Introduction
In Vitro Fertilization (IVF) is a successful treatment for purposes of infertility and in couples who are in need of Pre-implantation Genetic Diagnosis (PGD) so as to assess genetic abnormalities of their potential offspring. These two procedures can also be used by couples who do not have fertility problems.
In these instances, IVF and PGD are used as a form of assisted reproductive technology to guide the couples in selection of the offspring they intend to conceive based on the sex. Sex selection of an offspring may be due to preference or it may be because the couple is selecting a sex that does not have sex-linked genes (Elder, 2008, p52).
For instance, some genetic diseases are sex-linked, for example, Duchenne muscular dystrophy which affects boys but not girls (girls are only carriers of the disorder). In these cases, cells derived via IVF are analyzed so as to determine the sex of the embryo. In case male embryos have the sex-linked condition, only the female ones are implanted.
However, it is important for couples that decide to use these assisted reproductive methods to understand the risks, benefits, complications and challenges of the procedures and to decide whether the risks are worth taking so as to create gender balance in their family. The success rate of these procedures depends upon many factors like age of the woman and the physiological/health condition of the couples (Harper, 2009, p56).
Risks of PDG and IVF
Risks for PGD and IVF in sex selection procedures may be classified as; general risks, disorders in pregnancy outcome, risks to do with infant mortality and morbidity, and risks concerning imprinting disorders. Healthcare experts need to define the nature of the risks well because they determine the success rate of the procedures.
Some potential risks are extremely dangerous and they, hence, necessitate health care experts to abandon the procedure. However, some risks are worth taking if the couple is really intent on the sex selection exercise.
General risks and complications of PGD treatment are identical to those of IVF since the procedures depend on each other. Some potential risks for IVF are drug reactions, multiple births, ovarian hyper-stimulation syndrome (OHSS), and ectopic pregnancy (Tursi, 2008, p67).
Drug reaction
A good number of women have some form of reaction to the IVF drugs; this is manifested as hot flushes, irritability, headaches, restlessness, lethargy, nausea, vomiting, shortness of breath, abdominal bloating(due to excess fluid accumulation), abdominal pain and swelling and ovarian hypertrophy. Most of these side effects are mild and should not cause much alarm, hence, are considered as general risks.
Abdominal pain and swelling is as a result of ovarian hyper-stimulation in response to the injected gonadotrophins. Women who have these symptoms need to see a doctor urgently especially when there is abdominal pain and swelling (Center, 2009, p79).
Multiple births and birth complications
Placement of more than one embryo in the womb enhances the likelihood of a couple having twins or even triplets. This is not a bad thing, but, it increases complications for the pregnant woman and the embryo. Multiple pregnancies elevate the blood pressure of the woman and increase the risk of developing diabetes during the pregnancy period.
Statistics in the UK reveal that more than half of twins and 90% of triplet are prematurely born or are born with a subpar standard birth weight. Hence, this increases infant mortality and morbidity rates.
This is because it has been documented that the risk of an infant dying during the first week is about five times higher for the case of twins than when it is a single baby. For triplets, this is even worse, rising by about 9 times (Harper, 2009, p98).
Ovarian hyper-stimulation syndrome
This complication is rare in IVF procedures, but couples considering the procedure need to have this in mind. For highly sensitive women to the IVF drugs that are taken to enhance production of many eggs, too many eggs are produced in the ovaries which cause ovarian hypertrophy. The ovaries become very large and extremely painful. Women below 30 years are more likely to develop these complications during pregnancy.
Women who have polycystic ovary syndrome also have a higher probability of developing ovarian hyper-stimulation syndrome. Other symptoms are nausea, abdominal bloating and vomiting. Severe cases are dangerous since they complicate the pregnancy (Sutcliffe, 2009, p89).
Ectopic pregnancy
Having IVF increases the risk of developing an ectopic pregnancy whereby the implanted embryo will attach itself along the walls of the fallopian tube. This complicates the pregnancy due to retroperitoneal bleeding (bleeding into the abdomen) and vaginal bleeding. Ectopic pregnancies are very dangerous since extreme bleeding can cause hemorrhagic shock which is a cause of acute death.
Other complications and risks
Pelvic infections may also occur in some cases of egg collection, and in some cases, abscess formation also occurs. Even if the procedure is carried under sterile conditions, sometimes it is almost impossible to prevent infections.
Pelvic infections manifest with pain in the lower abdomen, red vaginal bleeding, diarrhea, fever and general malaise. The needle may also puncture the small bowel and the adjoining abdominal vessels. However, the bleeding can be stopped through pressure application at the injured site (Verlinsky, 2008, 78).
Ethical considerations of sex selection
Even though some methods for sex selection have been approved by various medical societies, ethical issues continue arising concerning the morality and nature of the process. Sperm sorting has been criticized by various groups and medical societies.
Sperm sorting involves sorting sperms based on the type of chromosome. This is of help to couples who are undertaking sex selection but most people feel that it is unethical to choose the type of sperm for fertilization.
Other people also argue that it is extremely unethical to disregard and discard babies simply because genetic conditions have been implicated in their chromosomes. To others also, it is unethical to create very many embryos so as to increase the chances of fertilization. Most of these extra embryos are unnecessary and are seen as wasteful.
Regardless of these ethical considerations, sex selection is a decision of a couple who decide what is good for their families especially since it causes gender balance. The couple should not be concerned about what other people in society feel as long as they understand the benefits it would bring to them.
Nobody has a right to decide what is acceptable or not. Gender selection is anyone’s fundamental right and if one decides to do it, they should go ahead (Kehoe, 2009, p97)
Factors that contribute to wanting gender selection
The motivation of desiring gender selection is the desire by couples to have a gender balanced family. For example, a couple may feel that they have many boys than girls, and they may, hence, decide to undertake gender selection so that there is an equal number of boys and girls in their family.
This is every couple’s preference; while some couples do not mind the sex of their children, some treasure some sexes as compared to others. As a result of this they decide to create gender equality.
Secondly, a couple may not want to pass undesirable traits to their offspring especially sex linked traits like haemophilia A and Duchene muscular dystrophy. These traits are deadly and, hence, a couple may decide to give birth to health children alone.
References
Center, G. P. , 2006. PGD: preimplantation genetic diagnosis : a discussion of challenges, concerns, and preliminary policy options related to the genetic testing of human embryos. New York: Genetics and Public Policy Center.
Joyce C. Harper, J. D., 2009. Preimplantation Genetic Diagnosis. New Jersey: John Wiley and Sons.
Kay Elder, B. D. , 2008. In-Vitro Fertilization. Cambridge: Cambridge University Press.
Sarah A. Tursi Msw, S. A. , 2008. Ivf: The Wayward Stork: What to Expect, Who to Expect It From, and Surviving It All. New York: iUniverse.
Sean Kehoe, L. C., 2008. Reproductive genetics. London: RCOG.
Steven R. Bayer, M. M., 2007. The Boston IVF handbook of infertility: a practical guide for practitioners who care for infertile couples. New York: Informa Healthcare.
Sutcliffe, A. G., 2009. IVF children: the first generation : assisted reproduction and child development. New York: Parthenon Pub. Group.
Yury Verlinsky, A. K., 2008. Atlas of preimplantation genetic diagnosis. London: Taylor & Francis.