Can You Choose Sex with IVF?

In vitro fertilization (IVF) has been a game-changer for couples struggling with infertility. But let’s be real—some parents don’t just dream of having a baby; they dream of having a boy or a girl. And thanks to modern science, IVF can make that happen. Let’s take a look at how this process works.

Key Takeaways

• Determining the sex of an embryo in an in vitro fertilization cycle has been possible for many years through the use of preimplantation genetic testing.
• There are many situations in which it is medically necessary to select the sex of an embryo to prevent the transfer of a genetic disease, and many other prospective parents use the testing to choose the sex of an embryo due to personal preferences.
• Many countries (not including the United States) have banned elective sex selection for non-medical reasons, and medical organizations in the US have advised “ethical caution” for providers who offer the service.

IVF and Sex Selection

The sex of a baby is determined at conception by chromosomes. Women carry XX chromosomes, and men carry XY chromosomes. The sperm’s chromosome (X or Y) determines whether the baby will be a boy or a girl. In natural conception, it’s a coin flip. But IVF lets parents cheat the odds through a process called preimplantation genetic testing (PGT).

When conception happens, the baby's sex is determined by which type of sperm (X or Y) fertilized the egg first. However, with IVF, the process can be guided, allowing parents to have a say in their baby's sex.

With IVF, the ability to choose the sex of the baby has become more widely accepted. However, this isn’t possible in many countries, as some countries like Europe, Canada, India, and China have banned sex selection for non-medical reasons. 

While the USA has legalized it, the ethics surrounding the practice have been highly scrutinized. In a 2022 revision of their guidance on sex selection, the American Society of Reproductive Medicine states that sex selection for non-medical reasons requires serious ethical caution. 

Cost of IVF Sex Selection

Sex selection isn’t a free add-on. Expect to pay between $1,000 and $4,000 on top of the base IVF price, which already runs $12,000 to $25,000 per cycle. Some insurance plans cover genetic testing, but most parents pay out of pocket.

Reasons for Choosing Sex

Different reasons can make a prospective parent choose the sex of an embryo before implantation. While some would just like to have a specific-gendered baby or would like to balance their family gender-wise, other parents do it to prevent passing on sex-linked genetic disorders that can affect the baby’s development. 

Sex-linked genetic recessive disorders are carried genetically on the X chromosome. These disorders tend to impact male embryos, as they only have one X chromosome. By selecting the sex of the embryo before implantation, it is possible to reduce or eliminate the risk of these conditions. 

Examples of sex-linked genetic diseases include:

• Hemophilia.
• Duchenne muscular dystrophy.
• Red-green color blindness.
• Certain forms of high blood pressure. 

Sex Selection Work in IVF

Preimplantation genetic testing (PGT) is the best way to test for genetic disorders or predispositions for future complications. PGT looks at the embryos for genetic disorders before they are transferred into the uterus during IVF. PGT can be done at PNWF, where our healthcare professionals will take you through what you should expect. 

Gender selection is done before the embryo is placed into the woman’s uterus. A single cell is taken from the embryo using a biopsy. Once an embryo reaches Day 5 of development (with about 100 cells), specialists take a single cell for testing. This biopsy reveals the embryo’s full genetic makeup—including its sex.

When the lab identifies which embryos are XX (girls) and which are XY (boys), only the desired embryos are transferred into the uterus. This guarantees the baby’s sex before pregnancy even begins.

In other cases, sperm sorting is done. This is where doctors separate X and Y sperm before fertilization, but it’s not widely used in the U.S. because it’s not as reliable as PGT.

Preimplantation Genetic Testing (PGT)

There are two main PGT protocols used to identify an embryo’s sex with nearly 100 percent accuracy. These tests are performed on an embryo after five days of development. A tiny biopsy is taken from the embryo for genetic testing, which provides insight into a wide variety of conditions and risk factors. 

Preimplantation Testing for Aneuploidy

Pre-implantation genetic testing-aneuploidy (PGT-A) tests abnormalities in the number of chromosomes in an embryo’s genetic makeup. Each person has 46 chromosomes, including 22 pairs from each parent and two sex chromosomes. PGT-A can tell you an embryo's sex by looking at the sex chromosomes XY for males and XX for females.

Preimplantation Testing for a Monogenic Disorder

Pre-implantation genetic testing-monogenic (PGT-M), previously known as pre-implantation genetic diagnosis (PGD), is used to test for single-gene disorders. This test is extremely effective at detecting cystic fibrosis, sickle cell anemia, Tay-Sachs disease, and many other genetic conditions. It can also be used to identify abnormalities in the number of chromosomes found in the DNA of the biopsied tissue, which is one of the leading causes of early miscarriage.

Ethical Debates on Gender Selection

Sex selection stirs up serious ethical questions. Some concerns include:

• Does it reinforce gender bias? If parents overwhelmingly choose boys over girls, does that create a social imbalance?
• Are we heading toward ‘designer babies’? If we can choose sex now, will parents one day select height, eye color, or intelligence levels?
• Should nature be left alone? Some argue that gender selection meddles too much with natural conception.

Many countries (including Canada, China, and most of Europe) ban non-medical sex selection outright. The U.S. has no law against it, but medical organizations remain cautious about the practice.

Bottom Line: Should You Choose Your Baby’s Sex?

Science says you can. But should you? That’s a personal decision. If you're looking to prevent a genetic disorder, the benefits are obvious. If you're just hoping for a matching set of "one boy, one girl," the ethics get murkier.

Either way, it’s a powerful, controversial, and deeply personal choice—one that parents and doctors must navigate with care.