Sex Selection For Non-medical Reasons Research Articles

Legal Framework about Preconception Sex Selection in Muslim and non-Muslim Jurisdictions

The approval of preconception sex selection for medical purposes by prominent bodies of collective Ijtihad and Fatwa councils has not only granted legitimacy but also paved the path for its commercialization. While some scholars have advocated for permissibility of preconception sex selection for non-medical reasons, others deemed it strictly unlawful. In the meantime, the exponential expansion of IVF clinics has made this contentious utilization of technology readily available to the public. It has emerged as a contentious issue in recent medical-related legislation, within Muslim and non-Muslim jurisdictions alike. This paper explores the legal framework of sex selection legislation worldwide, with a particular focus on Muslim-majority countries. In this regard, the study delves into the legal frameworks surrounding sex selection in Pakistan, other Muslim and non-Muslim countries. The comparative resource presented here aims to assist policymakers and scholars, particularly in Muslim nations, in addressing this pressing issue by highlighting diverse approaches ranging from comprehensive bans to regulated permissions and ethical guidelines. By understanding the complexities of sex selection regulation within unique cultural and religious contexts, policymakers can develop informed strategies aligning with Islamic law, ethical considerations and societal needs.

P-348 Assisted Reproduction Legislation: Listening to the voice of Health Care Professionals

Abstract Study question To investigate the perceptions of health care practitioners in Ireland to a draft Assisted Human Reproduction (AHR) Bill, currently being assess by government. Summary answer There is strong support for AHR and for national legislation in this field among healthcare professionals working in Ireland. What is known already AHR legislation is essential to protect the rights of those accessing, born from and providing AHR services. Ireland is one of the only countries in the EU which lacks specific AHR legislation. The General Scheme of an AHR Bill was published in 2017 and is currently awaiting review and approval by government. Study design, size, duration An anonymous 25-item questionnaire was distributed via secure email link. This was a detailed 5-point Likert Scale questionnaire based on clinically relevant aspects of the Irish draft AHR Bill. Consultants and trainees in Obstetrics and Gynaecology were identified through The Institute of Obstetricians and Gynaecologists. A snow balling approach was used to recruit General Practitioners and all Fertility Clinics in Ireland were asked to distribute the questionnaire to their staff. The study remained open for 28days. Participants/materials, setting, methods Participants included Consultant and trainee Obstetrician Gynaecologists, general practitioners and multidisciplinary staff at Irish fertility clinics. The questionnaire focused on six key factors; a national AHR regulatory authority, AHR treatment type and availability, age limits for AHR treatment, counselling prior to ART, posthumous use of gametes and embryos and legislations surrounding surrogacy. Main results and the role of chance In total 245 responses were received. The majority of respondents were female aged 31-59years. 42.2% (n = 103/244) are currently working or had previous experience working with ART. 93% (n = 215/231) of respondents believe that Ireland should have a national authority to regulate AHR – similar to the Human Fertilisation and Embryology Authority (HFEA) in the UK. Over 80% of participants strongly agreed with access to IVF and gamete and embryo vitrification being available in Ireland. The majority of participants also supported oocyte and sperm donation (69% and 71% respectively). Support for more recent technologies in AHR was variable. Over 50% of respondents strongly disagreed with sex selection for non-medical reasons and less than half of participants strongly agreed with ART for single men and transgender males/females. 80.5% (n = 170/211) of respondents felt that there should be an upper age limit for women receiving access to ART and 64.5% (n = 136/211) felt there should be an upper age limit for men. Those who had experience working in an AHR clinic felt more strongly that sperm / egg donors should be paid a modest fee for donation (p = 0.04; p = 0.03 respectively) and that counselling should be mandatory for every person considering gamete donation (p = 0.0233). Limitations, reasons for caution Due to reliance on third parties in distribution of the survey to target groups, a response rate could not be calculated, a limitation of the study. A further limitation is the high detail of the survey questions, which seemed to lead to participant fatigue with later questions. Wider implications of the findings National legislation on AHR is both needed and desired by health care professionals working in Ireland. It is hoped that results of this study will help inform the proposed national AHR legislation as it nears completion and in turn, elevate Irelands low position in the European Atlas of Fertility Policies. Trial registration number not applicable

Use of reproductive technology for sex selection for nonmedical reasons: an Ethics Committee opinion

Because the practice of preimplantation sex selection is ethically controversial, clinics are encouraged to develop and make available their policies regarding its use. Practitioners offering assisted reproductive services are under no ethical obligation to provide or refuse to provide nonmedically-indicated methods of sex selection. This document replaces the document of the same name, last published in2015.

