreneurial pioneer of sex selection, but also an early popularizer of the notion of "family balancing." The concept has been floated in assisted reproduction circles as a justification for sex selection at least since the early 1990s. According to the website Word Spy, which traces the origins and usage of recently coined words and phrases, the earliest use of the term in the mainstream media was a quote from Schulman in a 1994 Fortune article (6).

"Family balancing" is, of course, an application of high-tech sex selection with considerable commercial potential. GIVF's base charge for MicroSort is $2300; couples try an average of three times before a pregnancy is achieved or they drop out. When Fortune followed up on MicroSort in 2001 with a long article, it quoted an analyst at OrbiMed Advisors, an asset management firm focused on the "global healthcare industry," who estimated a market for sperm sorting in the US alone of "between $200 million and $400 million, if [it] is aggressively marketed" (7).

The fertility industry's trade organization

It's difficult to imagine that such projections did not play some role in a 2001 decision by the American Society of Reproductive Medicine (ASRM)-the fertility industry's trade organization-to give an ethical go-ahead to sperm sorting for "family balancing." A report by its Ethics Committee noted but overrode a range of social and ethical objections, including those that led to its rejection, just two years earlier, of using PGD for such purposes. In that earlier report, ASRM explicitly acknowledged that both PGD and sperm sorting have "the potential to reinforce gender bias in a society" (8).

ASRM remains officially opposed to the use of PGD for "family balancing," though it waffled on the point in 2001. In September of that year, an opinion issued by the acting chair of ASRM's Ethics Committee that seemed to overturn the organization's opposition to PGD for sex selection "stunned many leading fertility specialists," according to The New York Times. One fertility doctor quoted in the Times coverage asked, "What's the next step?...As we learn more about genetics, do we reject kids who do not have superior intelligence or who don't have the right color hair or eyes?" (10).

ASRM's apparent turnaround also sparked protest from feminists and others advocating responsible uses of human genetic technologies. A letter to ASRM asking that it maintain its stand against PGD for "family balancing" was jointly drafted by Center for Genetics and Society and several women's groups, and quickly signed by nearly 100 organizations and individuals. A few months later ASRM issued an official reaffirmation of its earlier conclusion (11).

While GIVF's website heralds ASRM's blessing of sperm sorting for "family balancing," its online offers fail to mention the organization's disapproval of PGD for this purpose (12). Of course, adherence to ASRM guidelines is purely voluntary, and they are regularly flouted (for example, GIVF is not the only US fertility business openly offering PGD for "family-balancing" on the Internet). But the existence of the guidelines is often cited as an argument against effective regulation of the assisted reproduction industry.

Global policy and implications

There are no legislative limits on the applications of PGD or sperm sorting in the United States. In a significant number of other countries, however, legislative or regulatory prohibitions on "non-medical" sex selection procedures are in place or pending. The Council of Europe's Convention on Human Rights and Biomedicine explicitly forbids them (13). But new methods of sperm sorting and the promotion of "family balancing" in the US are sure to affect practices and policies worldwide. If Americans start controlling the sex of their children, people and policy makers in other parts of the world will take note.

The UK provides one example. Its public regulatory agency, the Human Fertilisation and Embryology Authority (HGEA), has prohibited the use of PGD for "family balancing." But last year the HFEA began a "comprehensive review" of sex selection, in part to decide whether or not to regulate sperm sorting (14). HFEA's decision to re-open the question of sex selection may also have been influenced by publicity about Britons who traveled to the US to get access to PGD. (Information about the HFEA's "public consultation" and about a "Take Action on Sex Selection" campaign is available from the UK-based Human Genetics Alert (15).)

In South and East Asian countries, sex-selection technologies raise an additional set of concerns. Feminists assert that any increased acceptance of sex selection in the US will legitimize its use, and seriously aggravate urgent problems for women in societies where preference for sons is strong. They point to the persistence of female infanticide, neglect of girls, and sex-selective abortions, even in countries with laws against them, and to the prevalence of violence against women who fail to give birth to sons (16).

"An abusive spouse may use the birth of a daughter as a pretext for violence towards his wife, and then be violent towards the unwanted daughter," says a fact sheet on sex selection prepared for a national conference later this month of South Asian women living in the US. Even Fortune recognizes the gravity of the problem. "It is hard to overstate the outrage and indignation that MicroSort prompts in people who spend their lives trying to improve women's lot overseas," its reporter notes (17).

High-tech sex selection poses a range of difficult policy dilemmas, especially the problem of addressing it without weakening women's rights and access to abortion. But address it we must, because of the grave concerns it raises about exacerbating sexism, undermining disability rights, threatening the well-being of children, and setting the stage for a consumer eugenics in which parents are sold techniques to select not just their child's sex, but a range of other traits as well. As Human Genetics Alert asks, if we allow sex selection, how will we be able effectively "to oppose `choice' of...appearance, height, intelligence, etc. The door to `designer babies' will not have been opened a crack-it will have been thrown wide open" (18).

What technology can do; what technology should do

According to the limited public opinion data and marketing projections that are available, about a quarter of Americans would like to be able to select the sex of their offspring. That number indicates the potential for significant societal effects, and evokes the misogynist uses of sex selection in South and East Asia, and the decades of struggle by women's groups against them.

