As reported by the New York Times, August 20, 2011.

If You Really, Really Wanted a Girl...

By Pam Belluck

This month brought news that could alter the landscape of American pregnancy.

Tests using DNA to determine a fetus’s sex were shown to be remarkably accurate, able to tell with 95 percent certainty as early as seven weeks into pregnancy, if a woman is carrying a boy or girl. The tests, which detect the fetus’s DNA in a mother’s blood or urine, are available in drugstores and online, and reports about their accuracy are likely to increase their popularity.

But the tests also raise ethical questions: whether couples will abort fetuses of an unwanted sex — as has happened in China and India, where boys now outnumber girls. The possibility discomfits many, and is also providing fuel for anti-abortion politics.

The test is the first of an expected raft of DNA tests likely to detect disorders like Down syndrome and other genetic traits early enough in pregnancy that more women may consider abortion.

“I think over the long run this has the potential of changing attitudes toward pregnancy and to family,” said Audrey R. Chapman, a bioethicist at the University of Connecticut Health Center. “Women may be less invested in their pregnancies earlier than they are later, and the question has been raised whether women will look at their pregnancies increasingly as being conditional: ‘I will keep this pregnancy only if.’”

Fetal sex tests have a few medical applications, allowing couples with histories of rare sex-linked disorders to avoid costly and invasive genetic testing if they learn they are expecting the other sex. But for most couples, the tests, which are unregulated, simply answer the boy-or-girl question weeks earlier than ultrasound, and in a less invasive and safer way than amniocentesis.

“Seven weeks is a different time in pregnancy,” said Dr. James Egan, a professor of obstetrics and gynecology at the University of Connecticut Health Center who was a co-author of a study on sex selection with Dr. Chapman and others. “Women haven’t had the ultrasound where you see the fetus that looks like a baby. Many people don’t even know that a woman is pregnant. And you can have a medical termination,” using pills like RU-486, which can be used at home discreetly before 10 weeks of pregnancy.

There is evidence that some Americans want to choose their babies’ sex. At the Fertility Institutes, a set of clinics in Los Angeles, New York and Guadalajara, Mexico, 85 percent of roughly 500 couples each year seek sex selection, although three-quarters of them come from overseas, said Dr. Jeffrey Steinberg, the medical director.

“It’s jumped over the past four years,” said Dr. Steinberg, whose clinics determine sex through pre-implantation genetic diagnosis, an embryo screening that also detects genetic disorders. He said that “if a woman calls to make the appointment, the couple almost always wants a female. If a man calls, they almost always want a male.”

But clinics and some ethicists say this type of sex selection is more acceptable because it occurs before embryos are implanted, before pregnancy.

“We’re trying to prevent the abortion,” said Dr. Jamie Grifo, program director for New York University’s Fertility Center. His and other clinics typically allow sex selection for couples with two or more children, parents interested in “family balancing,” adding a child of the opposite sex.

“For someone who has two girls and wants to have a boy, so each sibling can grow up with brother and sister, what’s wrong with that?” Dr. Grifo said.

Still, the cost and commitment of the fertility process makes such sex selection cases relatively unusual. Fetal DNA tests, costing between $250 and $350, are more affordable.

Anti-abortion groups are incorporating sex selection in legislative agendas. Arizona and Oklahoma recently passed laws banning sex-selected abortion; a similar bill was just introduced in New York. “I think you will see more states introducing it,” said Mary Spaulding Balch, director of state legislation for the National Right to Life Committee.

The laws would probably not survive court challenges, said John Robertson, a professor of law and bioethics at the University of Texas. But while abortion rights groups, like NARAL Pro-Choice America, oppose such bans, they may be less eager to fight them politically or in court because sex selection is not the most socially sympathetic motivation for abortion.

After all, one concern is whether immigrants from countries like India and China would use sex tests to abort female fetuses here. Dr. Egan and Dr. Chapman’s study found that Asian-American mothers, especially with third pregnancies, had more boys than girls in ratios strongly suggesting sex selection.

Some fetal DNA test-makers are trying to discourage sex selection by not selling in China and India, and requiring customers to sign waivers saying that is not their motivation.

Most mothers in Dr. Egan’s data were born overseas, suggesting the possibility that American-born generations might become less concerned about having male heirs.

Still, fetal DNA tests for sex determination and other traits present “issues that I don’t think many general obstetricians are ready to deal with,” Dr. Egan said. “It’s a brave new world.”

Pam Belluck is a science reporter for The New York Times.