Desire a Son? PGD and Sperm Sorting a Booming Business in the USA

by Maureen Nandini Mitra

Arthur Yee wants a son.

“It’s important. As the oldest son in my family, it’s my duty to continue the bloodline,” says the Los Angeles based media professional whose wife, Kimme Setzo, is three months pregnant. Though he’d love to have a girl too, not having a son would diminish his status in his extended family, he says.

Yee comes from a traditional Chinese family that immigrated to the USA in the 1970’s. Like most first generation immigrants, his parents still cling to the cultural values of their original homeland where social norms favor sons. Hence parental pressure on Yee and Setzo to produce a boy is great. Setzo, though personally neutral about the gender of her forthcoming child, also hopes her first-born will be a boy, “just so that the pressure will be off.”

The couple has been trying to have a baby for a while. They opted for in-vitro fertilization (IVF) after Setzo suffered an ectopic pregnancy (where the embryo implants itself at a site outside the uterus) and miscarried. During the IVF process, Yee consulted their doctor about a procedure he had heard of called “pre-implantation genetic diagnosis” (PGD) that allows parents to select the sex of their offspring even before the embryo is implanted in the mother-to-be’s body. “They told me how they do it – by DNA sampling of embryos. But when you puncture the embryo to extract the fluid, you are actually endangering it. So I didn’t think it was worth it,” he says.

“In inexperienced hands you can end up damaging the embryo, but in experienced hands our loss rates of these embryos is less than one-tenth of one percent,” says Dr. Jeffrey Steinberg whose clinic, The Fertility Institutes, labels itself as “a leader world center for 100% PGD gender selection.” Yee and Setzo might have opted out, but hundreds of couples across the US and abroad are increasingly using PGD and sperm sorting, another new and sophisticated reproductive technology, to choose the sex of their babies even before they are conceived.

Initially developed to detect serious, often fatal, sex-related genetic disorders, the way these technologies are now used presents complex ethical challenges regarding gender discrimination, choice, and regulation.

Just an hour’s drive from Yee and Setzo’s home, The Fertility Institutes handles an average of 600 sex selection cases a year, half of them for international clients, usually from countries where embryo screening for gender and other non-medical reasons is banned. According to Steinberg, who’s been offering the service for fourteen years, business is booming.

Sperm sorting involves separating X-chromosome (female) sperm from Y-chromosome (male) sperm, and then using either male- or female-producing sperm to fertilize the ovum (female egg) through artificial insemination or in-vitro fertilization in order to produce offspring of the desired sex. In the USA, this technique is still under clinical trial at the Virginia based Genetics & IVF Institute and is tightly regulated by the Food and Drug Administration.

In the PGD process, several eggs are extracted from the mother and fertilized in-vitro with the father’s sperm. After three days, when several eight-cell embryos develop, one cell is removed from each embryo through a tiny straw one-quarter the diameter of the human hair, and screened for desired gender and genetic diseases. Healthy embryos of the desired gender are then implanted in the mother’s womb. So far, despite the risks involved, PGD has proved more effective in sex selection than the 74 to 88 percent success rate of sperm sorting. But, this technique also has drawbacks. Each PGD attempt comes with the hefty price tag of $18,000-$27,000 and often requires several attempts. Furthermore, in-vitro fertilization exposes the mother to significant risks, including potentially life-threatening ovarian hyper-stimulation syndrome (the excessive stimulation of the ovaries, a side effect of fertility medication) and multiple births.

Steinberg and other doctors offer these new sex selection techniques for what they call “family balancing” – helping a family with one or more child of one sex to conceive a child of the opposite sex. Human rights and women’s groups, however, accuse them of unabashedly promoting a practice viewed as an exercise of sexism at the most profound level – choosing who gets born. Biomedical ethicists and some doctors are critical of the practices because they believe it represents an early phase of eugenics, or genetic trait selection, and could lead to made-to-order babies. If it is okay to choose for sex, then how do you say it is not okay to choose for skin color or eye color or height?

One of the key critics of non-medical sex selection is Dr Mark Hughes who actually helped pioneer the PGD procedure more than a decade ago. Hughes believes doctors have “no business” helping families choose their child’s sex. “Your gender is not a disease the last time I checked,” he said during a television interview.

Any discourse on sex-selection has to take into account the implications of “son preference,” that is common to most patriarchal societies that value men over women. The prevalence of sex-selection practices in India, China, and other parts of Asia and its alarming effects on the gender ratio have been widely reported. In China, for instance, it is estimated that there are 123 boys to every 100 girls. A 2010 Chinese Academy of Social Sciences study predicts that in ten years one in five young men in China will be unable to find a wife. In India, the child sex ratio is 92.7 girls to every 100 boys.

