Man in control or God in control?
Gender Selection Has Become A Multimillion-Dollar Industry
Written for Slate by Jasmeet Sidhu
Megan Simpson always expected that she would be a mother to a daughter.
She had grown up in a family of four sisters. She liked sewing, baking, and
doing hair and makeup. She hoped one day to share these interests with a little
girl whom she could dress in pink.
Simpson, a labor and delivery nurse at a hospital north of Toronto, was surprised when her first child,
born in 2002, was a boy. That’s okay, she thought. The next one will be a girl.
Except it wasn’t. Two years later, she gave birth to another boy.
Desperate for a baby girl, Simpson and her husband drove four hours to a
fertility clinic in Michigan.
Gender selection is illegal in Canada,
which is why the couple turned to the United States. They paid $800 for a
procedure that sorts sperm based on the assumption that sperm carrying a Y
chromosome swim faster in a protein solution than sperm with an X chromosome
do.
Simpson was inseminated with the slower sperm that same day. Fifteen weeks
later, she asked a colleague at the hospital to sneak in an after-hours
ultrasound. The results felt like a brick landing on her stomach: another boy.
“I lay in bed and cried for weeks,” said Simpson, now 36, whose name has
been changed to protect her privacy. She took a job in the operating room so
she would no longer have to work with women who were giving birth to girls.
Simpson and her husband talked about getting an abortion, but she decided to
continue with the pregnancy. In the meantime, she looked for a way to
absolutely guarantee that her next child would be the daughter she had always
dreamed about. She discovered an online community of women just like her,
confiding deep-seated feelings of depression over giving birth to boys. The Web
forums mentioned a technique offered in the United States that would guarantee
her next baby would be a girl. It would cost tens of thousands of dollars,
money Simpson and her husband did not have. Simpson waited until her third son
was born. Then she began to make some phone calls.
The conventional wisdom has always been this: Given a choice, couples would
prefer sons. That has certainly been the case in places like China and India, where couples have used
pregnancy screening to abort female fetuses. But in the United States, a different kind of
sex selection is taking place: Mothers like Simpson are using expensive
reproductive procedures so they can select girls.
Just over a decade ago, some doctors saw the potential profits that could be
made from women like Simpson — an untapped market of young, fertile mothers.
These doctors trolled online forums, offering counseling and services. They
coined the phrase “family balancing” to make sex selection more palatable. They
marketed their clinics by giving away free promotional DVDs and setting up
slick websites.
These fertility doctors have turned a procedure originally designed to
prevent genetic diseases into a luxury purchase akin to plastic surgery. Gender
selection now rakes in revenues of at least $100 million every year. The
average cost of a gender selection procedure at high-profile clinics is about
$18,000, and an estimated 4,000 to 6,000 procedures are performed every year.
Fertility doctors foresee an explosion in sex-selection procedures on the
horizon, as couples become accustomed to the idea that they can pay to beget
children of the gender they prefer.
Inside a fourth-floor office suite off a palm-tree-lined street in Encino, Calif.,
in an embryology lab, two men wearing maroon scrubs peer into high-tech
microscopes. The men are fertilizing human eggs with sperm samples collected
earlier that day. After fertilization and three days of incubation, an
embryologist uses a laser to cut a hole through an embryo’s protective membrane
and then picks out one of the eight cells. Fluorescent dyes allow the
embryologist to see the chromosomes and determine whether the embryo is
carrying the larger XX pair of chromosomes or the tinier XY. The remaining
seven cells will go on to develop normally if the embryo is chosen and
implanted in a client’s uterus.
The lab is part of the Fertility Institutes, a clinic set up by Jeffrey
Steinberg, one of the most prominent gender selection doctors in the United States.
In his spacious, oak-paneled office down the hall, Steinberg is surrounded by
photos of his own naturally conceived children. His clinic is the world leader
for this gender selection technique, known as preimplantation genetic diagnosis
(PGD). “We’re by far number one. Number two is not even a close second,” he
said.
The United States
is one of the few countries in the world that still legally allows PGD for
prenatal sex selection. The procedure was designed in the early 1990s to screen
embryos for chromosome-linked diseases. It is illegal for use for nonmedical
reasons in Canada, the U.K., and Australia.
Steinberg’s gender-selection patients are typically around 30 years old,
educated, married, middle to upper class. They also typically have a couple of
children already, unlike the women in his waiting room undergoing in vitro
fertilization and hoping to conceive any child at all.
Statistics on gender selection are sparse. A 2006 survey by Johns Hopkins
University found that 42
percent of fertility clinics offered PGD for gender selection. But that was
half a decade ago, before many clinics undertook aggressive online marketing
campaigns to drive the demand.
Gender selection is the primary business at Steinberg’s Fertility
Institutes, with nurses casually asking couples in the waiting room whether
they, too, are interested in selecting the gender of their baby. Business
quadrupled when Steinberg started advertising PGD for gender selection.
Steinberg said he never intended to make gender selection his niche. But
then the ethics committee of the American Society for Reproductive Medicine, a
nonprofit organization that attempts to set standards in the industry, came out
against prenatal sex selection for nonmedical reasons in 1994. The group said
the practice would promote gender discrimination and was an inappropriate use
of medical resources. That made Steinberg angry.
“I took it on as a challenge,” he said. “The fact that they didn’t like it,
and the fact that I saw nothing wrong with it, made me more aggressive.”
He advertised in Indian-American and Chinese-American newspapers. Local
groups accused him of stoking cultural biases for boys in those communities,
and his ads were pulled by the publishers.
