Family Balancing & Sex Selection

Technology has advanced significantly in the past several years allowing couples the option of selecting the sex of their next child. While somewhat controversial, Fertility Center & Applied Genetics of Sarasota does provide the option to participate in a MicroSort® clinical trial. Dr. Pabon has a long association with the MicroSort® study team as a study collaborator. The following is a brief description of the process.

Fertility Center and Applied Genetics of Sarasota currently participates in a clinical trial using a system called MicroSort®, a proprietary sperm sorting procedure. While no medical procedures can be absolutely guaranteed, this proprietary process by which sperm samples can be preferentially enhanced to have a higher ratio of male Y chromosome sperm or female X chromosome sperm, does show promise. [The sex of a child is determined by the single sex chromosome carried by normal sperm. Some sperm carry an X chromosome and result in female child while the Y chromosome normal sperm will result in a male child.]

The main limitation of the MicroSort® system is that sorted sperm still contain sperm of both types. For that reason, a child of the sex opposite of the desired sex can result. Another limitation of the sperm sorting procedures is that after sorting, the sperm sample numbers may be significantly reduced and only usable for in vitro fertilization and intracytoplasmic sperm injection procedures. [A reasonable chance of pregnancy with a simple intrauterine artificial insemination is expected when the final total normal sperm cell count in the specimen is higher than 10 ­ 12 million normal sperm cells.]

In order to enter the MicroSort® trial and treatment, you must first make an appointment with our office for consult, consults and infectious disease screenings. Once complete, sperm samples can be presented to our laboratory where they are frozen and shipped to the MicroSort® laboratory in Virginia. The MicroSort® team will then sort the specimen and return it to the Sarasota laboratory for use in in vitro fertilization procedures.

Alternatively, our offices will assist a local patient in preparing for simple MicroSort® artificial insemination procedures to be performed at the actual MicroSort® site. Patients who choose to do this can have their ovulation monitoring (usually by ultrasound) at either our Sarasota or Naples location. Both partners would then travel to the MicroSort® site in Virginia to have sperm sorted for a fresh MicroSort® intrauterine insemination.

Pre implantation genetic screening (PGS) or Pre implantation genetic diagnosis (PGD) for Family Balancing or Sex Selection

The sex of a pre-embryo can be determined three days after the fertilization of the egg. This is through the process of PGD or PGS. Our center had its first live birth after PGD/PGS in 2002. The patient carried a sex- chromosome-linked fatal genetic disease. In this initial case, we able to screen three day old pre-embryos for abnormalities in eight key chromosome pairs. One of the chromosome pairs was the sex chromosomes. We were able to select XX carrying female pre-embryos to transfer into the mother. This avoided the severe neurological disease that was carried in the male offspring in this family. Since then, we have treated numerous patients [seven to ten per month] with PGD or PGS for not only sub-fertility, recurrent pregnancy losses, genetic disorders, as well as patients with a desire to pre-determine the sex of the next child.

Over the years, more patients have chosen to do IVF with PGS/PGD because it is much more certain than sperm sorting. Our patients are always counseled that no medical procedure can be 100% guaranteed. It should be noted however that since 2002, we have performed hundreds of cases without one misdiagnosis or surprise regarding the sex of the child. With PGS/PGD one can expect less than one percent chance of an undesired result when it comes to sex selection.

Family Balancing/Sex Selection Common Questions

Is Sex Selection ethically appropriate?
At Fertility Center & Applied Genetics of Florida, Inc., we treat all pre-embryos with the respect warranted and encourage families to freeze normal pre-embryos regardless of their sex chromosome status.

The ethics of sex selection are certainly controversial. There are certainly those who feel that this technology should only be applied to prevent devastating genetic diseases or conditions. Some feel it should not be an elective for family balancing. Family Balancing & Sex Selection is an extremely personal decision and while we feel the available technology and procedures are safe, like all fertility and genetics related measures, the decision to proceed should not be made lightly.

Given the safety of the processes involved, it is our opinion that family balancing through sex selection is acceptable. The processes are carried out on pre-embryos prior to any tissue differentiation or organ system development.

What if all the pre-embryos are of the opposite sex that we desire?
Patients must decide whether they wish to freeze normal pre-embryos of the opposite sex desired.

Can we do sperm sorting with Microsort® and use the sorted sperm for IVF with PGS/PGD?
Yes, couples may choose come to our Sarasota laboratory, provide a sperm sample that can be frozen and shipped to Microsort® for sperm sorting. This will add to the expense. In addition, patients with limited sperm counts may not sort well. That is, after sorting the sperm the counts may be extremely poor. This can result in more technically challenging insemination procedures.