OTTAWA, CA - A U.S. fertility specialist says about 70 Canadian couples have travelled to his clinics in Los Angeles and Las Vegas to choose the sex of their babies using a procedure that cannot be legally performed in Canada.
Dr. Jeffrey Steinberg's Fertility Institutes offer embryo selection for about US$18,000. The mother's eggs and the father's sperm are combined in a lab dish to fertilize the eggs and the sex of the resulting embryos are determined. Only embryos of the desired sex are implanted in the mother. In Dr. Steinberg's approximately 2,000 sex-selection procedures so far, the baby has always been of the "correct" sex.
About 60% of his practice is foreign patients, including many from China and India, who want boys for cultural reasons. There has been an eightfold increase in volume at his clinics in the past two years, since he was featured in Newsweek magazine.
The Canadian patients at first came mostly from the British Columbia and Saskatchewan, but now there are growing numbers from Toronto and Montreal. "They just beat a path to my door," he said. "We've had a ton of Canadian patients."
Chinese and Indian couples want boys. According to his figures, however, about 60% of the Canadian patients want to have a girl. Most patients already have children and want one of the opposite sex, he said.
These families do not have fertility problems -- in fact, mothers often have three or more children of one sex and simply want to balance out their family with the guarantee of the boy or a girl they are missing.
"It's always family balancing. If they have five boys, they want a girl. If they have five girls, they want a boy," said Dr. Steinberg.
"We're trying to provide families with happy, healthy babies they are content with. If the technology is available, they want to take advantage of it to take advantage of choice."
The medical technology to perform sex selection has been available for more than a decade, but the social and ethical debate is still raging. The procedure, which is available in many countries in Asia and the Middle East, is illegal in Canada and is considered unethical by major Canadian medical bodies.
The Canadian Fertility and Andrology Society and the Society of Obstetricians and Gyneacologists of Canada have released position papers against selecting embryos on the basis of gender, said Dr. Roger Pierson, a professor of obstetrics and gynecology at the University of Saskatchewan and the chairman of the fertility society's communications committee.
"It is considered morally reprehensible," he said. "We can't discriminate on the basis of gender. Until the courts tell us differently, we'll remain with that position."
In Canada, it is legal to use pre-implantation genetic diagnosis (PGD) to screen for genetic conditions ranging from Down syndrome to hemophilia and cystic fibrosis. Often, the embryos are created in an invitro fertilization lab in Canada and are sent to labs in the U.S. for assessment.
The list of diseases that can be screened using PGD keeps getting longer and longer, said Dr. Pierson. For example, one of the most recent developments has been a DNA chip that can test for about 1,000 diseases. DNA is extracted from a single cell and placed on a chip, which indicates if the DNA carries any of the test diseases.
But critics of sex selection have pointed out that a baby's sex is not a disease. The American Society for Reproductive Medicine has also released a position paper that frowns on selecting embryos solely on the basis of gender.
It's unclear how many labs in the U.S. and around the world perform sex selection, said Dr. Pierson. Statistics are not kept on the number of these procedures performed in the U.S.
Dr. Steinberg said he knows of at least one other clinic in Florida that offers sex-selection of embryos and believes that some clinics that offer PGD are doing a great deal of sex selection work.
In the U.S., fertility clinics are run on more of a business model, said Dr. Pierson. Some clinics are located in cities with easy access to Canadians to encourage "reproductive tourism" and sex-selection services are advertised in ethnic newspapers.
While a border guard might ask a traveller if they got new tires or car repairs while they are in the U.S., no one administers pregnancy tests at the border, he said.
"If you have the money, you can get anything you want. It's like Alice's restaurant."
As for the debate about the ethics of choosing the sex of a baby, Dr. Steinberg argues that women are already "choosing" their children. Pregnant women can have amniocentesis to screen for genetic abnormalities, such as Down syndrome. If the test is positive, the pregnant woman may choose an abortion, he said.
"If a decision on sex selection can be made before the pregnancy, why not make it?" said Dr. Steinberg. "I find that distinction confusing. We're choosing babies all the time."
© National Post 2006