The quest to identify fetuses carrying potentially fatal genetic diseases got a powerful tool in the early 1990s, with the development of Pre-Implantation Genetic Diagnosis. PGD, as it's known, allows doctors to scan the cells of an embryo fertilized outside the womb for signs of inherited diseases like cystic fibrosis or sickle-cell anemia, giving parents the option of not implanting that embryo.
In some fertility clinics, PGD is increasingly being used only to determine the embryos' sex, and then just boys, or girls, are selected to develop into babies. Dr. Daniel Potter offers his patients this controversial service at the Huntington Reproductive Center in Southern California. In his practice, he finds that immigrant couples are making different choices for children than American-born couples.
The procedure takes place in the Center's operating room. The patient is anesthetized, and the reproductive specialist extracts her eggs. They will be fertilized outside her body, even if the woman is completely capable of getting pregnant naturally.
Dr. Potter will analyze the chromosomes of her embryos, and select only the sex she's requested. "Virtually 100% of those pregnancies will be the desired gender," he says.
Many doctors, medical ethicists and even human rights activists say Daniel Potter should not be doing this invasive, risky procedure for a woman and her baby who have no medical need for it. The American Society of Reproductive Medicine supports PGD when needed to prevent passing on a genetic disease, but opposes it for gender selection.
Potter, however, says he's just fulfilling his patients' reproductive rights, explaining, "It's presumptuous of any organization to assert that a woman should or shouldn't be able to determine the number of children she wants to have, or the gender of these children."
But ethicist Arthur Caplan doesn't see this as an issue of reproductive rights. "Medicine has to say what it stands for," he insists. "If it's all about health and disease, then gender is neither." Dr. Caplan directs the Center for Bioethics at the University of Pennsylvania, where he investigates the ethical issues of reproductive technologies. He's concerned about the expectations parents will have for their gender-selected children. "If you spent $30,000 to get a boy to roughhouse and play sports with, and have a boy who is indifferent to sports, are you going to feel disappointed?" he wonders. "Are you going to feel shortchanged?"
Other ethicists worry that using PGD to guarantee a boy - or a girl - reinforces gender stereotypes. Sujatha Jesudason, program director at the Center for Genetics and Society in Oakland, California, goes even further. She says sex selection is sex discrimination. "When we say sex selection is okay, we are saying that it is okay to choose only certain types of children. When you have a father who says, 'I want a son to pass on the family business,' he thinks a girl can't do that." Jesudason, who was born in India, is especially sensitive about her culture's preference for boys. "There is a whole tone in the culture that says, girls are just not as desirable."
In an exam room at the Huntington Center, Dr. Potter greets a couple originally from India, who now live in Canada and have come to his clinic to have a boy. "When a daughter marries, she joins the other family. Girls get married and they move out," the woman explains. "With a boy, they will stay with us and carry on the family." In fact, she and her husband care for his parents at their home. Her parents are cared for in her brother's home.
Although they have two daughters, her husband says there'll be no one to take care of them until they have a son - yet to be born. "The sons will usually take care of the parents in old age. I think our new coming generation will do for us, too."
Foreign-born patients make up 25 percent of Potter's gender selection practice, and of those from India, Korea and China, 90 percent want boys. That adds up to six boys a month in his clinic alone. Of his American-born patients, 80 percent ask for girls.
And, Potter says, they tell him why: "It's about the woman desiring to have the relationship that she had with her mother - seeing their daughter walk down the aisle, going shopping with them. A potential daughter occupies a space in their consciousness like a living, human being. And for them to give up on that, it's like a death."
Whether parents want a boy or girl because of gender stereotypes, ethnic traditions, or simply because they have one sex and want the other - it's the intensity of that desire that's motivated doctors in many PGD clinics to take it from a procedure designed to detect genetic defects, to one that detects - and selects - gender.