The effect of religious background on the attitude towards sex selection.

ObjectivesSurveys of the general population regarding sex selection using pre-implantation genetic diagnosis are limited and were mainly conducted in the United States and Northern Europe. In those Western societies, surveys have shown that people’s interest in using sex selection techniques is encouraged by the desire for a sexually balanced family. It is important to determine attitudes to sex selection in a wider range of countries especially that cultural differences exist among countries.Study designA questionnaire-based cross-sectional study regarding attitudes towards sex selection for non-medical reasons was designed. One thousand five hundred participants of the reproductive age group presenting to the Women s Health Center at the American University of Beirut Medical Center were offered to complete the survey. The questionnaire included demographic details, obstetric and infertility history, opinions regarding sex selection, personal interest in expanding the family, and personal interest in choosing the sex of a future child.ResultsThe response rate was 86.6%. Nineteen per cent of the respondents considered it strictly prohibited, 38.8% considered the technique acceptable only if medically indicated while 33.4% believed that it should be available to all those who request it. Multivariate logistic regression on the predictors of the variable affecting the attitudes towards sex selection showed that the educational level, religious disapproval and the desire of the opposite sex of the already existing children were the only significant predictors.ConclusionThe middle-eastern multi-religious population studied has a negative attitude towards sex selection through pre-implantation genetic diagnosis. Religion, educational status and desire of children of both genders were identified as the significant predictors of the decision whether to accept sex selection or not.

Preimplantation embryos sex ratios in couples with four or more children of same sex, what should be expected from a preimplantation genetic diagnosis cycle?

Our aim was to assess the preimplantation embryos’ sex ratios in couples with four or more children of same sex, undergoing sex selection for nonmedical reasons. We conducted a cohort-historical study of all consecutive patients admitted to the IVF-PGD program in a large tertiary center. We reviewed the computerized files of all consecutive women admitted to our IVF for sex selection for nonmedical reasons. Patients and their PGD cycle characteristics were compared according to the desired sex of their embryo and the mode of fertilization. Nine patients underwent a total of 19 PGD cycle attempts during the study period. Of the 77 embryos with complete molecular diagnosis, 41 revealed a male embryo and 36 a female embryo. Thirty-five percent of all the diagnosed embryos were of the desired sex. For couples desiring a boy, IVF cycles achieved a higher ratio of the desired embryonal sex compared to ICSI (52% vs 18.7%, p = .03). For couples desiring a girl, ICSI cycles had a higher percentage of the desired embryonal sex compared to IVF cycles (38% vs 23%). Moreover, 29.7% of ICSI and 40% of IVF embryos achieved the desired sex. In conclusion, PGD for sex selection results in a relatively low percentage (35%) of embryos demonstrating the desired sex. Nonetheless, selecting the mode of fertilization (ICSI/IVF) might improve the success rate. Further studies are required to explore the appropriate and cost-effective method for sex selection for nonmedical reasons.

Izbor pola budućeg deteta iz nemedicinskih razloga u svetlu zaštite ljudskih prava

Despite the troubling data that points to population imbalance, more precisely, increased number of born males in many countries, the issue of sex selection for non-medical reasons was not addressed adequately from the human rights protection perspective. Sex selection is also complex ethical issue. One of the most common arguments used in favor of non-medical sex selection, is that the ban of sex selection will simply limit reproductive freedom. Many supporters of non-medical sex selection defend the practice by relying on the reason of 'family balancing'. However, this reason does not seem to be eligible to justify selection. Problem of reproductive tourism is also present, due to the different approaches of the countries in regulating non-medical sex selection. More precisely, people are traveling to countries where respect for individual autonomy plays dominant role. In addition, there is a simple option to send samples for analysis to companies that advertise genetic testing over internet. In the context of human rights protection, only the Convention on Human Rights and Biomedicine has ban on sex selection for non-medical purposes, however, this ban applies only to specific, less practiced technique of selection. When it comes to other techniques of selection, Article 5 (a) of the Convention on the Elimination of All Forms of Discrimination against Women might be helpful to some extent. The issue of non-medical sex selection was in the focus of interest of the United Nations, Council of Europe and European Union to some extent, however insufficiently.

