Getting The Girl
There is nothing sleek or high-tech about this third-floor conference room in Fairfax, Va., except, perhaps, the bright red laser pointer that skitters across the eerie greenish slide of phosphorescent sperm. The projector jams periodically during the hourlong presentation, and the central air-conditioning can’t keep up with the late-spring heat, so some very low-tech fans are brought in to move the muggy air around in circles.
The crowd — about 40 people, mostly couples, mostly in their mid-30’s, nearly all of them paying a baby sitter so they can be here — shifts and rustles in the hodgepodge of chairs. One very pregnant woman in the second row (planning ahead, for the baby after this one) fans her face with the cardboard information packet, creating a breeze in the most old-fashioned way.
There is, to be sure, a very high-tech laboratory downstairs, but it is highly unlikely that any of these people (What shall I call them? Clients? Patients? Research subjects?) will ever be allowed to see it. At its center is a flow cytometer, a beige box of a machine about the size of an L-shaped office desk that spends all day, every day, sorting sperm. Using fluorescent dyes followed by zaps from an ultraviolet laser, it separates sperm that carry X chromosomes (which create female embryos) from those that carry Y chromosomes (which create male embryos). It is a sensitive and delicate piece of technology, and the slightest change in room temperature, even the breeze created by too many people walking about, can alter the results. So no one, other than the masked-and-gloved lab technician, is allowed in the room while the sorting is going on.
The process — known and now trademarked as Microsort — has been used in cattle for more than a decade. The Genetics and I.V.F. Institute, an infertility clinic with a reputation somewhere between cutting edge and maverick, is the only place in the world authorized to use it on humans. Scientists don’t like the word ”experiment,” with its Frankensteinian overtones, but that is precisely what is under way here. On this day in late May, only 111 pregnancies and 46 births have resulted from the Microsort method, and that means there is not yet enough data to declare it safe for widespread use and to bring it to a for-profit clinic near you. To reach that statistical comfort level, Edward Fugger, the aw-shucks Texas native who runs Microsort, estimates that he will need to engineer several hundred more births. These 40 people, like the hundreds of others who have called and E-mailed and scheduled appointments since the clinical trial became public last fall, have come to this conference room to learn how to sign up.
They are here for a constellation of reasons: perhaps they want a little girl, to balance a houseful of boys; or maybe they want a little boy, to carry on the family name. Could be they are carriers of genes for diseases that can be inherited only by boys. But whatever the specifics of the yearning, it all boils down to the same thing: they want to help dismantle one more barrier of nature, to be among the first to cross yet another Rubicon of science, to make a breathtaking leap in the evolution of human reproduction. They want to do what generations before them have sought to do, and what generations after them may routinely do. They want to choose the sex of their next child.
And why am I here? The simpler of my answers is that I am a reporter. I specialize in subjects like these — stories about the collision between what technology can and should make possible. I have written a book about medical ethics, and I know all the arguments against this manipulation of nature, arguments that are rallied increasingly as this dizzying decade transforms so much of science fiction into fact.
Along the way, I have developed a healthy fear of the ”slippery slope” — if we allow parents to choose the sex of their child today, how long will it be before they order up eye color, hair color, personality traits and I.Q.? I understand the risks of tampering with nature, as they do in China, where the population has been so drastically skewed (through abortion and infanticide) that at one point there were 153 boys to every 100 girls. I cringe at the idea of treating human beings as a commodity — pay Microsort $2,500 (per try, not per pregnancy; the average pregnancy takes three tries) and purchase the sex of your choice. And I am all too aware that to people with real problems — couples who cannot have children, couples whose children are injured or ill — this talk of sperm sorting sounds shallow and vain.
I know all this . . . and yet, I am also the mother of two sons. I love my boys fiercely, and I cannot imagine the world without them. But I always thought — always assumed — that I would have a daughter. Emma, I called her during our silent conversations. Emma, or maybe Emily. And her middle name would be Penina. It means ”pearl” in Hebrew, and that was my favorite grandmother’s name.
I bought Emma clothes during my first pregnancy. A dusty pink dress, falling in folds from the lacy Peter Pan collar, which stirred a memory of something I think I wore when I was a toddler. Also a blue-and-white polka-dot number, with matching navy leggings, because rearing my strong, feminist daughter would mean freedom to climb and freedom from pink. I tucked Emma’s outfits into the far reaches of the closet, and over the years — it has been eight years now — I have found them during periodic cleaning sprees. I always hesitate for a moment, then brush them lightly with my fingers and hang them back in place.
