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Choosing the sex of an IVF baby is banned. Should it be?

Choosing the sex of an IVF baby is banned. Should it be?

The Age17-06-2025
'I'm here to promote awareness for the availability of gender selection and to hopefully ignite some conversation so that perhaps in the future, people won't have to travel to the United States to have this done,' Potter says.
What are the rules and the concerns behind them?
The National Health and Medical Research Council reviewed their guidelines on assisted reproductive technology in 2017 and upheld its view that sex selection should not be used unless to reduce the risk of a genetic disease. (Duchenne muscular dystrophy, for example, mostly affects males.)
One of the concerns cited by the NHMRC's ethics committee was that nonmedical sex selection could lead to people favouring one sex over the other based on cultural or personal biases.
What the NHMRC considered in its ban on sex selection
Whether sex selection is a justifiable use of medical resources.
Whether there's an ethical difference between people wanting sex-balanced families and people choosing a particular sex due to personal or cultural bias.
The possibility that sex selection my validate or reinforce gender stereotyping and discriminatory attitudes, and create pressure on the person born to conform to their parents' gender expectations.
The possibility that sex selection may open the way for selecting other characteristics such as eye or hair colour.
Concerns that people may be terminating pregnancies as an alternative sex-selection technique.
Concerns Australians seeking sex selection could be travelling to international clinics with a lower standard of care.
Values inherent in Australian society that relate to freedom and autonomy, particularly in relation to reproductive choices.
Read the full reasoning behind the guidelines.
The imbalance of the sex ratio in China is often cited as an example of cultural bias favouring male babies; in 2004 there were 121 males to every 100 females, at least partly because sons were preferred, so female fetuses were more likely to be aborted. China's sex ratio has since evened out, but there's still a male skew.
Choosing the sex of an embryo to 'balance' a family's split between male and female children is one of the most common reasons people seek out sex selection, and it's viewed as more ethically acceptable.
Alex Polyakov, an associate professor at the University of Melbourne and medical director of Melbourne's Genea IVF clinic, believes couples should be able to choose the sex of their third child, as long as their first two children are of the same sex.
'I think the argument that it will skew the sex ratio is really quite nonsensical,' he added, arguing the proportion of people taking part in sex selection would have to be huge to have such an effect. 'I don't really see an ethical or moral issue if safeguards are put in place.'
By the same token, Polyakov has also warned embryo testing and selection strategies can decrease chance of pregnancy or lead to the discarding of healthy embryos, which in some cases has risked parents missing out on biological parenthood altogether.
'I think we often forget that the overriding aim is to increase the pregnancy rate, to get someone pregnant as soon as possible,' he says.
Do people choose more males over females?
Data is mixed on whether people are more likely to choose male or female embryos. An analysis of about 2300 embryo transfers at a US IVF clinic between 2012 and 2021 found 56.5 per cent of people who opted for sex selection chose male embryos. A study on a different hospital found roughly equal rates of sex selection when it was someone's first child, but a 59 per cent preference for females on the second child.
Potter said about 70 per cent of his clients request female embryos, often driven by women who wanted a mother-daughter relationship.
'This process is driven by the female partner in most cases. For a lot of women, they've been imagining having a daughter ever since they were playing with dolls and modelling parenting behaviour as a child,' he says.
Sex v gender
Bioethicist Dr Tamara Browne, a senior lecturer in health ethics at Deakin University, says she's sad this debate has rekindled.
'We really haven't gotten very far when it comes to counteracting gender stereotypes and achieving gender equality,' she says. 'The two are interlinked, and I've become even more convinced that if we're to achieve gender equality, we have to stop parenting children differently according to their sex.'
Assuming daughters will be closer to their mothers, or that boys offer different, more 'macho' experiences such as being into sport, plays into outdated gender beliefs, Browne says.
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'We don't have any good scientific evidence that you can only get these sorts of parenting experiences with a child of a certain sex,' she says.
She makes the point that sex selection allows people to choose the sex chromosomes and genitalia of their child. It can't decide a child's gender – the way they express that sex.
How, Browne argues, do we expect more men to take up nursing or childcare roles, and women to take up STEM subjects like maths and engineering, if we reinforce the idea they're born with different traits and abilities and therefore should be parented differently?
I also ask Potter if he ever discusses with his clients the chance that a child born from a sex-selected embryo could eventually embrace a different gender identity – for example, a baby born from a female embryo who grows up as a trans man. (About 5 per cent of Americans under 30 say their gender is different to the sex they were assigned at birth, according to Pew Research Centre.)
'There would be no reason to discuss that, any more than it would be to discuss with an expecting mum,' Potter says. 'It's a pretty unlikely thing and kind of a grim topic.'
How much should it cost?
Dr Hilary Bowman-Smart, a research fellow at the University of South Australia who has studied prenatal testing, thinks sex selection in embryos isn't a particularly valuable use of medical resources, but the current reasons to keep it illegal were not compelling.
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Bowman-Smart is concerned, though, about companies making money from sex selection services. 'I would be concerned about this becoming an expensive service that is advertised to people during a vulnerable time in their lives who otherwise might not have cared too much either way,' she says.
While Polyakov backs sex selection in some circumstances, he doesn't believe it should be covered by Medicare. If it were legalised in Australia he estimates the practice would cost about $500 to $700 per embryo.
'So if you have 10 embryos, that adds about $5000 to $7000,' on top of the existing costs, he says.
