Gender choice: is it playing God?

Christian Century, May 4, 2004 by Mark O'Keefe

DON'T GET Lizette Frielingsdoff wrong. She loved her three boys--Jordan, Justin and Jake. Yet somehow she felt incomplete, especially when watching her friends happily shop with their daughters or when recalling those special times when her own mother took her to the ballet.

"Boys are great, but I started to think I'd love to have a girl, too," she said. "I just wanted those things you do with a daughter."

So at every bedtime she and her husband, Andy, bowed their heads and asked God for the pitter-patter of feminine feet. But they didn't stop there. Like increasing numbers of parents, the Frielingsdorfs--she's 33, he's 35--turned to biotechnology to get the gender of their choice. The couple requested that their New York suburb not be identified, for reasons of privacy.

The decision to choose a child's gender raises ethical and religious concerns, with some people arguing that it's a first step toward genetic engineering and a world in which babies are just another commodity with optional features. Gender selection used to be limited to at-risk couples wanting to prevent sex-linked genetic diseases. But at dozens of clinics nationwide it is now being done for "family balancing" of the sexes and other reasons. Patients can choose from several methods.

The most controversial, pre-implantation genetic diagnosis, or PGD, virtually guarantees success by separating male and female embryos. But that creates the moral dilemma of what to do with embryos of the undesired sex. The Frielingsdorfs flatly rejected that option. "What would I do with an embryo that's not a girl?" asked Lizette, who is Catholic. "I couldn't just throw it away. That is a life, at least the way I see it."

Instead, they turned to the Genetics and IVF Institute in Fairfax, Virginia, which used its patented Micro-Sort technique to sort Andy's sperm for those carrying the girl-producing X chromosome, Lizette was then artificially inseminated. They knew there was a 90 percent chance that a pregnancy would produce a girl, and Lizette took comfort in the notion that "it wasn't me playing God, there was still a chance God could say, "This is not what I intend for you"' and give her another boy.

She got a girl--Jessica, now two--whom she calls "my $15,000 baby." "They give you a $2,300 price," said Lizette, who made several trips to the institute in Virginia. "But each time we did this, it was about $4,600 when you factor in travel, hotels and fertility medication."

Some bioethicists see gender selection of any kind as the edge of a slippery slope, and not just for religious reasons. Harvard professor Michael Sandel writes about the controversy in "The Case Against Perfection," Atlantic Monthly's April cover story. A member of the President's Council on Bioethics, Sandel refers to the science-fiction film Gattaca (1997), which depicts parents designing offspring not only for gender but for height, immunity to disease and IQ. "The danger," he said in an interview, "is that parents who choose the sex and other genetic traits of their children will come to regard those children as consumer goods."

Christine Rosen, a fellow at the Washington-based Ethics and Public Policy Center, worries that sex selection could create a gender imbalance similar to China's. There, females are more likely to be aborted as fetuses or killed as infants because the culture prefers males and the government tries to limit parents to one child. Morever, Rosen says, she is concerned that sex selection could lead to wider testing for disease and, ultimately, creation of a genetic underclass. "You will be seen as an irresponsible parent if you have a child who is genetically predisposed to obesity or manic depression or Alzheimer's," Rosen said. "This will mean less diversity, less tolerance and more conformity, and I don't think that's necessarily a good thing for society."

Unmoved by these arguments, Dr. Jeffrey Steinberg of the Fertility Institutes in Los Angeles believes gender selection is about autonomy and reproductive choice, with parents making the decisions. Steinberg offers not only sperm sorting but PGD, with a price tag of about $15,000. "This is actually fun, happy medicine," he said.

"People come in wanting to have a boy or wanting to have a girl, and four weeks later they know they're having a boy or a girl." He notes that the issue of spare embryos also arises with in vitro fertilization--in which women's eggs are harvested and fertilized outside the womb, and one or more of the resulting embryos is transferred to the uterus. That technique has been used to assist infertile couples for a quarter of a century.

Matt Mandolesi, 32, and his wife, Beth, 39, of Alliance, Ohio, considered gender selection after Matt's father, Eddie, made it known he was unhappy that he had nine granddaughters and no grandson to carry on the Mandolesi name. When the senior Mandolesi, now 67, suffered a stroke, Matt and Beth moved quickly. Since Beth had undergone tubal ligation after her two girls, now teenagers, were born, they needed in vitro fertilization to conceive. Selecting gender was a $250 add-on to a $13,000 medical procedure; the couple froze the two spare embryos in hopes they will be adopted.