Overview: High-tech sex-selection techniques
The following gender-selection methods draw from two existing infertility treatments:
in vitro fertilization (IVF) and artificial insemination (AI). IVF starts with a round of fertility drugs to stimulate your ovaries to produce several eggs for fertilization, instead of the single egg you normally release each month. Fertility drugs may also be used for AI. For AI, also known as intrauterine insemination (IUI), your doctor uses a catheter to insert a concentrated sperm sample directly into your uterus.

For IVF, fertilization occurs outside your body (in vitro means literally in glass). Your doctor gives you an anesthetic and removes your eggs from your ovaries by inserting a needle through your vaginal wall. Your eggs are then fertilized with sperm in a petri dish. Two to five days later your doctor places the fertilized eggs — now embryos — in your uterus by inserting a thin catheter through your cervix. The number of embryos inserted depends on your age, the quality of the embryos, and your reproductive history. As a general rule, if you're under 35 and the embryos look healthy, no more than two are transferred.

Preimplantation genetic diagnosis (PGD)
What it is
An in vitro fertilization (IVF) technique in which embryos are created outside the womb and then tested for genetic disorders and gender.

When PGD was introduced back in 1989, it was used solely to help couples or individuals with serious genetic disorders reduce their risk of having a child who suffered from the same condition. Today PGD is still used for this reason, but is also used commonly when women are 35 or older and/or have a history of recurrent miscarriage. Only a handful of clinics offer the technique for sex selection for nonmedical reasons.

Effectiveness
Almost 100 percent effective.

How it's done
During an IVF cycle, eggs are fertilized with sperm in a petri dish. A single cell or cells are later removed from each of the resulting 3- to 5-day-old embryos and tested for gender.

In a regular IVF cycle scientists try to determine which embryos are normal merely by looking at them under a microscope. But with PGD, the embryos are tested thoroughly for genetic abnormalities and sex. By transferring only healthy embryos to the uterus, you're less likely to miscarry or have a child with a genetic disorder. Prenatal tests such as amniocentesis or chorionic villus sampling (CVS) are still recommended if you're 35 or older because more genetic abnormalities can be detected later in pregnancy.

In a regular IVF cycle, doctors usually transfer two or more embryos to your uterus — the number depends on your age, the quality of the embryos, and your reproductive history. (If you're 40 or older, typically four or five embryos may be transferred.) But in PGD, doctors transfer no more than two because they've already weeded out embryos that are unlikely to implant or to result in a healthy pregnancy.

Pros
• If you do get pregnant, PGD guarantees with almost 100 percent certainty that you'll have a baby of your desired gender.

• Following a PGD cycle, remaining embryos of the selected gender are automatically frozen. These can used in another attempt, if you miscarry or decide you want more children down the road. Frozen embryo transfers aren't as successful as fresh transfers, but the procedure is less invasive and significantly cheaper.

Cons
• A single round of PGD can cost nearly $20,000.
• The procedure is invasive and the removal of eggs from your ovaries can be painful.
• The fertility drugs you have to take can have uncomfortable side effects such as weight gain, bloating, swelling, and blurred vision.
• As with any IVF pregnancy, you're more likely to have multiple births. According to the latest statistics from the Centers for Disease Control and Prevention, 38 percent of infants conceived as a result of IVF and related procedures were twins.
• About 43% of fresh IVF cycles result in a live birth, and that figure goes down as you get older. But some doctors claim higher success rates with PGD because defective embryos are excluded.
• You'll need to decide what to do with the embryos of the undesired gender: freeze, destroy, or donate for other couples or research.

Cost
IVF cycles cost an average of $12,400. PGD adds an additional $3,000 to $6,000-plus to the tab. Check with your medical insurance company — part of the expense may be covered.

Availability
Most fertility clinics that provide PGD don't allow it to be used solely for sex selection. You must have a medical reason such as a family history of genetic diseases or repeat miscarriages, or be over a certain age, usually about 38, to qualify for the procedure.

