results of sex selective abortions

LOS ANGELES, U.S.

"Be certain your next child will be the gender you're hoping for," promises the Web site of L.A.'s Fertility Institutes. Dr. Jeffrey founded the clinic in 1981, just as in-vitro fertilization was taking off.

Today 70 percent of his patients come to select the sex of their baby. Steinberg's favored method is preimplantation genetic diagnosis, PGD, an add-on to in-vitro fertilization that allows parents to screen embryos before implanting them in the mother. Like amniocentesis and ultrasound before it, PGD was developed to test for defects or a propensity toward certain diseases.

But lab technicians working with eight-celled embryos can also separate XY embryos from XX ones, thus screening for sex—the first nonmedical condition to be turned into a choice. PGD thus attracts Americans who are perfectly capable of having babies the old-fashioned way but are hell-bent on having a child of a certain sex. So determined are they that they're willing to submit to the diet of hormones necessary to stimulate ovulation, pay a price ranging from $12,000 to $18,000, and live with IVF's low success rate. Decades after America's elite introduced sex selection to the developing world, they have taken it up themselves.

High-tech sex selection has its critics. They point to a litany of ethical issues: that the technology is available only to the rich, that it gives parents a degree of control over their offspring they shouldn't have, that it marks the advent of designer babies. But in surveys of prospective American parents over the past 10 years, 25 to 35 percent say they would use sex selection techniques if they were readily available; presumably that means more affordable and less invasive.

A squat, balding man who exudes a jovial confidence, Dr. talks as if he has all the time in the world, peppering his stories with Hollywood gossip. (To wit: The producers of the show CSI once stopped by the clinic to evaluate a sperm cryopreservation tank's potential as a weapon.) The patient response to his clinic offering sex selection, Steinberg tells me after ushering me into a spacious corner office, has been "crazy."

The fertility doctors who perform preimplantation sex selection take care to distinguish it from sex-selective abortion. In America, they point out, patriarchy is dead, at least when it comes to choosing the sex of our children. As late as the 1970s, psychologists and sociologists found that Americans were far more likely to prefer sons to daughters. Not anymore.

National figures are not available, but two of America's leading clinics—HRC Fertility in Los Angeles and Genetics & IVF Institute in Fairfax, Virginia—independently report that between 75 and 80 percent of their patients want girls. The demand for daughters may explain why at rg's clinic everything from the entrance wall to the scrubs worn by the laboratory workers are pink.

For the most part, however, Americans don't talk about gender preference. We say "family balancing," a term that implies couples have an inherent right to an equal number of boys and girls. (Many patients seeking sex selection via PGD already have a child of the opposite sex.) We talk about "gender disappointment," a deep grief arising from not getting what we want. The author of the reproductive technology guide Guarantee the Sex of Your Baby explains: "The pain that these mothers feel when they fail to bear a child of the 'right' sex is more than just emotional angst. The longing that they hold in their hearts can translate into real physical pain."

Rhetorical differences aside, "family balancing" is not in fact all that different from what is happening in China and India. In Asia, too, most parents who select for sex do so for the second or third birth. And examining why American parents are set on girls suggests another similarity: Americans who want girls, like Asians who opt for boys, have preconceived notions of how a child of a certain gender will turn out.

Bioethicist S. Davis writes that people who take pains to get a child of a certain sex "don't want just the right chromosomes and the attendant anatomical characteristics, they want a set of characteristics that go with 'girlness' or 'boyness.' If parents want a girl badly enough to go to all the trouble of sperm sorting and artificial insemination, they are likely to make it more difficult for the actual child to resist their expectations and follow her own bent."

When Dr. Puri surveyed Bay Area couples undergoing PGD for sex selection, most of them white, older, and affluent, 10 out of 12 wanted girls for reasons like "barrettes and pink dresses."

Some mention that girls do better in school, and on this point the research backs them up: Girls are more likely to perform and less likely to misbehave, while boys have lately become the source of a good deal of cultural anxiety. Others mention more noble goals. They talk about raising strong daughters; women mention having the close relationship they had—or didn't have—with their own mother.

But regardless of the reason, bioethicists points out, sex selection prioritizes the needs of one generation over another, making having children more about bringing parents satisfaction than about responsibly creating an independent human being.

At stake with preimplantation sex selection is much more than the global balance of males and females, as if that weren't enough. If you believe in the slippery slope, then sex-selective embryo implantation definitely pushes us a little further down it.

In 2009 rg announced that the clinic would soon offer selection for eye color, hair color, and skin color. The science behind trait selection is still developing, and some later doubted whether he in fact was capable of executing it. Still, rg might have eventually gone through with the service had his advertisement not set off an uproar. The press descended, the Vatican issued a statement criticizing the "obsessive search for the perfect child," and couples who had used PGD for medical reasons balked, fearing frivolous use of reproductive technology would turn public sentiment against cases like theirs. For the moment, at least, Americans had problems with selecting for physical traits, and Steinberg retreated.

"The timing was off is all," he tells me. "It was just premature. We were ahead of our time. So we said, 'OK, fine. We'll put it on the back burner.'" In the meantime, he says, couples obsessed with blue or green eyes continue to call the office. He keeps their names on a mailing list.

Mara is a China-based correspondent with Science magazine. She's also written for Harper's, Scientific American, and Popular Science. This piece is adapted from her new book, Unnatural Selection: Choosing Boys Over Girls, and the Consequences of a World Full of Men (PublicAffairs, 2011.)