In 2009, Steinberg came under a worldwide media firestorm when he announced
on his website that couples could also choose their baby’s eye and hair color,
in addition to gender. He revoked the offer after receiving a letter from the Vatican.
Steinberg seems to enjoy the attention, whether good or bad. After all, the
publicity only helps bring in more patients to his clinics.
Many women who undergo PGD for gender selection discovered the procedure in
online forums. Reading the posts on these forums is like entering another
world. Users adorn their avatars with pink and princess imagery. They talk
about their desperation to have daughters. They share notes on the process of
going through PGD, recounting in detail their own experiences: blood-test
results, drug effects, in vitro cycles.
Daniel Potter, the medical director of the Huntington Reproductive
Center, has written more
than 1,000 posts for in-gender.com and answered forum members’ questions about
the procedure and its costs. He arranged in-person and phone consultations with
forum members, including Megan Simpson. In 2011, he even started a personal
website where he calls himself the “gender selection expert.”
From posting on message boards to using Twitter, Facebook, and YouTube,
fertility doctors have appropriated 21st-century marketing methods to bring a
21st -century technology to the masses. Competition is stiff for
search-friendly domain names for clinic websites and sponsored Google search
ads. For example, there’s genderselection.com, not to be confused with
gender-selection.com. There’s also gender-select.com and genderselectioncenter.com,
all websites maintained by fertility clinics promoting PGD. These sites are
filled with glossy stock photos of happy families, polished YouTube videos of
doctors making their pitch, and patient testimonials in numerous languages.
In May 2008, Simpson and her husband traveled to California
to undergo PGD at the Laguna Hills branch of the
Huntington Reproductive Center.
There, she met up with some of the women she had made friends with online. “We
went shopping and picked out girly clothes and dreamed of the day we could have
a baby to wear them,” Simpson recalled.
Three days after arriving in California,
Simpson underwent egg retrieval surgery. Eighteen eggs were retrieved; of
these, 11 were mature and were fertilized.
Her husband left after the surgery to return home and take care of their
three boys. After resting for five days, Simpson returned to the clinic for her
embryo transfer.
She was met with devastating news: all of her embryos were found to be
chromosomally abnormal. None were useable.
“I cried. And cried some more,” recalled Simpson. “All that money, the drugs,
the travel, time off work. The
money.”
Despite the financial and emotional setbacks, she wanted to try PGD again,
soon. Three months later, she was back in Laguna
Hills. She had taken out $15,000 on a line of credit
to pay for the second attempt.
She went through the whole process again. This time, the embryos were good
to go. An ultrasound was used to guide a catheter containing the embryos into
her uterus. Six days later, Simpson took a pregnancy test. It was positive.
When she was 15 weeks pregnant, she asked a friend at work to once again
sneak her into an after-hours ultrasound. Simpson was anxious, haunted by the
memory of her last ultrasound.
But this time, it was different. She was pregnant with a girl.
After nearly four years and $40,000, Simpson’s dreams of being a
“girl-mommy” were finally going to come true.
Simpson gave birth to her daughter during a home delivery in her bathtub in
2009. “The moment she was born, I asked if it was still a girl,” she recalled.
Simpson had to work six days a week right up until the delivery and months
afterward to repay the loan she took.
“My husband and I stared at our daughter for that first year. She was worth
every cent. Better than a new car, or a kitchen reno.”
Much of the evidence that Americans preferentially choose girls is
anecdotal, as no larger body tracks gender selection procedures. But data from
Google show that “how to have a girl” is searched three times as often in the United States
as “how to have a boy.” Many fertility doctors say that girls are the goal for
80 percent of gender selection patients. A study published in 2009 by the
online journal Reproductive Biomedicine Online found Caucasian-Americans preferentially
select females through PGD 70 percent of the time. Those of Indian or Chinese
descent largely chose boys.
So where does this preference come from? And with the sex-selection rhetoric
in the United States
centered around “family balancing,” a feel-good term that implies couples are
rationally planning their families, is it still sexist to choose for girls?
For Jennifer Merrill Thompson, the reasons were simple. “I’m not into
sports. I’m not into violent games. I’m not into a lot of things boys represent
and boys do,” she said. Thompson is the author of
Chasing the Gender
Dream, a self-published book that documents her use of gender-selection
technology to conceive her daughter.
Interviews with several women from the forums at in-gender.com and genderdreaming.com
yielded the same stories: a yearning for female bonding. Relationships with
their own mothers that defined what kind of mother they wanted to be to a
daughter. A desire to engage in stereotypical female activities that they
thought would be impossible with a baby boy.
The American Society for Reproductive Medicine says it’s concerned that
gender selection is leading otherwise healthy women to undergo unnecessary
medical procedures, and that fertility doctors might turn their attention away
from treating infertility to pursue a more lucrative specialty. And the group
points out the possible psychological harm to children born through gender
selection. They fear these children would be pressured to live up to the
stereotypes of the gender that was picked out and paid for by their parents.
“It’s high-tech eugenics,” said Marcy Darnovsky, director of the Center for
Genetics and Society, a Berkeley,
Calif. nonprofit focused on
reproductive technologies. “If you’re going through the trouble and expense to
select a child of a certain sex, you’re encouraging gender stereotypes that are
damaging to women and girls. …What if you get a girl who wants to play
basketball? You can’t send her back.”
Despite the objections from some medical ethicists, it seems that gender
selection, like many aspects of fertility medicine, will remain legal and
unregulated in the United
States.
