Preimplantation genetic diagnosis for gender selection: You don’t always get what you want

Tanmoy Mukherjee,Alan B Copperman,Lawrence Grunfeld,Eric Flisser,Benjamin Sandler,Jason Barritt

doi:10.4236/ojog.2012.23062

Abstract

Parenting children of opposite genders is a powerful motive for parents to seek “sex-selection” services. Medical beneficence and patient autonomy support making these services available. Our goals in this study included data to permit proper patient education, assess outcome, and evaluation of potential biases in this technology. IVF/PGD cases from August 2004 to December 2009 were studied (n = 122). FISH was used to analyze nuclear DNA of biopsied embryos. The variables analyzed were patient age, Day 3 Fluorescent In Situ Hybridization (FISH), the number of fertilized embryos, the number of embryos biopsied, Preimplantation Genetic Diagnosis (PGD) results, the number of embryos transferred, and the fate of remaining embryos. Female embryos were sought in 84 cycles, and male embryos desired in 38 cycles. Couples seeking female offspring had a reduced likelihood of a female-only transfer vs. those seeking males (p < 0.001). No transfer was performed in 32 cases for lack of normal embryos of desired gender. Clinical pregnancy rate per embryo transfer was 30.4%. PGD success rates for gender variety were lower than expected comparative to traditional IVF. In this report we present our clinical experience with IVF/PGD for gender selection. We attempt to analyze which patients seek this specialized treatment and to provide direct clinical and laboratory outcome data from our completed cycles.

Highlights

Application of preimplantation genetic diagnosis (PGD) during embryonic development to identify the presence of lethal genetic diseases in cycles of assisted reproduction (ART) produced the first human live births in 1990 [1]
In this report we present our clinical experience with in vitro fertilization (IVF)/Preimplantation Genetic Diagnosis (PGD) for gender selection
The incidence of patient interest in non-medical elective sex selection in the United States is difficult to estimate because the Society for Assisted Reproductive Technology (SART), the agency tasked with tracking the use and outcomes of in vitro fertilization (IVF) treatment in the US, does not denote PGD cycles undertaken for the purposes of gender selection [8,9,10,11]

Summary

Introduction

Application of preimplantation genetic diagnosis (PGD) during embryonic development to identify the presence of lethal genetic diseases in cycles of assisted reproduction (ART) produced the first human live births in 1990 [1]. In addition to detection of single gene defects, technical advances in single-cell genetic analysis, including single nucleotide polymorphism (SNP) array, comparative genomic hybridization (CGH), and whole genome amplification (WGA), may improve diagnostic precision and permit useful preimplantation genetic screening (PGS) in patients with recurrent pregnancy loss and unexplained in vitro fertilization (IVF) treatment failure, where chromosomal errors are the result of potentially de novo mutations or meiotic and mitotic aberrations [2,7,8,9,10,11]. The incidence of patient interest in non-medical elective sex selection in the United States is difficult to estimate because the Society for Assisted Reproductive Technology (SART), the agency tasked with tracking the use and outcomes of in vitro fertilization (IVF) treatment in the US, does not denote PGD cycles undertaken for the purposes of gender selection [8,9,10,11]. In contrast to preconception techniques for gender selection, such as sperm-sorting protocols, the issue of gender selection during cycles of assisted reproduction, and especially so in the absence of infertility or genetic disease, is complicated by cost scale, alloca-

Methods

Results

Conclusion