A family of two children was always our plan, our goal, the symmetrical box within which my husband and I have built our life. We are comfortable in there. And yet . . . I’ve always said — always joked — ”If someone could guarantee me a girl. . . .” Now here stands Fugger, with his crew cut and his cowboy boots, aiming his laser pointer at his slides of glowing sperm and claiming a 93 percent success rate for couples seeking to conceive a daughter.
That is not a guarantee, of course, but it is as close to one as the world has ever been offered. (I am not counting a method known as preimplantation genetic testing, in which embryos are grown to the eight-cell stage in a petri dish and only those of the desired sex are implanted in the uterus; this process determines sex with absolute certainty, but the cost is so prohibitive, and the process is so invasive, that its use, at least thus far within the United States, has been limited to couples with genetic or reproductive disorders.) Microsort is not an absolute, but it takes choosing the sex of a child out of the realm of how-to books and old wives’ tales and hurtles it into the realm of available and quantifiable science that is affordable to many.
We care about the sex of our children. Some of us care more than others, but we all care. It is the first question asked about a baby, almost from conception, certainly at the moment of birth. Any preference has always been but a wish, a dream, sometimes a throbbing unspoken regret. Now those of us who choose to take the controls are being handed them.
And that is why I am here, scribbling, hiding behind my notebook. I want to explore what this means for science, for society. And I need to explore what it means for my family and myself.
Humans have sought to influence the sex of their babies for nearly as long as there have been humans. In ancient Greece, men believed they could have a boy if they had sex while lying on their right sides. Thousands of years later, in 18th-century France, men had made rather dubious progress and would tie off their left testicles to ”guarantee” having a boy. One Italian grandmother told an acquaintance of mine: ”You make the baby when the moon wax, you have the boy. When the moon she wane, you have the girl. You put the knife under the bed for the boy, you put the egg for making the girl.”
In more modern America, at the end of the 20th century, an ob-gyn named Landrum B. Shettles has sold more than one million copies of ”How to Choose the Sex of Your Baby,” first published in 1970. His method is based on the theory that male sperm move faster and die sooner, while female sperm move slower and live longer.
Shettles, who will turn 90 this year and now lives in Las Vegas (the land of playing the odds) gives detailed instructions, not only about the timing of intercourse (three days before ovulation for a girl, the day of ovulation for a boy) but also about sexual positions and whether or not the woman should have an orgasm. His is a complicated (and sometimes very messy) approach, and its followers make use of everything from egg whites and Robitussin to coffee and beer.
Shettles’s chief rival over the years has been Ronald J. Ericsson, whose own method involves layering live sperm over an albumin-based medium — thicker for Y-bearing sperm, thinner for X-bearing ones — and then using the resulting distillate for artificial insemination. Ericsson, who is 64, lives on a ranch in the Black Hills of Wyoming, where he oversees 1,000 cows. He has licensed the Ericsson method, and there are currently 28 fertility clinics in the United States and 15 more around the world charging up to $1,100 per procedure.
Ericsson says that the rate of success of the 2,500 births reported by these clinics is 73 percent for couples seeking girl babies and ”in the low 80’s” for those seeking boys. (He adds, however, that getting those clinics to return their data ”is like pulling teeth.”) Shettles, in turn, claims a success rate of at least 75 percent for both sexes and says he bases that number largely on the more than 25,000 questionnaires returned to him over the years by readers of his book.
Although both men cite long lists of evidence that they say support their theories, the medical establishment has long dismissed methods of sex selection as so much hocus-pocus. It is an attitude that extends beyond just Shettles and Ericsson, to include a universe of offerings — the half-dozen other how-to books currently listed on amazon.com; the many money-back guarantees available on the Internet; the ancient Chinese birth calendar, which legend says has been buried in a tomb outside Beijing for 700 years. (By its reckoning, I should have had two girls.)
”They don’t work, nothing works,” says Dr. Alan DeCherney, chairman of the department of obstetrics and gynecology at the University of California at Los Angeles and editor of the medical journal Fertility and Sterility.
Which is why it is striking how quickly the establishment has responded to the news out of Fairfax, Va. Not all doctors approve of the technology, and most want to know much more, but from the first announcement of the earliest results, they have considered Microsort to be real science.
”It’s in a different category from everything else,” says Dr. Alan Copperman, director of reproductive endocrinology at the Mount Sinai Medical Center in Manhattan. ”It is not a scam.”
He is reassured, he says, by the fact that the first Microsort results were published in Human Reproduction, ”a reputable peer-reviewed journal,” but he notes that it was only one study and a small one at that. Of 14 couples using Microsort to conceive a girl, 13 were successful. ”I hope that over the years we can see numbers large enough to call it safe,” Copperman says, adding that he does not foresee ever offering it to his own patients. ”But you can definitely call it science.”
