Choosing the sex of an IVF baby is banned. Should it be?
'I'm here to promote awareness for the availability of gender selection and to hopefully ignite some conversation so that perhaps in the future, people won't have to travel to the United States to have this done,' Potter says.
What are the rules and the concerns behind them?
The National Health and Medical Research Council reviewed their guidelines on assisted reproductive technology in 2017 and upheld its view that sex selection should not be used unless to reduce the risk of a genetic disease. (Duchenne muscular dystrophy, for example, mostly affects males.)
One of the concerns cited by the NHMRC's ethics committee was that nonmedical sex selection could lead to people favouring one sex over the other based on cultural or personal biases.
What the NHMRC considered in its ban on sex selection
Whether sex selection is a justifiable use of medical resources.
Whether there's an ethical difference between people wanting sex-balanced families and people choosing a particular sex due to personal or cultural bias.
The possibility that sex selection my validate or reinforce gender stereotyping and discriminatory attitudes, and create pressure on the person born to conform to their parents' gender expectations.
The possibility that sex selection may open the way for selecting other characteristics such as eye or hair colour.
Concerns that people may be terminating pregnancies as an alternative sex-selection technique.
Concerns Australians seeking sex selection could be travelling to international clinics with a lower standard of care.
Values inherent in Australian society that relate to freedom and autonomy, particularly in relation to reproductive choices.
Read the full reasoning behind the guidelines.
The imbalance of the sex ratio in China is often cited as an example of cultural bias favouring male babies; in 2004 there were 121 males to every 100 females, at least partly because sons were preferred, so female fetuses were more likely to be aborted. China's sex ratio has since evened out, but there's still a male skew.
Choosing the sex of an embryo to 'balance' a family's split between male and female children is one of the most common reasons people seek out sex selection, and it's viewed as more ethically acceptable.
Alex Polyakov, an associate professor at the University of Melbourne and medical director of Melbourne's Genea IVF clinic, believes couples should be able to choose the sex of their third child, as long as their first two children are of the same sex.
'I think the argument that it will skew the sex ratio is really quite nonsensical,' he added, arguing the proportion of people taking part in sex selection would have to be huge to have such an effect. 'I don't really see an ethical or moral issue if safeguards are put in place.'
By the same token, Polyakov has also warned embryo testing and selection strategies can decrease chance of pregnancy or lead to the discarding of healthy embryos, which in some cases has risked parents missing out on biological parenthood altogether.
'I think we often forget that the overriding aim is to increase the pregnancy rate, to get someone pregnant as soon as possible,' he says.
Do people choose more males over females?
Data is mixed on whether people are more likely to choose male or female embryos. An analysis of about 2300 embryo transfers at a US IVF clinic between 2012 and 2021 found 56.5 per cent of people who opted for sex selection chose male embryos. A study on a different hospital found roughly equal rates of sex selection when it was someone's first child, but a 59 per cent preference for females on the second child.
Potter said about 70 per cent of his clients request female embryos, often driven by women who wanted a mother-daughter relationship.
'This process is driven by the female partner in most cases. For a lot of women, they've been imagining having a daughter ever since they were playing with dolls and modelling parenting behaviour as a child,' he says.
Sex v gender
Bioethicist Dr Tamara Browne, a senior lecturer in health ethics at Deakin University, says she's sad this debate has rekindled.
'We really haven't gotten very far when it comes to counteracting gender stereotypes and achieving gender equality,' she says. 'The two are interlinked, and I've become even more convinced that if we're to achieve gender equality, we have to stop parenting children differently according to their sex.'
Assuming daughters will be closer to their mothers, or that boys offer different, more 'macho' experiences such as being into sport, plays into outdated gender beliefs, Browne says.
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'We don't have any good scientific evidence that you can only get these sorts of parenting experiences with a child of a certain sex,' she says.
She makes the point that sex selection allows people to choose the sex chromosomes and genitalia of their child. It can't decide a child's gender – the way they express that sex.
How, Browne argues, do we expect more men to take up nursing or childcare roles, and women to take up STEM subjects like maths and engineering, if we reinforce the idea they're born with different traits and abilities and therefore should be parented differently?
I also ask Potter if he ever discusses with his clients the chance that a child born from a sex-selected embryo could eventually embrace a different gender identity – for example, a baby born from a female embryo who grows up as a trans man. (About 5 per cent of Americans under 30 say their gender is different to the sex they were assigned at birth, according to Pew Research Centre.)
'There would be no reason to discuss that, any more than it would be to discuss with an expecting mum,' Potter says. 'It's a pretty unlikely thing and kind of a grim topic.'
How much should it cost?
Dr Hilary Bowman-Smart, a research fellow at the University of South Australia who has studied prenatal testing, thinks sex selection in embryos isn't a particularly valuable use of medical resources, but the current reasons to keep it illegal were not compelling.
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Bowman-Smart is concerned, though, about companies making money from sex selection services. 'I would be concerned about this becoming an expensive service that is advertised to people during a vulnerable time in their lives who otherwise might not have cared too much either way,' she says.
While Polyakov backs sex selection in some circumstances, he doesn't believe it should be covered by Medicare. If it were legalised in Australia he estimates the practice would cost about $500 to $700 per embryo.
'So if you have 10 embryos, that adds about $5000 to $7000,' on top of the existing costs, he says.
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