How Sex Selection Undermines Reproductive Autonomy.

Non-medical sex selection is premised on the notion that the sexes are not interchangeable. Studies of individuals who undergo sex selection for non-medical reasons, or who have a preference for a son or daughter, show that they assume their child will conform to the stereotypical roles and norms associated with their sex. However, the evidence currently available has not succeeded in showing that the gender traits and inclinations sought are caused by a "male brain" or a "female brain". Therefore, as far as we know, there is no biological reason why parents cannot have the kind of parenting experience they seek with a child of any sex. Yet gender essentialism, a set of unfounded assumptions about the sexes which pervade society and underpin sexism, prevents parents from realising this freedom. In other words, unfounded assumptions about gender constrain not only a child's autonomy, but also the parent's. To date, reproductive autonomy in relation to sex selection has predominantly been regarded merely as the freedom to choose the sex of one's child. This paper points to at least two interpretations of reproductive autonomy and argues that sex selection, by being premised on gender essentialism and/or the social pressure on parents to ensure their children conform to gender norms, undermines reproductive autonomy on both accounts.

WHAT ROLE SHOULD PUBLIC OPINION PLAY IN ETHICO-LEGAL DECISION MAKING? THE EXAMPLE OF SELECTING SEX FOR NON-MEDICAL REASONS USING PREIMPLANTATION GENETIC DIAGNOSIS.

In this article, we consider the prohibition on the use of preimplantation genetic diagnosis to select an embryo on the basis of its sex for non -: medical reasons. We use this as a case study to explore the role that public consultations have and should play in ethico-legal decision-making. Until the Human Fertilisation and Embryology Act 1990 was amended by the Human Fertilisation and Embryology Act 2008, non-medical sex selection of an embryo was not statutorily regulated, but it was the policy of the Human Fertilisation and Embryology Authority that such selection should not occur. However, since 2009, it has been a criminal offence to select an embryo on the basis of its sex for non-medical reasons. We consider the reasons given for this change and explore the role that 'public opinion' had in the decision-making process. On the face of it, asking the public what they think seems reasonable, fair and democratic, and those who are not in favour of public consultations being accorded great weight in matters of policy may appear out of touch and as wanting to impose their moral views on the public at large. But there are problems with doing so, especially when seeking to regulate ethically controversial issues. We discuss whether regulation should be influenced by public opinion obtained via 'public consultations', and utilise sex selection for non-medical reasons as an example of how (apparently) public opinion was used to support the criminalisation of this practice.

Use of reproductive technology for sex selection for nonmedical reasons

Because these practices are ethically controversial, clinics are encouraged to develop and make available their policies on the provision of nonmedical sex selection, and to accommodate their employees' decisions about whether or not to participate in such treatment. Practitioners offering assisted reproductive services are under no ethical obligation to provide or refuse to provide nonmedically indicated methods of sex selection. This document replaces two documents previously published by the ASRM Ethics Committee, titled, "Sex selection and preimplantation genetic diagnosis" (Fertil Steril 2004;82:S245-8) and "Preconception gender selection for nonmedical reasons" (Fertil Steril 2004;82:S232-5).

ESHRE Task Force on ethics and Law 20: sex selection for non-medical reasons

This Task Force document revisits the debate about the ethics of sex selection for non-medical reasons in the light of relevant new technological developments. First, as a result of improvement of the Microsort® flow cytometry method, there is now a proven technique for preconception sex selection that can be combined both with IVF and IUI. Secondly, the scenario where new approaches that are currently being developed for preimplantation genetic screening (PGS) may lead to such screening becoming a routine part of all IVF treatment. In that scenario professionals will more often be confronted with parental requests for transfer of an embryo of a specific sex. Thirdly, the recent development of non-invasive prenatal testing based on cell-free fetal DNA in maternal plasma allows for easy and safe sex determination in the early stages of pregnancy. While stressing the new urgency that these developments give to the debate, the Task Force did not come to a unanimous position with regard to the acceptability of sex selection for non-medical reasons in the context of assisted reproduction. Whereas some think maintaining the current ban is the best approach, others are in favour of allowing sex selection for non-medical reasons under conditions that take account of societal concerns about the possible impact of the practice. By presenting these positions, the document reflects the different views about this issue that also exist in the field. Specific recommendations include the need for a wider delineation of accepted 'medical reasons' than in terms of avoiding a serious sex-linked disorder, and for a clarification of the legal position with regard to answering parental requests for 'additional sex selection' in the context of medically indicated preimplantation genetic diagnosis, or routine PGS.