Like much technology, this science began with a narrow, lofty goal — to help couples who are carriers for a specific subset of genetic flaws. There are 350 ”X-linked” genetic disorders — conditions like hemophilia and Duchenne’s muscular dystrophy, which are most prevalent in boys. If an affected couple can be guaranteed a girl, they can be spared the wrenching decision of whether or not to terminate a second-trimester pregnancy.
In the early 1990’s, there were no such guarantees. Fugger was the head of the cryobank at Genetics and I.V.F. at the time and had just pioneered the earliest use of frozen embryos for in vitro fertilization. Looking for his next project, he approached Lawrence Johnson, a scientist at the Department of Agriculture who had developed a machine for sperm sorting in farm animals. Female sperm, in all mammals, have more genetic material than male sperm, meaning they are larger, and Johnson’s flow cytometer first dyed the sperm and then passed them one by one through a narrow opening. As they shuffled along they were zapped with a laser. The X-bearing sperm glowed more brightly, and the machine used that difference to sort X from Y.
Johnson began his experiments in cattle and swine. By the time Fugger called, the flow cytometer had been used in the births of 400 animals, including sheep, pigs, rabbits and cows. The offspring born of the method appeared normal, as did the subsequent generation, so Genetics and I.V.F. licensed it from the U.S.D.A. and proceeded to figure out to how use the same techniques on people.
First, the machinery had to be fine-tuned. In humans, the gap between the size of X-bearing and Y-bearing sperm is only 2.8 percent, far smaller than the difference in most animal species, and therefore much more difficult to sort. It took nearly two years to adapt the flow cytometer to account for the smaller difference. Additional testing was also required, to explore the effects of the dye and the laser on human DNA — the effects that still concern doctors like Copperman as well as many potential patients.
”The particular dye we use is nontoxic,” Fugger says. He answers defensively, and admits it is a question asked by prospective parents and one reason many choose not to proceed at this time.
”It’s reversible,” he continues. ”Which means it goes in, and when you dilute it with solution it comes out. Another key factor is, it doesn’t bind on the inside of the DNA — it binds on the outside of the minor group of DNA. While there’s still a lot unknown about it, the preliminary tests that we used before we started on humans, and the fact that there were all the normal animals born using the same dye in the same concentration, that was our rationale.”
It was a sufficient rationale to satisfy the clinic’s institutional review board, which, following F.D.A. guidelines, approved a clinical trial in 1993. The first human Microsort baby arrived in 1995. She was a girl, born to a woman who had lost two brothers and two sons to X-linked hydrocephalus, a fatal swelling of the brain that occurs only in boys. For several years, nearly all Microsort babies were much like her — born to families that used technology to prevent nature’s deadly mistakes. But word spread and the clinic began receiving requests from couples who simply preferred children of a certain sex. Fugger calls this ”family balancing,” and he struggled for months with criteria that he could use to evaluate those requests.
It was dogmatic, he says, to restrict the procedure only to carriers of genetic disorders. (Nor, it should be noted, was it good for business.) But he was equally uncomfortable with the appearance that anyone could come in and order up a baby. This was, as he describes it, a practical struggle as much as a philosophical one, in that it was conducted with an emphasis on what the institutional review board would permit, rather than what was best for society.
The resulting policy — a couple must have at least one child to be eligible for the program, and they may select a child only of the ”nondominant” sex in their family — addresses potential ethical objections, but leaves the door open for expansion. Keith Blauer, a reproductive endocrinologist at Microsort, says: ”That is the policy for the clinical trial. What will happen in 5, 10 years will depend on what society wants.”
Microsort’s decision to accept requests to balance families led to several surprises. The first was the discovery that the technique is better at producing girls than boys. While the success rate for daughters is 93 percent, it is only 73 percent for sons. Fugger attributes that gap, in part, to practice. ”When we started, we were sorting only for the X sperm because we were only interested in the X-linked disease disorders,” he says. ”So we have a longer experience with that than we do with the Y.” Another reason is the nature of the Microsort machine. ”The instrument determines the X and Y based on the fluorescent intensity. X sperm are fuller and brighter, and Y sperm are dimmer. It is easier, at least at the level of technology today, to determine a bright cell rather than a faint cell.”
The second surprise was that Americans, unlike much of the rest of the world, do not prefer boys. Of the first 111 Microsort attempts, 83 were for females and 28 were for males. True, the process began as a way to select for girls, and true, because it is better at selecting girls it is more likely to attract couples who want them. But there is something else going on as well, something Shettles and Ericsson learned a long time ago.
