April 10, 2020

ivf birth defect

Author Name: Dr. Pratibha V. Pawar || Mentor Name: Dr. Shyam Gupta on April 10, 2020

During our day to day practice, we quiet often come across couples bringing in such requests. In India, as we all know that it is illegal to indulge in any kind of activity or use any technology to determine the sex of baby by any means. At present, it is controlled by Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994 which is an Act of the Parliament of India put into practice to stop female foeticide and control the decreasing sex ratio in India. The act has banned any kind of sex determination and accounts for punishable offense. According to World Health Organization (WHO) , these regulations have not been strictly enforced. Of late the Supreme Court of India has issued detailed directives to the national and state governments to raise awareness on the law on sex determination and for increased surveillance of all clinics providing ultrasounds.

In 2001, as per census the country sex ratio was 933 females to 1000 males. In some state of India like Haryana, this discrepancy increased to 861 females to 1000 males, with only 820 females in the under six age category. According to 2011 Census, Gender Ration of pan India was 943 and according to UN 2019, it has become 924.

There are three core motivations for engaging in sex determination and sex selection according to WHO.

1. Medical reasons—such as preventing the birth of children affected or at risk of X-linked disorders.

2. Family reasons— where couples choose to have a child of one sex because they already have one or more opposite sex child in family.

3. Gender reasons— often in favour of male offspring stemming from cultural, social, and economic bias in favour of male children and as a result of single child policy eg. in china.

Ethical Issues Raised by Sex Selection

The principal concerns are that the act of sex selection will
1. Disturb the natural sex ratio leading to a gender imbalance and ecosystem
2. Reinforce discriminatory and abusive stereotypes towards women by devaluing females.

What all technologies can be used for baby’s gender selection?

It can be any one of the following procedures:
1. USG
2. Fetoscopy
3. Sampling of chorionic villi / amniotic fluid / fetal blood
4. PGS of embryo

However, use of such technology, by law, is permissible only for medical indications such as any genetic / metabolic / chromosomal / congenital abnormalitie.

During the process of IVF, PGS (Prenatal Genetic Screening) OR PGD ( Prenatal Genetic Diagnosis) of embryos are done for certain indicated conditions like when the women has had multiple miscarriages, when her age is 35 yrs or more, when they have had 2 or more IVF failure, when parents are carriers of genetic abnormalities or having X chromosome linked disorders. In such cases the embryos, formed by fertilizing a women egg with husband’s sperm in lab, are grown for 5-6 days called Blastocyct stage and are put under microscope to remove 2-4 cells from the outer layer which are sent for prenatal genetic screening. The intention for doing such procedure is to screen for healthier embryos and transfer so that to have healthier babies thus making pregnancy less stressful.

There has been vast improvement in medical sciences over the past few decades as a result we have witnessed major discoveries and inventions in field of genetics. Hence there is need for an authorized body to maintain regulations and ethics for protection of humans in biochemical and behavioral researches. Under the regulations for human rights, racial preferences is strongly prohibited so sex selection before birth remains controversial as it would favor one gender over other, diminishing opposite sex value in society.

Now if we use this technology to allow baby’s gender selection in INDIA, where the population has preferences inclined towards having baby boy based on the cultural belief or some inheritance related issues, it would raise many ethical issues and concerns. Authorities fear it would lead to screwing up of gender ratio significantly. Where as in eastern European and North American countries where sex preference seldom has ethical concern and discrimination, there are no legislation or guideline for regulation from the governing bodies.

From history until to this day, we have seen couples seeking out to different methods favoring male child like timing in intercourse (following Chinese calendar), position of intercourse and even consuming a special diet to the present day’s latest technologies in field of fertility and conception like spermatozoa separation technique & PGS. All these methods including sperm sorting techniques are not definite and are not reliable unlike PGS. But selecting baby for a desired sex without any medical obligation becomes unethical as baby has autonomic rights and no one has the right to intervene with its life.

Sperm sorting techniques called MICROSORT are used to separate of X and Y spermatozoa with flow cytometry whenever there is need for prevention of X linked disorders .But it has to be cautioned, as mutational agents like ultraviolet rays and fluorochrome stain are used ,although pregnancies following this method have yielded normal births. PGS forms an invasive procedure where few cells are removed at the embryonic stage and limited amount of cellular material is obtained for testing .Challenges arise when there are chromosomal mosaicism which will lead to false results. Safety of PGS remains unclear; reports claim that children born following PGS are not at increased risk of fetal abnormalities and complications compared to the children born through ivf. Another factor that influences is the cost, which is high for PGS and expertise requirements to do the procedure.

In India, though law allows sex determination and selection of embryos under medical indication of X chromosome linked disorders, it has become a taboo allowing baby’s gender selection for family balancing. Many claim that when a couple is allowed to choose when to have babies, how many to have and terminate when they inadvertently get pregnant they should also be allowed to choose gender of baby for balancing family. Such practice has to be restricted to couples who have at least one child and desire to have a child of opposite sex. Extra embryos of undesired sex should be treated same way like any extra embryos handled by IVF lab. This will protect couples right to choose also embryos right to live. For couples planning for their first pregnancy through IVF with no genetic problems, baby’s gender selection during IVF will be inappropriate

Another school of thought question whether is it right to forgo nature’s gender selection? Purpose of developing technology was to provide more control over healthy offspring than it was in past, Just because we can do something doesn’t mean we should do! If gender selection is allowed, it not far, couple would start asking for tailor made baby of certain eye/hair color or height. We have seen couples coming up with such weird requests when it was in news all over about 3 parent IVF procedure done in UK, done to prevent defective mitochondrial gene transmission from mother to offspring. When it comes to use of technology, humans cannot be trusted upon, they will abuse the technology. Already India has witnessed gender specific abortions causing loss of millions of female fetus provoking PCPNDT LAW to be enacted. In western countries women have equal status as men and they restrict family size as it becomes too expensive for them, but in India scenario is different. Indians have strong preference to son as it’s considered synonymous with economic and social benefits and only affluent couples restrict their family size. For a poor farmer every child is additional source of income. That is why it needs to be policed in India, to prevent its abuse for non medical reasons and adhering to professional guidelines.

Lately, medical technology has come in so handy that doctors too feel it’s not justified to transfer embryos whose genetics is not known. But to do it for every patient, financial constraint is an issue.


The issue of sex selection through IVF in India for non-medical reasons will often reflects discriminatory attitudes or stereotyping views, hence allowing the practice is fundamentally at odds with a human rights based on the sexual equality. In this view, limiting to the present ban will send a clear and consistent message to society that selecting the sex of one’s offspring is morally wrong and moreover it is a criminal offence in India.
“Stop SEX SELECTION, Save the Girl CHILD.”

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