Ethical Attitudes of German Specialists in Reproductive Medicine and Legal Regulation of Preimplantation Sex Selection in Germany

BackgroundBecause of its ethical and social implications, preimplantation sex selection is frequently the subject of debates.MethodsIn 2006, we surveyed specialists in reproductive medicine in Germany using an anonymous questionnaire, including sociodemographic data and questions regarding ethical problems occurring in the practice of reproductive medicine. Most questions focused on preimplantation sex selection, including 10 case vignettes, since these enabled us to describe the most difficult and ethically controversial situations. This is the first survey among specialists in reproductive medicine regarding this topic in Germany.Results114 specialists in reproductive medicine participated, 72 males (63%) and 42 females (37%), average age was 48 years (age range 29–67 years). The majority of respondents (79%) favoured a regulation that limits the use of preimplantation sex selection only for medical reasons, such as X-linked diseases (including 18%: summoning an ethics commission for every case). A minority of 18% approved of the use of sex selection for non-medical reasons (4% generally and further 14% for family balancing). 90% had received obvious requests from patients. The highest approval (46%) got the counselling guideline against a preimplantation sex selection and advising a normal pregnancy, if preimplantation sex selection would be allowed in Germany. The majority (67%) was opposed the personal use of preimplantation sex selection for non-medical reasons, but would think about it in medical cases. In opposite to woman, 14% of the men were in favour of personal use for non-medical reasons (p = 0,043). 25% of specialists in reproductive medicine feared that an allowance of preimplantation sex selection would cause a shift in the sex ratio.ConclusionsThe majority of German specialists in reproductive medicine opposes preimplantation sex selection for non-medical reasons while recommending preimplantation sex selection for medical reasons, e.g. X-linked diseases like haemophilia.

Reproduction opportunists in the new global sex trade: PGD and non-medical sex selection

Regulatory differences between countries are an important driver of the cross-border trade in assisted reproduction as people move to seek services unavailable in their home countries. The development of a lucrative global trade in non-medical sex selection needs to be considered in ethical debates over its availability. I suggest that depictions of non-medical sex selection as a means of ‘family balancing’ or supportive of reproductive autonomy serve to distance the technologies rhetorically from the gender stereotyping inherent in their use and the commodification upon which they depend. They construct new social categories such as the ‘unbalanced’ family, the pathologization of ‘gender disappointment’ and a limited and highly individualized definition of reproductive freedom that permits medical interventions on healthy bodies. Orientalism pervades ethical debate depicting non-medical sex selection in the West as more acceptable to practices in ‘Asia’. A case study of the interconnections between Australia and Thailand highlights the global economy sustaining the practice. A lucrative trade exists as patients move across border to avail themselves of reproductive technologies that are unavailable in their home countries due to regulatory differences. This paper considers the trade in one such technology, preimplantation sex selection for non-medical reasons (social sex selection) which is banned or regulated in most countries, but in some settings is available due to a lack of regulations and has become a ‘market advantage’ for some clinics. I suggest that these technologies are inherently gender discriminatory and that our ethical discussions need to include considerations of the commodification of sex characteristics inherent in this new trade. I argue that descriptions of these technologies as a means of ‘family balancing’ or supportive of reproductive autonomy construct new social categories such as the ‘unbalanced’ family, the pathologization of ‘gender disappointment’ and a limited and highly individualized definition of reproductive freedom. They try to characterize sex selection in the West as more acceptable than that carried out in Asian countries. A final case study of the trade between Australia and Thailand highlights the global economy of these technologies.

Avoiding transgenerational risks of mitochondrial DNA disorders: a morally acceptable reason for sex selection?