”More want girls,” Shettles says. ”Definitely we heard more from women who had many boys and wanted a girl.”
Ericsson, too. ”We see more requests for girls,” he says. At some Ericsson clinics, the ratio is as high as 2 to 1, despite Ericsson’s own statistics showing a higher success rate for boys. It is, he says, a gap that has been growing since he first introduced his method 25 years ago.
In a lopsided, counterintuitive way, he insists, this is a streak of feminism, although it hardly appears that way at first, what with all the talk of ponytails, dresses and bows.
”Women are the driving force, and women want daughters,” he says. ”And they’re not apologizing about it anymore. They used to call and there would be this qualification: ‘I love my two boys to death, but.. . .’ Now they go right to the Net. And there’s no apology. It’s, ‘I live in South Jersey — where’s the closest center?”’
Microsort published its first and only journal article about the births in September 1998. I filed the information in the back of my brain, where I file all the things I am not ready to confront just yet. Not until several months later, in spring 1999, did I take my first exploratory leap by typing ”gender preselection” into my Web browser.
I was looking for Web sites of clinics. What I found was a parallel universe, a world of women to whom the sex of their children deeply matters, and who are determined to do something about it. They were everywhere — at the Determining Sex bulletin board at babycenter.com, at the Gender Selection message board at parenthoodweb.com and at the Gender Determination board at parentsoup.com, where I began lurking for hours at a time, scrolling through conversations that could have easily been my own.
This is a sorority in which screen names double as proclamations. Some are statements of who the owner is: 4boysrus, somanygirls. Others declare a desire: wantonlygirls, thinkpink. In this language, ”BD” means baby dancing, which is what you do with your ”DH” (dear husband or, under these circumstances, designated hitter) when you’re ”TTC” (trying to conceive) a ”DS” (dear son) or ”DD” (dear daughter). The letter O means either ovulation or orgasm; it’s usually clear from the context.
These women do not question whether the sex of a child should matter. They take it as a given. Just as it is different being a boy than a girl, they say, it is equally different being a parent to a boy than to a girl. Yes, they understand that the health of a child is most important, but that does not mean that everything else is unimportant. They talk about sex selection as if it were the norm, their right. And all their talk goes a long way toward making it so. As Ericsson noted, they do not feel the need to apologize.
Also in keeping with his experience, most yearn to parent girls. They speak of Barbies and ballet and butterfly barrettes. They also describe the desire to rear strong young women. Some want to recreate their relationships with their own mothers; a few want to do better by their daughters than their mothers did by them. They want their sons to have sisters, so that they learn to respect women. They want their husbands to have little girls. But many of them want a daughter simply because they always thought they would have one. They feel that their little girl is out there, somewhere. Every so often, while their boys are playing, they catch a mind’s eye glimpse of her, and wonder where she is.
Some have gone to remarkable lengths to find her. Lynzi Sheppard, who lives in Queensland, Australia, has had six boys — now ages 22, 21, 19, 16, 10 and 5 — in her quest to have a girl. Her daughter, her seventh child, is now 4 years old. Michelle Beatty, a homemaker who lives near Toronto, has two sons and has spent more than a year battling infertility to have a daughter.
Cindy McCoy, a 33-year-old stay-at-home mother from Xenia, Ohio, also proves how deep the roots of this desire can go. The mother of three boys, ages 6, 5 and 2, she was pregnant with her fourth child when I first found her on the parentsoup.com message board. On the day before her sonogram, she wrote: ”I’ve told myself that I will love another little boy, but I also know I will be devastated. Does that sound bad?”
Hours after the sonogram, she was back. ”It’s a boy,” she wrote, then added that she had learned more from the sonogram than that. ”There is a high probability that he has Down’s syndrome,” she wrote, and the words seemed to clang as I read them. Then she wrote what I expected her to: ”You know, in the realm of things it doesn’t matter whether this baby is a boy or a girl. I just want him healthy.”
It could have ended there, a neat object lesson, but her story went on, and its message was more complex. An amnio done days after the sonogram showed that the baby was fine, and when she received the phone call, Cindy whooped with joy. Then she asked, ”Are you sure it’s a boy?” A few weeks later she was back on the message boards, 20 weeks pregnant with the baby she had named Cameron, and wondering whether she should try one more time. ”In no way do I want five kids,” she wrote. ”However, I can’t help thinking that maybe I will get that little girl.”
Is it the anonymity of cyberspace that brings forth these confessions? Or is it that preferring one sex over another has moved closer to the sunlight? Whatever the reason, women come on line every morning and spill their souls.
