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Gender Selection Overview

There is a rapidly increasing demand for gender (sex) selection in the United States. There are two main reasons for this development: Medically Indicated and Elective.

What is Medical Gender Selection?

As our understanding of genetic diseases increases, and with it our ability to diagnose couples at risk to have children affected with a heritable genetic disease, we more frequently use the tool of preimplantation genetic screening (PGT-A) to genetically assess embryos prior to their implantation into the uterus. Some genetic diseases are only expressed in males, and parents, therefore, at times make a conscious choice to have only female offspring. When gender selection is used to prevent a genetic disease its indication is considered medical.

What is Family Balancing? (Elective Gender Selection)

In contrast, if the decision to choose a child’s gender is done for family balancing purposes, then the process is considered elective. Elective gender selection is the ability to increase the chances of having a child of a particular sex. The sex of a fetus is determined by two chromosomes, one inherited from the mother and one from the father. These chromosomes are either X or Y. The egg, from the mother carries an X chromosome and the sperm from the father carries either an X or a Y and this is what determines the sex of the baby. If a Y bearing sperm fertilizes the egg, the embryo is male. If an X bearing sperm fertilizes an egg, the embryo is female. It is possible to have an abnormal arrangement of sex chromosomes, however, this is rare.

Family Balancing Process

Gender selection utilizing in-vitro fertilization (IVF) with PGT-A, is the most accurate means of determining gender and will result in the gender of your choice in close to 100% of cases (some technical errors may happen, of course).

In this technique, embryos are produced from eggs and sperm of the couple. On the fifth or sixth day of embryo development, when the embryos have reached approximately 80-100 cell stage “blastocyst”, a laser is used to create a very small hole in the outer wall of the embryo allowing three to four of the outer cells that would form the placenta “trophoblasts” be carefully removed from the embryo. These cells are then prepared and sent to a genetic laboratory to analyze its chromosomal make up. This then allows us to determine whether the embryo, from which the cell was taken, was female or male. In addition, each embryo is also tested to make sure it has the correct number of chromosomes for all 24 pairs of chromosomes, thereby minimizing the risk of potentially transferring a chromosomally abnormal embryo regardless of the gender. Only embryos of the desired gender that have a normal number of chromosomes, are then transferred into the mother’s uterus, making this a very reliable technique of gender selection. The remaining embryos that were tested normal can also be preserved through cryopreservation (freezing) for use later, donated to others who have difficulty having children in a process known as embryo donation, or disposition at the will of the patient.

Ethical Concerns

Gender selection is a hotly debated topic in many countries including the United States. Some have moral and ethical concerns with sex selection for non-medical reasons. The ethics committee of the American Society for Reproductive Medicine (FertilSteril 2001;75:861-4) has concluded that “the most prudent approach at present for the non-medical use of these techniques (for sex selection) would be to use them only for gender variety in a family.” They also state, “physicians should be free to offer preconception gender selection in clinical settings to couples who are seeking gender variety in their offspring if the couples 1) are fully informed of the risks of failure, 2) affirm that they will fully accept children of the opposite sex, if the preconception gender selection fails, 3) are counselled about having unrealistic expectations about the behavior of children of the preferred gender, and 4) are offered the opportunity to participate in research to track and assess the safety, efficacy, and demographics of preconception selection.”

We at Advanced Fertility Care operate within the appropriate standards of medical care and therefore respect and support an individual’s procreative autonomy, which is a person’s choice as to how, when and what children to have. We are happy to provide this service to any family which already has at least one child and wishes to benefit from family balancing.


As part of the informed consent process prior to undergoing IVF with PGT-A, you will be required to sign a consent form giving us permission to proceed and acknowledge that all methods have limitations. Pregnancy success including the desired sex cannot be guaranteed with 100% certainty.

Gender Selection for Family Balancing Next Steps

If you are interested in scheduling an appointment to discuss the option of family balancing please contact our office or call to schedule an appointment in one of our 3 convenient locations.


There is hope. Are you ready to make your miracle happen?