In the United States, preference for sons is much less strong than in some other parts of the world, although a 1995 study found that 34 percent of US geneticists would perform prenatal testing because a family wanted a son-a ten percent increase from ten years earlier (19). But anecdotal evidence-based on reports from the companies offering various methods for sex control, and on perusals of the "Gender Determination" message board at http://www.parentsoup.com (which has over a quarter million postings) suggests that of the Americans actively trying to determine the sex of their next child, many are women who want daughters.

That Americans may not use new technologies to produce huge numbers of "extra" boys doesn't necessarily mean that sex selection and sexism are unrelated. One study, by Roberta Steinbacher at Cleveland State University, found that 81 percent of women and 94 percent of men who say they would use sex selection would want their firstborn to be a boy. Steinbacher points out that the research literature on birth order is clear: firstborns are more aggressive and higher-achieving than their siblings. "We'll be creating a nation of little sisters," she says (20).

Observers of sex selection point to another discriminatory impact: its potential for reinforcing gender stereotyping. Parents who invest large amounts of money and effort in order to "get a girl" are likely to have a particular kind of girl in mind. As the mother of one of the first MicroSort babies put it in a fairly typical comment, "I wanted to have someone to play Barbies with and to go shopping with; I wanted the little girl with long hair and pink and doing fingernails" (21).

Of course, there are many reasons that people may wish for a daughter instead of a son, or a boy rather than a girl. In a sympathetic account, The New York Times reporter and feminist Lisa Belkin describes some of the motivations of US women who are "going for the girl." "They speak of Barbies and ballet and butterfly barrettes," she writes. But "they also describe the desire to rear strong young women. Some want to recreate their relationships with their own mothers; a few want to do better by their daughters than their mothers did by them. They want their sons to have sisters, so that they learn to respect women. They want their husbands to have little girls. But many of them want a daughter simply because they always thought they would have one" (22).

Compelling though some of these longings may be, the issue raised by sex selection is not primarily one of the rightness or wrongness of parental desires. The preferences of prospective parents are obviously relevant in matters of child-bearing, but so are the well-being of future children, and the social consequences of a set of technologies that are certain to be "aggressively marketed."

As effective technologies for predetermining sex have moved into commercial application, a disturbing number of fertility industry figures have shed their deference to ethical and social deliberations. But serious considerations of sex selection, no matter what their conclusions, continue to raise a bevy of concerns about its potential to promote sexism and gender stereotyping, to commodify children and put them at risk of parental disapproval (if the child turns out to be the "wrong" sex) or rigid expectations (if the child turns out to be the "wrong kind" of girl or boy), to create societal distortions in sex ratios and in the number of firstborn boys, and to move us toward the "designing" of future generations.

From a social and political perspective, the paramount question is this: If new technologies make it possible to fulfill desires and satisfy preferences, is that reason enough to use them? More succinctly: If we can, does that mean we ought?

FOOTNOTES

1. Gina Kolata, "Fertility Ethics Authority Approves Sex Selection," The New York Times, September 28, 2001
   http://www.genetics-and-society.org/resources/items/
   20010928_nytimes_kolata.html
2. ibid.
3. Susan Sachs, "Clinics' Pitch to Indian Emigrés: It's a Boy," The New York Times, August 15, 2001
   http://www.genetics-and-society.org/resources/items/
   20010815_nytimes_sachs.html
4. http://www.microsort.com
5. GIVF press release,
   http://www.microsort.net/Release102002.htm
6. http://www.wordspy.com/words/familybalancing.asp
7. Meredith Wadman, "So You Want A Girl?," Fortune, February 2001
8. The Ethics Committee of the American Society of Reproductive Medicine, "Sex selection and preimplantation genetic diagnosis," 1999
   http://www.asrm.org/Media/Ethics/Sex_Selection.pdf
9. Kolata, op. cit.
10. Kolata, op. cit.
11. Accounts of this episode can be found at
    http://www.genetics-and-society.org/resources/cgs/
    2002_asrm_sex_selection.html
12. http://www.givf.com/gender_selection.cfm
13. Excerpts from the Council of Europe's Convention on Human Rights and Biomedicine can be found at
    http://www.genetics-and-society.org/policies/international/council.html
14. Human Fertilisation & Embryology Authority, "Sex Selection: Choice and responsibility in human reproduction,"
    http://www.hfea.gov.uk/forPatients/Consultations/default.htm
15. Human Genetics Alert, "Take Action on Sex Selection,"
    http://www.joebutton.co.uk/hgmail/contact.php
16. Rupsa Mallik, "A Less Valued Life: Population Policy and Sex Selection in India," 2002
    http://www.genderhealth.org/pubs/MallikSexSelectionIndiaOct2002.pdf
17. Wadman, op. cit.
18. Human Genetics Alert, op. cit.
19. Lisa Belkin, "Getting the Girl," The New York Times Magazine, July 25, 1999
20. ibid.
21. "Choosing Your Baby's Gender," cbsnews.com, November 7, 2002; posted in the "News Articles" section of the MicroSort website, http://www.microsort.com
22. Belkin, op. cit.