Could Gender Detection Lead to Gender Selection?

May 4, 2007 — -- "Pink or Blue?"

While many soon-to-be parents eager to pick out nursery colors may fret over this question in the tense months before their baby is born, a test by the same name offers to provide an answer to the sex question as soon as six weeks into pregnancy.

The company that markets the test says the technology is a cutting-edge convenience for eager couples.

But some bioethicists and genetic counseling experts fear the results of the test could be used as a tool to selectively abort fetuses that are not of the preferred sex.

"This is a huge potential problem," says Dr. William Hurlbut, a consulting professor at the Stanford University Medical Center Neuroscience Institute who has served on the President's Council on Bioethics since 2002.

"Now we're really opening up the door to social prejudice and a frivolous kind of preference."

"There are multiple considerations," says Bonnie LeRoy, director of the graduate program in genetic counseling at the University of Minnesota. "And there are obvious ethical considerations as to whether or not using technology to determine the sex of a baby fits in with the morals of society."

Dot-Com for the Not-So-Calm

According to DNA Worldwide, the U.K.-based company that holds the rights for the product in that country, the test has been available in the United States since 2006.

Prospective parents need not head to a clinic; the test can be ordered over an Internet site -- www.tellmepinkorblue.com. The test works by detecting trace amounts of the baby's genes present in the mother's blood. Using the kit, the mother sends a sample of her blood into a lab for testing.

Answers in five business days cost $215.00. For those who need the results within three business days, the cost goes up to $264.00.

But the question in many bioethicists' minds is how the information will be used.

In a statement issued Friday, director of DNA Worldwide David Nicholson said that the aims of the test are benign and have nothing to do with abortion.

"This can be for any number of reasons; in the main it is as ordinary as choosing the correct nursery furniture and clothing colors," Nicholson said in the statement.

"A significant proportion of customers already have several children of the same sex and just knowing takes the stress out of the early stages of the pregnancy."

Lily Nguyen, product manager for Consumer Genetics, Inc., the firm that markets the tests in the U.S., maintains that the product is not designed for sex selection.

"We're not pro-gender-selection," she says. "We want to bring recent genomic discoveries to the hands of consumers. We hope that they don't do anything dangerous with our test results."

But this possibility is precisely what Robyn Shapiro, director of the Center for the Study of Bioethics at the Medical College of Wisconsin, is concerned about.

"The worry, of course, is that there will be an abortion if the answer is not the preferred answer," Shapiro says.

She acknowledges that in some cases, it may be advantageous to get at early peek at the sex of a fetus. Certain genetic diseases are sex-linked, meaning that a baby boy might, for example, stand a much greater chance of suffering from the condition than a baby girl.

But Dr. Michael Grodin, director of the Bioethics and Human Rights Program at Boston University, says that past this, the results of such a test could lead to increased gender stereotyping at best -- and at worst, the termination of a healthy fetus based solely on its sex.

"It's a bad, bad idea," Grodin says. "[The test] is going to be used sociologically to select males over females.

"The bottom line is that being male or female is not a disease."

And Nguyen admits the company acknowledges that its test can be used in this way.

"I wouldn't say we're concerned," she says. "We are aware of it, that somebody might order [the test] for this purpose.

"If they purchase our test, it's their choice. Whether they decide to have a termination, that is their choice as well. We don't in any way advocate this."

The company already refuses to sell the test in countries like India and China, where male offspring are known to be preferred.

Other Tests Exist

Pink or Blue is not the first test with the capability of determining a baby's sex before it is born.

Ultrasound screenings, which were first devised in the late 1950s, can usually allow parents to know the sex of their baby as early as 16 to 20 weeks into the pregnancy.

More recently, researchers have developed tests such as amniocentesis and chorionic villus screening (CVS) to give doctors and parents a peek into their future children's genes, including those that determine sex. These tests can normally determine sex at 12 to 16 weeks, compared to Pink or Blue, which delivers results in as little as six weeks.

Another difference is that the Pink or Blue test is designed expressly to test one thing -- the sex of a baby -- whereas CVS and amniocentesis are usually reserved for women with fetuses at a high risk for genetic diseases.

Hurlbut says the Pink or Blue test may well have opened up a Pandora's box of considerations when it comes to all of these tests.

"The problem is, if you say, 'No, people can't test for sex,' then you are also essentially saying that you can't test for sex chromosomes associated with certain diseases. No one will think that's fair.

"But if you say you can do it, you run into problems with the much bigger phenomenon of people choosing boys instead of girls."

"On one hand, people say this is an issue of reproductive freedom and it should be up to parental choice," Shapiro says. "On the other side of the coin, it could create an imbalance among genders as this happens in other countries."

An Imperfect Test

Another thing that sets this test apart from other methods is that fact that it is currently only about 95 percent effective when used at home.

Nguyen says the accuracy can go up to 98 percent if the test is conducted in a clinic; however, the detection method used is so sensitive that any male DNA -- even from a husband or son who happens to be nearby while a woman performs the test -- can affect the results.

This would mean that on the whole, about one out of every 20 tests conducted at home would actually give the wrong result. The company has a policy of refunding the money spent on the test if this occurs.

But it's unlikely that they'll agree to repaint your nursery. And for parents who do choose to use the results to decide whether or not to abort, the ethical implications of this margin of error could be even greater.

"The only take-home point that I have is 'go slow,'" Shapiro says. "Decisions like this do not only have implications for the population at large, but also for the individual.

"We all have to think about whether this is a direction in which we want to go."