Oh, Boy: Is This the Era of the Designer Baby?

Kim Kardashian and Kanye West have shot down the rumors that they used IVF technology to guarantee a male baby. But is choosing a baby's sex even a thing now?

Oh, Boy: Is This the Era of the Designer Baby?

North West may have a designer wardrobe, an overflowing passport and a bigger bedroom than you do, but one thing she hasn't had is a sibling. This week, though, mom Kim Kardashian announced that she and husband Kanye West are expecting a baby boy. Before Nori could start hiding her toys, rumors swirled that K & K—who have been open about their fertility struggles—used genetic-based technology to choose the sex of their baby-to-be to ensure they had "an heir." The couple denies this. But now everybody and their mother are talking about the controversial process.

Can you select a sex?

During standard in vitro fertilization (IVF), medication is used to stimulate a woman's ovaries to produce more eggs than normal. Those eggs are then retrieved and fertilized in a lab, grown for three or five days in a petri dish, and then a pre-determined number are transferred back to the woman's uterus where, hopefully, it/they implant.

Some parents-to-be opt for a service called preimplantation genetic diagnosis and screening (PGD/PGS), explains Jennifer Hirshfeld-Cytron, MD, a reproductive endocrinologist at the Fertility Centers of Illinois. With these techniques, which costs about $6,000 (on top of an average $11,000 IVF cycle, not including medication costs), a cell is removed from each embryo on the fifth day of incubation. "Inside that single cell, we can learn the entire DNA sequence necessary to identify countless diseases," Hirshfeld-Cytron explains. These sorts of genetic testing is usually done following multiple miscarriages (to determine any potential medical causes), with advanced maternal age (as risk of chromosomal abnormality rises) or if one or both parents is known to be a carrier of a genetic mutation that they would not wish to pass down (like cystic fibrosis, Tay-Sachs or sickle-cell anemia.) In that case, only a healthy embryo would be put back in.

But the glimpse into each embryo's DNA also reveals its sex, and patients are routinely offered the chance to learn whether their embryos are female or male—and choose to subsequently implant only boys-to-be or girls-to-be.

The problem with "designer babies"

Hirshfeld-Cytron estimates that 15-20 percent of her clinic's patients opt for embryo testing for any reason. Most of them are there for medical reasons, but she says about 5-10 percent are solely interested in gender. "The majority of them are doing it for family balancing reasons—they have all daughters, for instance, and want to have a son."

But some patients are interested in using PGS to ensure a firstborn child of a specific gender. "They're not infertile, not screening for chromosome abnormalities; they simply want a boy or a girl," says Hirshfeld-Cytron.

Canada and a number of European countries have banned this technology; according to the American Society for Reproductive Medicine, opponents fear it could be used to promote a pro-male gender-biased society similar to those seen in India and China as a result of abortion and infanticide. Hirshfeld-Cytron confirmed that when patients do come to her solely for the selection of their first child's sex, they're usually after blue booties, not pink.

According to a 2014 ASRM survey, only 21 percent of the American public agrees with the practice of choosing gender based solely on sex preference with no medical underlying. (Most, however, "approve of the use of PGD to identify diseases fatal early in life and diseases that cause lifelong disability," the ASRM says.) The slippery slope question: If we can choose the sex of our baby, how soon before parents start shooting for only blondes, or kids likely to earn straight As or shoot hoops well enough to earn a basketball scholarship? "Parents desire the best for their children, and may believe that selecting for their hair color, eye color, or even intelligence level will enhance their offspring's life," say Mark S. Frankel, PhD, director of the Scientific Freedom, Responsibility and Law Program at the American Association for the Advancement of Science and Cristina J. Kapustij, public policy associate with the American Institute of Biological Sciences, in The Hastings Center Bioethics Briefing Book.

But these so-called "designer babies" present a dilemma: "Choosing traits in order to 'improve' the human bloodline will, for some, sound eerily reminiscent of Nazi efforts to create a master race, understandably raising concerns about abuse and 'playing God.' We need to consider the implications of shifting responsibility for human traits and behavior from nature versus nurture to nature versus know-how."