The Guardian reports that the first-ever trial in the US of sex selection through pre-implantation genetic diagnosis in IVF has been OK’d – after an IRB review lasting 9 years! What is interesting is the focus of the trial – not on whether sex selection is practical (we know that perfectly well), but on the parents’ motivations for making such a decision, as well as its ramifications for the eventual children.

A clinical trial into the effects of allowing couples to choose the sex of their babies has been given the go-ahead at a US fertility clinic. The controversial study was given the green light by an ethics committee after nine years of consultation. The purpose of the study is to find out how cultural notions, family values and gender issues feed into a couple’s desire to choose the gender of their child. . . .

Fertility specialists at Baylor College of Medicine in Texas have already received 50 inquiries from couples about joining the trial, according to the journal Nature today. Only couples who have already had one child and want another of the opposite sex are eligible. As well as assessing the factors that contribute to a couple’s decision to select the sex of their next baby, doctors will monitor the health of the children and any social issues that arise in their families as they grow up.

There is something slightly odd about this. First, if the interest is merely in psychological factors influencing the desire of the parents to use sex selection, it is not necessary to actually perform sex selection at all. It would be possible simply to survey couples requesting sex selection (or who indicate they would strongly desire it if it were available), asking them what “cultural notions, family values and gender issues” had led them to make that request. Second, if the study is aimed at effects on children born through sex selection (by “monitoring the health of the children and any social issues that arise”), they have skewed the results of the study by restricting it only to certain couples. In particular, they have guaranteed that the most pernicious effect of sex selection – distorting the sex ratio – cannot occur, and therefore will be invisible to the study; it may also be that parents who want sex selection to balance the genders of their children have more benign (or at least different) attitudes about gender compared with those who would have wanted it only to preferentially choose one sex, and who again are weeded out before the study proceeds. At best, this study will tell us something about the effects of sex selection among the population of couples-that-have-one-child-not-born-by-sex-selection-and-want-another-specifically-of-the-opposite-sex, which is hardly representative of the entire population.

However, if they are going to do the trial at all, we should give some consideration to whether the line they are crossing is problematic. Given that the most serious problem associated with sex selection is not an issue in this trial, I don’t see this trial as a danger in itself. The concern, of course, is that allowing sex selection under limited conditions creates pressure toward allowing it without constraint – a situation that has been disastrous in some countries.

However, there are competing concerns. Restricting reproductive autonomy has arguably led to worse problems than has sex selection, even in the worst environments (and both stem from partriarchal fears of women’s independence, which should be the first locus of our efforts at addressing either problem). It is also very intrusive and paternalist to demand that patients stipulate their reasons for wanting a certain procedure, and agree to provide it only if we agree with those reasons – we have seen that in the past with abortion, and increasingly today with birth control, and the results speak for themselves. We hardly need to set up more medical star chambers to pass judgment on what pregnancies women may, or must undergo. Yet again, though sex selection has shown itself to be a serious problem in some cultures, sex selection by selective abortion has been available in the US, one way or another, for decades, yet there is no visible trend toward prefering one sex over the other. There seems to be little reason to think that allowing sex selection in the much-less-common, and more expensive, scenario of IVF will create a demand for control of gender that has not been shown to exist even where that control is available more readily and cheaply. Finally, there is something off-putting about demanding control over patients’ choices in IVF simply on the basis of technological hegemony. The fact that IVF providers happen to have absolute control over patient’s ability to make certain choices, whereas in other pregnancies the patient has many more options, does not give them greater moral ownership of those choices. If we do not prohibit sex selection by ultrasound and abortion – even though we may deplore the idea of it – it is hard to justify prohibiting it in IVF simply because we control the technology that makes it possible.

With those concerns in mind, the Baylor trial would seem to be, from the perspective of patients’ autonomy, long overdue – if not unnecessary on its face (since it does not introduce any new effects, but merely a new technology for achieving those effects). This is not to say that sex selection does not have a highly problematic potential, or that it is not offensive to certain liberal values. But annexing technological gatekeeping authority over people’s family-planning choices, simply because we have it in our power to do so, is not likely to be a better solution.