One daily visitor is Kristie Andrews, a mother of two boys in Front Royal, Va. Her sons are 3 and 4, and only after the birth of the second one did she realize, with a surge of emotion, that she had to have a girl. Her parents divorced when she was young, and she spent much of her childhood living with her father and stepmother. Now her mother, who is 50, has been stricken with breast cancer.
Kristie is pregnant again, and the fact that such cancer might be genetic and that she might pass a gene on to this unborn child does not sway her. In fact, her mother’s illness served to make Kristie want a daughter all the more. ”It was like I was robbed of my little girlyhood,” she told me. ”I just want a girl to share the things I didn’t get to share with my mom.”
Kristie believed in the Shettles method, had even preached it to others. Her husband, Joe, a tough-talking guy who assembled a track in the basement to race model cars with the boys, scoffed at the whole idea of needing a baby of a certain sex. He wasn’t even sure he wanted a third child at all. So Kristie worked out the timing and positions as best she could, trying not to ”drive him crazy with all the details.”
As her ultrasound appointment loomed in late May, she was increasingly nervous that she hadn’t got the timing right. She agonized electronically over whether to find out the sex of the baby before it was born. ”I have done much of nothing these past 14 weeks but pray this baby is a girl,” she wrote. ”I have set myself up for a girl sooo bad that if I did have a boy I think I would feel . . . that I was grieving the loss of a girl.” She feared her own growing obsession. ”Will I go psycho and not eat right? . . . I’m afraid that if I have this baby and it is a boy I may then have postpartum depression.”
A week before her sonogram, she was leaning toward waiting for the news. If it was a boy, she reasoned, the blow would be softened by holding him immediately. In the privacy of my office, staring at my computer screen, I found myself shaking my head. I opted for surprise with my first pregnancy, and long after the birth I was numb that Emma was a boy. When I looked at my son, adorable though he was, I saw a stranger. Where was the daughter I had been talking to for nine months? The surprise was layered with guilt and stirred by hormones, in all an explosive combination. I cried on and off for weeks.
I approached my second pregnancy determined not to be surprised. I was still in my bathrobe the morning the geneticist called with my amnio results. Yes, I asked first if the baby was healthy. Then I crawled back into bed and stayed there for hours, mourning my daughter. ”She’ll never wear my wedding gown,” I blubbered. ”She’ll never read ‘Anne of Green Gables.”’
It was a hellish morning, but as a strategy it worked. When they put my younger son in my arms the bonding was as the books said it should be. Not ”Who are you?” but ”I know you.” I had adjusted. The storm was over. Or so I thought.
Now everywhere on this board I was stumbling across thoughts and feelings that raised memories of my own. ”My in-laws have two boys and have three grandsons,” wrote Laura Woolsey, the mother of two of those grandsons, who confessed that she was afraid of getting pregnant for fear she would have another boy. ”They are getting their long-awaited granddaughter any day now thanks to my SIL,” she continued, referring to her sister-in-law. ”Ouch.”
Reading that, I thought of my own ”SIL,” my brother’s wife, who is pregnant with their second girl. The first one melts my heart. Since the day she was born she has looked like my baby photos. Eight months into this second pregnancy, I asked if they had chosen a name. They had, they answered, but they weren’t telling. I understood, but felt a prick, a twinge. Would I ever be a part of naming a little girl?
Most technology doesn’t make an instant splash. Inventions and breakthroughs, however stunning, rarely change the world overnight. The initial announcement is like a first burst of fireworks. What follows is slow and silent, as the sparkles fade to smoke, then drift down to earth, becoming part of the air, part of the landscape.
When I first found the Gender Determination board, there was almost no talk of Microsort. If it was mentioned at all, it was with awe and a measure of distrust. As recently as March, the only woman eager to try it was Jennifer S., a Los Angeles lawyer who agreed to be interviewed as long as her last name was not used.
”My husband is one of three boys,” she wrote. ”His older brother has three boys. His younger brother has two boys. We have two boys.” Later she added: ”For some reason, which escapes me now, I was sure I would have girls. I was actually worried about giving my DH a son. For my entire 35 years my mother has repeated the story about how my grandmother cried the day I was born because she was so happy that my mom had a daughter.”
If Kristie is emotional and wavering, Jennifer is the voice of determination and certainty. In 1992, when an ultrasound showed her first child to be a boy, Jennifer began thinking about her second child. ”I became fully versed in albumin columns, centrifugation, Clomid, fish (fluorescent in situ hybridization), Shettles,” she wrote. But because nothing she read seemed scientific, she once again left the sex of her child to chance.