In this article, we discuss sex selection not intended to help a couple avoid having a child with a severe genetic disorder, but to avoid possible health risks further along the line of generations. Sex selection may be put to this use in the context of preventing mitochondrial DNA disorders by means of preimplantation genetic diagnosis (PGD) and possibly in the future also through nuclear transfer (NT; also known as mitochondrial gene replacement). A relevant analogy can be found in the context of PGD for X-linked diseases, where sex selection against healthy female carrier embryos would have the same 2-fold purpose of (i) avoiding difficult reproductive decisions for the future child and (ii) avoiding transmission of the mutation to a possible third generation. Because sex selection would still be done for reasons of health, this application should not give rise to the moral concerns associated with sex selection for non-medical reasons. However, the proportionality of adding the relevant procedures to PGD or NT is a relevant concern. We discuss post- and preconceptional sex selection strategies. We conclude that if PGD is already part of the procedure, either as the central technology or as a back-up test after NT, preferentially transferring male embryos could in principle be a morally acceptable way of reducing possible burdens and risks. To start an IVF/PGD-cycle especially for this purpose would be disproportional. The alternative approach of preconceptional sex selection may be morally justified as a means to increase the chances of obtaining male embryos.

Towards an Ethical Policy for the Prevention of Fetal Sex Selection in Canada

The troubling practice of fetal sex selection has historically been considered an Asian phenomenon. However, recent evidence shows that a similar situation is emerging in North America, albeit on a smaller scale. The Society of Obstetricians and Gynaecologists of Canada has firmly stated its opposition to sex selection for non-medical reasons, as well as to the use of any technology used solely for the purpose of determining fetal sex. However, because fetal sex may be disclosed to the parents at the time of ultrasound examination if they request this information, guidance for health care professionals to assist in discouraging fetal sex selection would be useful.Because no declaration of motives or reasons is required when a woman seeks a termination of pregnancy, we suggest that health care professionals need not disclose the sex of a fetus until it has reached a gestational age at which abortion for non-medical purposes would not be possible. This proposal would facilitate consistency between clinical practice and the values of Canadian citizens, the SOGC, the Canadian Medical Association, and other professional organizations, while still respecting current laws pertaining to disclosure of patient information and patients’ rights to autonomous decision-making.

Sex preference and interest in preconception sex selection: a survey among pregnant women in the north of Jordan

Preconception sex selection for non-medical reasons is a controversial issue in bioethics. Little research has described preferences for preconception sex selection among Arab populations. This study describes the sex preference and interest in employing sex selection techniques among pregnant women in northern Jordan. A self-reported questionnaire was administered to 600 pregnant women in Irbid, Jordan. chi(2) test and binary logistic regression were used to examine the factors associated with interest in preconception sex selection. In general, the interest in using sex selection was low. Women who preferred boys were more likely to be interested in sex selection, if paid for by the couple [odds ratio (OR) = 4.40, 95% confidence interval (CI): 1.75-11.11] or by health insurance (OR = 3.42, 95% CI: 1.94-6.06), or, if feasible, administered through oral medication (OR = 8.84, 95% CI: 5.05-15.63). Women with lower education were more likely to be interested in sex selection, if paid by health insurance (OR = 1.96, 95% CI: 1.10-3.45) and were more likely to believe that sex selection is legal (OR = 1.79, 95% CI: 1.06-2.86). Women who had no boys were more likely to be interested in sex selection, if paid by health insurance (OR = 1.94, 95% CI: 1.10-3.42) or, if feasible, through medication (OR = 3.03, 95% CI: 1.82-5.00). The majority of participants were not in favor of using preconception sex selection. Those with a preference to have boys, with lower education, and those with an imbalanced family were more likely to be interested in using sex selection technology.

Sex Selection by Preimplantation Genetic Diagnosis (PGD) for Nonmedical Reasons in Contemporary Israeli Regulations

We report here on recent developments in Israel on the issue of sex selection for nonmedical reasons by preimplantation genetic diagnosis (PGD). Sex selection for medical reasons (such as in cases of sex-linked genetic diseases) is generally viewed as uncontroversial and legal in European and American law. Its use for nonmedical reasons (like “balancing” the gender ratio in a family) is generally illegal in European countries. In the United States, it is not illegal, although in the opinion of the Ethics Committee of the American Society for Reproductive Medicine (ASRM), it is problematic. This position is undergoing reconsideration, albeit in a limited way.