MicroSort
What it is
A dye technique that attempts to segregate girl-producing sperm from the boy-producing variety. Sperm of the desired gender is inserted directly into your uterus, usually via artificial insemination (AI).

Effectiveness
The method is about 90 percent successful when it comes to choosing girls and about 74 percent successful for boys. These rates are per pregnancy, not per cycle.

How it's done
MicroSort is based on the premise that girl-producing sperm, which carry X chromosomes, are bigger than the boy-producing sperm, which carry Y chromosomes. The procedure involves coloring a sperm sample with fluorescent dye and then zapping it with a laser that illuminates the dye. The bigger X chromosomes absorb more dye and glow brighter than the Y ones. Sperm are then sorted by supposed gender and the preferred sex is transferred to the uterus, usually via AI. In some cases in vitro fertilization (IVF) is used — which may increase the likelihood of a pregnancy but is also more invasive and expensive.

Pros
• Artificial insemination poses virtually no health risks and is cheaper than IVF. But you may have to take fertility drugs, which can cause side effects and increase your chances of having multiples.
• Because the method typically uses AI instead of IVF, you don't have to worry about what to do with extra embryos.
• MicroSort can also be used to try and prevent the transmission of X-linked disorders — diseases that moms carry and can transfer to boy babies but not girls, such as hemophilia and Duchenne's muscular dystrophy. It lowers the risk of transmitting these disorders but isn't 100 percent effective.

Cons
• The procedure is still being tested in clinical trials and hasn't been approved by the Food and Drug Administration.
• Since MicroSort is relatively new (it's been available since 1995 and as of January 2004, more than 500 pregnancies had been achieved), little is known about possible risks.
• MicroSort can't guarantee a specific gender because the technology doesn't completely exclude sperm of the unwanted sex.
• The pregnancy rate for each artificial insemination cycle is modest — 16.6 percent. With IVF, the pregnancy rate is 43 percent.

Cost
Approximately $3,000 per treatment cycle if AI is used. Fertility drugs can increase the cost by another $2,000. IVF adds an average $12,400 to the cost of each cycle.

Availability
To qualify for MicroSort's program, you must be married and have at least one child and want a child of the opposite gender. You, or your egg donor, must be 39 or younger.

There are two MicroSort centers: The Genetics and IVF Institute has a MicroSort clinic in Fairfax, Virginia. Telephone: (800) 277-6607. The second clinic is in Laguna Hills, California, and operates in partnership with the Huntington Reproductive Center. Telephone: (866) 472-4483.

MicroSort patients who opt for AI must undergo the procedure at one of these two facilities. But if MicroSort is carried out with IVF or PGD, sperm samples can be processed at one of the labs and then shipped to a collaborating medical facility. If you're interested in exploring that option, talk to your doctor.

Ericsson
What it is
A technique that aims to separate faster-swimming boy-producing sperm from slower-swimming girl-producing sperm. Sperm of the desired gender are inserted directly into your uterus via artificial insemination (AI).

Effectiveness
Ericsson claims his technique is 78 to 85% effective when it comes to choosing boys and 73 to 75% effective for girl babies.

How it's done
This technique, which has been around since the '70s, attempts to separate boy and girl sperm by pouring a sperm sample on a gluey layer of fluid in a test tube. All the sperm naturally swim down, but the boys tend to swim faster and reach the bottom earlier. Once the fast and slow swimmers are separated, you're inseminated with the sperm that will enable you to conceive the gender you desire.

Pros
• Inexpensive compared to higher-tech methods.
• Noninvasive.
• Relatively safe.

Cons
• There's no guarantee of success. The technique's pioneer, Ronald Ericsson, has published extensively and claims a success rate of approximately 75 to 80 percent. But some fertility doctors dispute this figure and say that it's no higher than 50 percent.
• AI is not as effective as in vitro fertilization (IVF), and it may take many cycles to achieve a pregnancy, depending on your age and fertility.

Cost
Approximately $600 per insemination.

Availability
Available to anyone who wants it at clinics in California, Michigan, Texas, Connecticut, Montana, Washington, Florida, New Mexico, Maine, and New York.

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