In 1996, when another ultrasound showed another boy, Jennifer went home and began combing the Internet in preparation for yet another child. Microsort was accepting its earliest patients and therefore had no actual results. ”I didn’t want my child to be a guinea pig,” she told me, so she settled on the Selnas method — a money-back offer, with little in the way of documented results, that is currently popular in Europe. She paid $300 for a calendar that told her which days were favorable for conceiving a girl, and she quickly became pregnant, but she miscarried in her first trimester.
Shortly after she lost the baby, she went on line again. By then Microsort had published its first results in Human Reproduction, so Jennifer signed up. Her insemination would be in early June.
As Jennifer prepared for her trip to Fairfax, she posted daily reports of the advance work — the blood taken in a private lab, then shipped overnight to Virginia; the effects of Clomid, which stimulates ovulation (”a hot flash or two, plus I managed to lose weight instead of gaining”), the flight across country with her husband and two sons. (”Conception Tour 1999,” her husband called it.)
From her hotel near Microsort, using her Epson laptop, she continued to send posts. Every morning there was a new account of her three maturing follicles, which started at 17 centimeters and, three days later, were ripe, at 22 centimeters. Every afternoon the women on the board wrote back, some sending along questions for Jennifer to ask the doctors on their behalf.
Sitting at my own screen, scrolling through the messages, I had the sense that I was watching a new technology catch hold, seeing it burrow into the Zeitgeist and make the transition from ”Huh?” to ”Why not?” The women on the board still had concerns. ”Anyone here believe that God determines sex?” one post asked. But more than one woman answered, ”The Lord helps those who help themselves.”
Microsort is too ”mechanical and invasive,” another post said.
”I just want it to happen,” Kristie agreed. ”I don’t want to have to use a machine to make it happen.”
”Yes,” Jennifer wrote. ”It is invasive. Yes it is unspontaneous.” At another point: ”I am the type of person that needs to do everything possible in order to feel like I have tried my hardest. I have a no-regrets policy. If I have done everything I possibly can do, and the result is still contrary to what I want, then no regrets.”
It was apparently a persuasive argument. One day, Becky Powell, who plans to start trying for a Shettles girl in August, and who is such a fierce advocate of that method that you would think she had invented it, posted an informal poll question. ”If money was no object, which type of gender selection would you choose?”
Those who responded praised the ”naturalness” of Shettles and then voted for Microsort — including Kristie Andrews.
Choosing the sex of a child is a selfish act. I use the word carefully, without its negative connotations. All I mean is that it is done by the parents, for the parents. It can’t, by definition, be done for the child, who has not yet been conceived.
Medical ethicists as a group are troubled by selfish acts. To them, ”Because I want to” is never good enough. Their next question is always ”What if everyone uses it?” or ”What if the wrong people use it?” or ”What if well-meaning people use it in the wrong way?”
Ethicists, not surprisingly, are troubled by Microsort, and their reasons are global. ”Any new biotechnology is not simply confined within one nation,” warns Lori Knowles, the associate for law and bioethics at the Hastings Center, in Garrison, N.Y. Although the limited experience of Microsort shows a preference for girls within the United States, she says, ”it will be used in cultures where women are oppressed, and it will be used to select for male children. That will further institutionalize the discrimination against women.”
Take such prenatal screening methods as ultrasound and amniocentesis, she says. Created for the relatively benign purpose of identifying abnormalities early in a pregnancy, they are periodically used in some countries as screening tools by parents who wish to abort a fetus of the ”wrong” sex.
Lori Andrews, a professor of law at Chicago-Kent College of Law and the author of ”The Clone Age,” describes the 258 clinics in Bombay that advertise prenatal screening as a way to end a pregnancy and avoid a dowry: ”Spend 700 rupees now and save 700,000 rupees later.” One study of 8,000 abortions, she writes, found that 7,999 of the fetuses were female.
The United States is not free from abortions performed on the basis of sex. Although numbers are not available, such abortions are known to exist, albeit to a much lesser extent than in other parts of the world. A 1995 study found that 34 percent of American geneticists would perform prenatal testing because a family wanted a son. That was a 10 percent increase from 10 years earlier.
Even if Microsort is not used here as it might be in India, ethicists say, there is potential for abuse. ”People say we’re not like that, but I think we have more subtle forms of sex discrimination,” Andrews says. ”In the U.S. the tilt toward boys isn’t as pronounced.”
The Microsort data, she notes, derive from a time when families are required to have a first child to be eligible. What happens down the road, she asks, if that rule is lifted? She cites a study by Roberta Steinbacher at Cleveland State University that found that 25 percent of Americans would use sex selection. Of those, 81 percent of the women and 94 percent of the men would want their firstborn to be a boy.