Ethical objections to sex selection for non-medical reasons

This paper examines the main ethical argument used to support the use of sex selection for non-medical reasons, namely that sex selection for non-medical reasons should be allowed on the grounds of reproductive autonomy. A critique of this argument is offered, concluding that sex selection for non-medical reasons should not be permitted.

The ethics of preimplantation genetic diagnosis

Key content Preimplantation genetic diagnosis (PGD) is an alternative to prenatal diagnosis and termination of affected pregnancies. PGD for late‐onset and susceptibility conditions requires careful consideration on a case‐by‐case basis. PGD for sex selection for nonmedical reasons is prohibited in the UK. The use of PGD is expanding and its ethical implications are likely to increase. Learning objectives To recognise the main ethical difficulties raised by the practice of PGD. To understand the role of regulation. To appreciate the potential ethical implications of new developments in reproductive genetics. Ethical issues Is PGD more acceptable than prenatal diagnosis and termination for all disorders? Should PGD be offered for Huntington disease on a nondisclosure basis? Should noncarrier embryos be replaced in preference to carrier embryos in recessive conditions? Is PGD for HLA typing a step too far? Please cite this article as: El‐Toukhy T, Williams C, Braude P. The ethics of preimplantation genetic diagnosis. The Obstetrician & Gynaecologist 2008;10:49–54.

Preconception sex selection: a survey of visitors to an internet-based health forum

The aim of this survey was to explore the attitudes towards gender selection, focusing on people who were affected by infertility and also familiar with advanced technologies such as the internet. A questionnaire was posted on a German internet site targeting infertile people with a wish for a first or another child. Nearly all respondents (736/742) were female. Most respondents (82.7%) were firmly against sex selection if the techniques used would require several treatment cycles and corresponding costs for the couple. Even if, hypothetically, sex selection could be achieved by simply taking a ‘pink’ or ‘blue’ pill before intercourse, only 19% would take this option. More respondents had some interest, if any, in conceiving a girl as first child or next child (27% girl versus 11% boy). A positive attitude towards sex selection was more likely if the respondents had a preference for either a boy or a girl (odds ratio [OR] = 12.8, P < 0.01) and, or had an unbalanced family (OR = 1.8, P = 0.03). Although this survey is based almost exclusively on answers from women, it seems reasonable to conclude that a widely available service for preconception sex selection for non-medical reasons would not cause a severe gender imbalance in Germany.

Preimplantation Genetic Diagnosis: Rationale and Ethics, an Islamic Perspective

DOI: http://dx.doi.org/10.5915/39-4-6316 Preimplantation genetic diagnosis (PGD) is a relatively new procedure meant to diagnose genetic or chromosomal defects in fertilized eggs produced by in vitro fertilization (IVF) so as to avoid implanting an embryo. It has also been used to diagnose mutations associated with several types of cancer. One or two blastomeres are removed from the preembryo (8-16 cell morula stage). A polymerase chain reaction (PCR) procedure tests for genetic mutations, and fluoresence in situ hybridization (FISH) tests for chromosomal abnormalities. The various clinical applications of PGD are presented and classified into acceptable, questionable, and unacceptable. The main advantage of PGD is that it will eliminate or significantly reduce the risk couples with genetic diseases face of having a baby with those diseases, thus avoiding some terminations of pregnancy. However, PGD raises significant ethical issues, the most important of which is the sanctity of human life. While PGD does not result in loss of biopsied healthy preembryos, it involves discarding of affected human embryos. The arguments for and against this are discussed in detail. Further, the implications of PGD on a societal level and the danger of using it for eugenics are also discussed. While the use of PGD for sex selection for medical reasons is acceptable, its use for nonmedical reasons is controversial. Islam encourages scientific developments as long as they benefit humankind and do not contradict basic Islamic rulings. Most Muslim scholars approve of PGD use as it involves a preembryo before it is implanted and allows for benefits to the couple involved, i.e. the prevention of having a baby with genetic diseases. They do not approve of its use for sex selection for nonmedical reasons.