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Gender Vending

The urge to predetermine the sex of a baby is as old as our species. After Eve gave birth to Cain and Abel, she and Adam probably tried for a girl. But ask any expectant parents which sex they're hoping for, and you'll hear something like, "We don't care, as long as the baby's healthy." No doubt, this is the truth  -- but maybe not the whole truth.

In many countries, gender bias has long been embedded in cultural tradition, with society placing a higher value on male children. Boys carried on the family name; the eldest son inherited the family's wealth; males did the hard labor in factories and fields to bring in money; and male children married without having to supply a dowry. In modern-day America, however, these reasons rarely hold water.

So why the interest in choosing a future Dick or Jane? The answers vary. Some couples want to avoid passing on a hereditary disease that almost exclusively affects boys, such as hemophilia or Duchenne's muscular dystrophy. Others want to "balance" their family  -- they have two boys and dream of a girl, or want to give their two daughters a little brother. Regardless of the reasons, more and more prospective parents are expecting science to give them the power to choose the sex of their babies. And not surprisingly, given the rules of supply and demand, a number of laboratories have responded with a spate of sex-selection methods.


A Free Country?

Just because the technology exists doesn't mean that every couple should start planning their family tree. "Most doctors, including the American Society for Reproductive Medicine (ASRM), believe sex selection should be limited to circumstances where there is a medical need," says Robert Stillman, M.D., medical director of the Shady Grove Fertility Reproductive Science Centers, in Rockville, MD, and a member of ASRM's board of directors. In other words, if you want to play God, you'd better have a good reason. Other doctors have a more democratic view: "Our technique is mainly for people who want to choose their baby's sex, and I don't apologize for that," says Ronald Ericsson, Ph.D., creator of the albumin filtration method. "It's about human rights."

Who is allowed to access the latest technology is only one of the sticky ethical issues surrounding the practice of sex selection. What if the parents don't get the child of the sex they want? Would they welcome their baby all the same, or resent their child because he or she isn't the "right" sex? And then there's the hubris of messing with Mother Nature's carefully balanced gender mix. Doomsayers paint a scenario of a heavily male-populated country in which the birthrate plummets due to a lack of marriageable females.

Of course, no one can say for sure which sex would win the gender draft. But one thing is clear: Only a select portion of the population would get to pick the proverbial teams. The reason? High technology carries a high price tag. Some methods, such as preimplantation genetic diagnosis, run as much as $12,500 per trial. Others, such as flow cytometric separation, have a substantial margin of error, which means that you could ante up thousands of dollars and still not get the heir or heiress you desire. And, to make things worse, taking the high-tech road to conception is a decidedly unromantic process that can involve stirrups, large needles, and petri dishes. Do-it-yourself techniques based on timing or sexual positions are free (and presumably more fun), but according to many doctors, you get what you pay for.

So which method is the best? The answer depends on the prospective parents, their motivation, and their checking account. {C}