”Now look at that in light of other research, which consistently finds that firstborns are more aggressive, more achieving, of higher income and education then later-borns,” she says. ”We’ll be creating a nation of little sisters.”
Knowles, too, warns of the more subtle effects of sex selection on the children born of the procedure. ”When you’re going to this length to have a girl, chances are you have a particular girl in mind,” she says. ”’I really want someone to go shopping with,’ ‘I really want her to take ballet.’ All these things point to a particular role that this child is envisioned as having in the family. If you are willing to spend that kind of money, you’re heavily invested in this — heavily invested. There are going to be some very, very pressured kids.”
And what, she asks, of the mistakes? ”If there’s a 93 percent chance of a girl, that means there’s a 7 percent chance of a boy,” she says. And since the odds of conceiving a boy are lower, there’s an even higher chance that ”there are going to be some little girls born to parents who have invested, emotionally and financially, in a boy.”
This exercise in wish fulfillment, Andrews says, ”is part of a larger move of turning children into commodities, consumer goods.” It used to be, for instance, that sperm donors were selected by a third party who tried to match the traits of the donor to those of the prospective father. Now couples can flip though catalogues of sperm and egg donors and look for an idealized version of themselves. There was even a lawsuit in Utah last year, Andrews says, in which a couple lost a case against a sperm cryobank they had sued because the clinic gave them the wrong sperm donor; among the parents’ many causes of distress was the fact that their children were not attractive enough.
”If we can’t say there’s something wrong with choosing the gender of our child,” she asks, ”how can we say it is any different than choosing the hair color or the eye color or the height? We’re dangerously close to creating a blueprint for your brave new baby.”
This fear of the slippery slope, of a slide into eugenics, is why many countries have prohibited technologically assisted sex selection. The draft guidelines on bioethics of the World Health Organization warn that ”sex is not a disease,” and nations like Austria, France, Germany, Norway, Spain and Sweden ban the practice. However, all these prohibitions were put in place before Microsort published its results last fall, and the only existing methods were techniques like abortion or preimplantation embryo screening, which take place after conception.
On the ethical spectrum, a preconception method like Microsort is more defensible, says Dr. John Fletcher, professor emeritus of biomedical ethics at the University of Virginia School of Medicine. Not that he approves, but he allows that the existence of a preconception screening method might have the ”dubious advantage” of increasing the likelihood that couples will become pregnant with the sex of their choice, thereby preventing the abortions that result from disappointment.
None who object to Microsort think there is a chance that their objections will keep it from being used in the United States. Military hardware aside, no technology has ever been invented that has not eventually been used. ”People want it,” says Dr. Benjamin Younger, executive director of the American Society for Reproductive Medicine. ”And when people want things, science finds a way to make it happen.”
His concerns, therefore, are less global and more nuts and bolts. He wants more data, better data, so his members can advise their patients, and perhaps get in on the process. But because Genetics and I.V.F. controls the technology, he says, even the initial 14-patient study cannot be reproduced or verified by anyone else.
”We need to be sure the facts are what they say they are,” Younger says. ”It needs to be available at multiple sites. Results are always better in a controlled initial study than when they go out for general use. We need to be able to verify this.”
In other words, while ethicists like Knowles and Andrews worry that Microsort will spread too quickly and work too well, practitioners like Younger worry that it will take too long and not work well enough.
Fugger, in turn, says he is working as fast as he can. Because Microsort is a procedure, not a drug, it does not require any Government approval. The clinical trial will therefore end whenever Fugger and his clinic’s institutional review board declare it complete — in other words, when they have enough data to persuade their medical colleagues that the process is safe and effective. That would require 300 to 500 births, Fugger estimates, after which the saturation of the market can begin.
”We could sublicense the technology” to existing infertility clinics, Fugger says, or ”we could set up our own facilities around the country. It will be as common as the number of people who desire to use it.”
After weeks of scanning the message boards, I start to travel. My first stop is the Microsort orientation in Fairfax, where the only ethical concern raised by the assembled audience is, ”What about a couple with no children?”
Told that the rules prevent their inclusion, the woman who asked the question bristles: ”I can’t believe you’re not regulated. You can just decide yourselves?”
The next morning, I drive 40 miles east to meet Kristie Andrews, who after many conversations by phone and E-mail, has invited me along for her sonogram. She still hasn’t decided if she wants to know if her baby is a boy or a girl.
Before we leave, she takes me to the basement of her sparsely furnished house and shows me box after box of baby clothes — all frilly and pink. There are fleecy blankets and dresses with matching hats and socks and booties. ”This one is my favorite,” she says at least three times, opening another flowery package. We have to be quiet while we ooh and ahh, she warns, because ”Joe doesn’t know about all of this.”