But such a culture is not unique to Asia. Male-dominant power structures are common throughout the world. “There are a whole list of other countries that are at the heart of this global phenomenon that don’t get talked about,” says Sujatha Jesudason, executive director of Generations Ahead, an Oakland, CA, based group that focuses on the social and ethical questions surrounding reproductive technologies. There is increasing evidence of son preference in the USA, where sex selection via PGD and sperm sorting bring in an estimated $200 million in revenue every year.

Several recent studies of the 2001 US census data (by Columbia University and the University of Texas, among others) have revealed that sex selection is affecting gender ratios among Asian American, African American, and Hispanic communities within the country. Clinics offering sex selection cash in on this bias through slick marketing campaigns often targeted at specific ethnic communities. Advertisements touting PGD and sperm sorting often appear in Chinese and Indian newspapers with large readership with headlines like “Desire a Son?” and “Do you want to choose the gender of your next baby?”

Interestingly, newsletters and online testimonials for these clinics usually feature Caucasian couples who’ve chosen to have daughters. Yet doctors like Steinberg openly admit that Asian couples form a large part of their client base. “About 35-40 percent of our clients are from India and probably an equal number are Indian Americans,” he told me. “I think [PGD] is a safer, more humane alternative to the other options. Of course, the other option is infanticide which is to me repugnant,” he said, while acknowledging that son preference is a “deep-seated problem” in certain communities and did disturb him “a little.”

One of the key questions regarding sex selective practices is whether we should be regulating these technologies and if the government should play a role in setting these boundaries. Jesudason thinks government regulation could be one way to go, but it isn’t the best option. “If you have a regulation banning sex selection in place but you haven’t changed the mindset of people regarding gender equality, they will find ways to do it. India is a classic example of this,” she says. “The broader social goal should be that we change the context in which people are making such decisions.”

About the Author
Maureen Nandini Mitra is an independent journalist of Indian origin who divides her time between Berkeley, CA, and Calcutta, India. A journalism graduate from Columbia University, her work has appeared publications such as The New Internationalist, Sueddeutsche Zeitung, The Caravan, Economic and Political Weekly and Down to Earth magazine. Her website is

6 comments on “Desire a Son? PGD and Sperm Sorting a Booming Business in the USA
  1. Laxworthy says:

    While the idea of eliminating genetic disease is promising, the use of genetically modifying embryos could easily be used to alter the future generations of children with a little financial persuasion, and to me, that is frightening.

  2. CorWelsh says:

    Amazingly ironic that the doctor who helped make the procedure possible sees the controversy in actually deciding the sex of one’s child. This confirms a spiritual notion about science versus faith: just because you can doesn’t necessarily mean you should.

  3. Zee says:

    The whole idea kind of creeps me out and seems to lead down a path that we really don’t need to go.
    At the same time, I’m wary of governmental regulation because I heartily agree with Jesudason, we have to change the underlying reasons why. Regulation likely has a place in this, but I’m not sure what, because any restrictive laws/rules around reproductive health can too easily be turned against women.

  4. MaureenNandiniMitra says:

    @Zee: In light of the slew of anti-abortion legislations sweeping through the United States it is indeed going to be tough for the gender rights movement to take a stand on this matter, especially since abortion is still the most popular method of sex selection worldwide and in the US.
    Perhaps the way forward, as Jesudasan says, begins with acknowledging that gender discrimination exists and discouraging sex selective practices while also protecting women’s right to reproductive self-determination. However, as she herself admits, this “not an easy position for the reproductive rights movement and for the most part, most people, to understand or engage in.”

  5. Viv says:

    I remember visiting a doctor in Preet Vihar in Delhi for some business. In passing I told him my wife and I were expecting our first child – he offered me a free scan and a ‘solution’ if I needed one. Needless to say our contract wasn’t concluded but I am ashamed to admit that I didn’t really do anything more than walk away.
    Ten years passed and we had two daughters during that time. Holidaying in Delhi, on a whim I decided to visit his clinic and see how his practice was doing. Turned out that it was locked up by the police, the good doctor was under arrest and in jail serving a fairly long sentence.
    I suppose anything can be rationalised but it’s pretty clear to me that morally some of the doctors you’ve talked to should be cellmates with my own Preet Vihar friend.

  6. Megh Singh Rathore says:

    What is the cost of sperm soarting in India?

Leave a Reply

Your email address will not be published. Required fields are marked *