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Like many rural parents, Lizzy went to the private health system to receive a formal diagnosis for her son. That has opened up valuable learning and support programs, sparking a change in her son that's like "night and day". "I am grateful for the team we were able to eventually access, but I'm more worried about the people that don't have that or it's not accessible," she said. "You have to fight really hard to get it and to be seen and heard." Lizzy is a proud mother of two rambunctious boys who love playing with their friends, kicking the footy and swimming. It was during COVID-19 lockdowns that she began noticing her kindergarten son struggling with reading and literacy. When he returned to normal lessons at school he was getting top marks for effort, but his learning difficulties were discouraging him by year 3. "We had a lot of pushback about attending school and not wanting to be there, but when he was there he was wonderful and his teachers loved him," said Lizzy, a mum from rural NSW who asked not to use her surname. "Then he'd come home and he'd just completely implode. "They couldn't see the frustration and pressure because he was masking it during the day." Lizzy's son falls into what rural psychologist Tanya Forster describes as "the missing middle". These are the often compliant and quiet children whose learning difficulties may go unnoticed in under-resourced public schools, particularly in rural and regional areas. Their delays also often don't fall into the narrow diagnostic eligibility for further learning support in the education system. "The pressure on (teachers) in the classroom is really considerable and the way that the school system is designed, it's still quite a traditional model," says Ms Forster, who leads the Macquarie Health Collective in Dubbo. 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"You have to fight really hard to get it and to be seen and heard." Lizzy is a proud mother of two rambunctious boys who love playing with their friends, kicking the footy and swimming. It was during COVID-19 lockdowns that she began noticing her kindergarten son struggling with reading and literacy. When he returned to normal lessons at school he was getting top marks for effort, but his learning difficulties were discouraging him by year 3. "We had a lot of pushback about attending school and not wanting to be there, but when he was there he was wonderful and his teachers loved him," said Lizzy, a mum from rural NSW who asked not to use her surname. "Then he'd come home and he'd just completely implode. "They couldn't see the frustration and pressure because he was masking it during the day." Lizzy's son falls into what rural psychologist Tanya Forster describes as "the missing middle". 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Lizzy is a proud mother of two rambunctious boys who love playing with their friends, kicking the footy and swimming. It was during COVID-19 lockdowns that she began noticing her kindergarten son struggling with reading and literacy. When he returned to normal lessons at school he was getting top marks for effort, but his learning difficulties were discouraging him by year 3. "We had a lot of pushback about attending school and not wanting to be there, but when he was there he was wonderful and his teachers loved him," said Lizzy, a mum from rural NSW who asked not to use her surname. "Then he'd come home and he'd just completely implode. "They couldn't see the frustration and pressure because he was masking it during the day." Lizzy's son falls into what rural psychologist Tanya Forster describes as "the missing middle". These are the often compliant and quiet children whose learning difficulties may go unnoticed in under-resourced public schools, particularly in rural and regional areas. Their delays also often don't fall into the narrow diagnostic eligibility for further learning support in the education system. "The pressure on (teachers) in the classroom is really considerable and the way that the school system is designed, it's still quite a traditional model," says Ms Forster, who leads the Macquarie Health Collective in Dubbo. "Unfortunately, at the moment, it's not necessarily meeting the inclusive needs of modern-day students." The situation is likely borne out in the recent NAPLAN results, which show one-in-10 Australian students need more help to meet basic education standards. NAPLAN also confirmed an enduring regional divide with just 20 per cent of students in very remote areas exceeding expectations, compared to 70 per cent of their city peers. "The results tell us a lot about what we probably already know: that there are lots of kids at school that are struggling," Ms Forster told AAP. "Unfortunately, many of those kids can't access the support that they really need." Federal Education Minister Jason Clare says while there are some encouraging signs of improvement in numeracy and literacy, the results show there is more work to do. All states and territories have signed agreements with the government to fix public school funding, Mr Clare says. "This funding is tied to real and practical reforms," he said in a statement issued on Wednesday. "Phonics checks and numeracy checks to identify students who need additional support, and evidence-based teaching and catch-up tutoring to help them keep up and catch up." But regional families come up against other deeply entrenched problems, such as poor access to specialist services. There were 53 specialists per 100,000 people in remote areas in 2022, compared to 160 in the cities, with years-long public waitlists for developmental assessments with pediatricians in the regions. Disasters such as floods, fires and COVID-19 may have pushed regional kids out of school, with the non-attendance rate at 14.6 per cent compared to the pre-pandemic level of 10.6 per cent, according to a Jobs and Skills Australia report. The report recommended a suite of changes to re-engage and motivate young people, including linking them with local mentors and employers outside schools. While health and education reforms slowly work away in the background, former high school teacher Shannon Chapman says families can look at NAPLAN results as an opportunity to explore children's strengths. "NAPLAN results do not capture valuable skills and knowledge, such as a student's resilience, confidence, their creativity, their leadership," said Ms Chapman, a teaching and learning facilitator at the Dubbo clinic. "You probably do have this incredibly well-rounded child that may have below the standard NAPLAN results, but that does not capture a lot of skills and knowledge." Like many rural parents, Lizzy went to the private health system to receive a formal diagnosis for her son. That has opened up valuable learning and support programs, sparking a change in her son that's like "night and day". "I am grateful for the team we were able to eventually access, but I'm more worried about the people that don't have that or it's not accessible," she said. "You have to fight really hard to get it and to be seen and heard."

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