We all pile into the minivan and drive to see the doctor, who is a half-hour away, as is the hospital where the baby will be born. Kristie and Joe fight during most of the trip — about the distance (there is another hospital, minutes from the house) and about money (the family’s health insurance doesn’t include prenatal care or delivery, and this more-distant doctor will cost $1,000 less). Once the ultrasound screen comes on, Kristie forgets that she does not want to know. ”Tell me it’s a girl,” she pleads. The doctor says he sees nothing definitive, but will try at her next appointment.
A week later, Kristie E-mails a photo of her crib ensemble. It is pink and white, and it is already set up in the baby’s room. A week after that, she calls in tears. The baby is a boy. And Joe has figured out how much she has spent on clothes. When I speak to him, he is in a rage. ”Women,” he all but spits. ”Who cares what sex the kids are? Have one, or two, then forget it. Not Kristie. Oh, nooooo. We have to repopulate the [expletive] earth.”
Next, I meet with Jennifer, five days after her Microsort insemination. The last leg of ”Conception Tour 1999” swings her near my house, so I take my younger son, she takes her two sons and we meet for gooey desserts.
The actual procedure, she says, was ”radical.” It took all day for the machine to sort the sperm, and it was not until early evening that a technician came in with an ice chest. He took out a test tube with her husband’s name on it and the words ”X Sort.” Then the nurse practitioner used ultrasound to locate the tip of the uterus, inserted a catheter and pushed the plunger. Staring at the computer screen, Jennifer watched the cloud of sperm race upward. ”Other than seeing the faces of my children before they were born,” she says, ”I have never seen anything like it.”
We slurp chocolate for a while, I more enthusiastically than she because she is already nauseated (and will learn, 10 days later, that she is in fact pregnant). Eventually she looks up from a spoonful of whipped cream and asks, ”So, are you going to do it?” The question, although obvious, takes me by surprise. I know the answer. It’s just that I haven’t spoken it aloud to anyone yet.
True, using technology to choose a child’s sex is selfish. But using the word the same way — something done for oneself — isn’t having children in the first place equally selfish? We have them because we have a vision of life as we wish it to be, and we set out to fulfill that vision. If there is a gap between hope and reality — if we find we cannot have children — we turn to science to bridge that gap, and society accepts (in fact, often applauds) our use of science.
What, then, is the difference between a dream of children and a dream of a son or a daughter? I do not dismiss the ethical gray tones, the risks of misuse. Instead, I weigh them and conclude that for every problem this technology might create, there is an existing problem that it might solve. Yes, parents might pressure their Microsort girls to be girls, but wouldn’t those same parents potentially damage their natural boys? Yes, there might be a preponderance of little sisters, but might we also have fewer families of four, five and six children, all conceived in the search for an elusive girl or boy?
If something like Microsort had been available in India, there might well be 8,000 more baby boys, but there might not be 8,000 aborted baby girls. If something like Microsort had been available to Kristie Andrews, she might not be having a third baby, a boy that she fears she might not love and cannot afford. And if it had been an option for me five years ago, I might have used it for my second child. Which would mean there would be no Alex. How could there be no Alex?
I look over at him. He has finished with his frozen hot chocolate and is pretending to be Anakin Skywalker with Jennifer’s boys. I try to picture Emma, but she fades. She has been fading a lot lately. No. I will not do this. I do not want it badly enough.
I started this journey thinking it would leave me feeling empty, as if an opportunity had passed, or energized, determined to seize an unexpected gift. Rather, I find myself content. The exploration alone has been liberating.
Reproductive technology is all about control. Controlling that which was always random. And now this technology, by its very existence, has given me an oblique but precious form of control. I can have my daughter if I want her. I am not too old; the technology exists. So the reason I have two boys is not that fate deprived me of a girl. The reason I have two boys is that I chose to. Microsort opened the door. I chose not to walk through it.
As I sit down to write this article, the telephone rings. I pick it up and find my mother on the line. She doesn’t say hello. (Do mothers and daughters ever bother with hello?) Instead, she announces, ”Emma Penina.” There is a moment of shaky confusion, and then I realize she isn’t reading my mind. She is telling me I have a newborn niece.
We never discussed names, my brother and I. After all, until today, his daughter’s name was a secret and my daughter’s name was a fantasy. I wait for this to hurt and am relieved that it doesn’t. I sit very still and quiet for a while. Then I go upstairs, reach to the back of the closet and send Emma the clothes that have been waiting there for her all this time.
This article was originally published on www.nytimes.com
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