Sex selection: what role for providers.

“Are we having a boy or girl?” is one of the first things prospective parents wonder about the most. During pregnancy, couples wanting to know the sex of the future child may use ultrasound, chromosome analysis or testing of fetal DNA in maternal blood early in pregnancy, to find out the answer months before delivery. An estimated 50–70% of parents want to learn the sex of their future child during pregnancy [1]. The desire for a child of a particular sex is not a new story. Since the beginning of time, couples have attempted to use the various methods rumored to influence whether the child would be male or female. Actually selecting the sex, however, involves a different set of parental actions. Now, new genetic technologies — sperm sorting and preimplantation genetic diagnosis — allow couples to choose a baby's sex even before pregnancy begins. With people becoming parents later in life, desires for smaller families, and struggles with infertility, more people — of all cultures and backgrounds — may expect doctors to help them get exactly the family they want. The decision to use sex-selective technologies is motivated by a range of factors and may “look” different in different contexts and cultures. Most people assume that concerns about sex selection should be directed at traditional families and cultures where there is a strong bias for having a son. Due to strong cultural preferences for sons, marked sex ratio disparities have emerged in countries like China, Armenia, Azerbaijan, South Korea and India [2]. This lopsided preference for boys is often explained by gendered expectations that rely on sons to carry on the family name, support elderly parents, keep property within the family, perform specific religious rituals or contribute more to the family's economic status. But in the United States, it is more common for families to express a desire to experience particular “boy” activities or “girl” activities with their child. Sometimes parents say they want the “full parenting experience” by having at least one child of each sex. Using sex-selective technologies to achieve this goal is often referred to as “family balancing,” which some ethicists consider to be a justifiable use of sex