RPMG and Dr. Wisot in ELLE

Girl Crazy: Women Who Suffer from Gender Disappointment

Reproductive Partners was cited in an article in the November 2009 issue of ELLE magazine, “Girl Crazy: Women Who Suffer from Gender Disappointment.” The article profiles women whose lives are disrupted because they have not been able to have the girl child that they are craving. According to the author, they resort to a variety of techniques to try to achieve their elusive dream from folk remedies to IVF with preimplantation genetic screening (PGS), also know as preimplantation genetic diagnosis ((PDG) for chromosomes. The focus of the article was the degree of emotional impairment from which these women suffer rather than the procedure itself. The article profiles a physician whose practice is devoted to IVF/PGS for gender selection, although the technique is widely available, including at Reproductive Partners.

The article states, “Physicians at other clinics, including California’s topranked Reproductive Partners Medical Group, use PGD as a screening tool to identify embryos with defects, and—if pressed— will reveal the sex of embryos in conjunction with other findings. ‘We would transfer embryos of one sex or another if that is the patient’s preference,’ says Arthur Wisot, its executive director and a clinical professor of reproductive medicine at UCLA. ‘We would do it if they seem like reasonable people and no one is hurt by it. But we certainly don’t advertise it and promote it the way Steinberg does. The people he services are more on the fringe, and he’s just playing to their neuroses.’”

Actually Reproductive Partners offers IVF/PGS for family balancing and we do not need to be “pressed” to reveal the sex of embryos. It is just not the only focus of our practice. We mostly employ this technology to detect embryos with chromosomal abnormalities, when appropriate, and diseases caused by known gene abnormalities carried by one or both parents. In fact, the most recent recommendation from the American Society for Reproductive Medicine has reduced the number of reasons for doing PGS for chromosomes because of evidence that it does not improve live birth rates in patients with advanced maternal age, previous implantation failure, recurrent pregnancy loss and even those who have recurrent pregnancy loss from chromosomal abnormalities.

WFWW-Gender Selection

Wisdom from Wisot Wednesdays

Can I do gender selection?

I have been an infertility patient with 2 successful frozen embryo transfers, one singleton and now a twin pregnancy, all 3 boys. I can't believe we are considering this already, but we've been throwing around the idea of trying again. I was wondering if I can do some procedure to do gender selection and look for any little girl embryos to transfer back.

There are two procedures you can take advantage of to try to increase your chances of a girl. One is sperm selection through a patented sperm selection technique called Microsort. This technique is 90% effective creating girl embryos; 70% success when boys are desired. It can be used with either intrauterine insemination or IVF depending on how many viable sperm of the desired sex are available after the separation process, as well as fertility issues in the intended parents.

If IVF is needed, as in your case, the process can be increased to virtually 100% accuracy by adding preimplantation genetic diagnosis (PGD) to select girl embryos. In addition to sorting the sperm to increase the number of girl embryos with Microsort, the embryos could be biopsied three days after retrieval and insemination. One cell is removed from the then six to eight cell embryos and sent to the genetics lab where from five to twelve chromosomes, including the sex chromosomes, will be examined. Chromosomally normal female embryos will be identified for transfer five days after retrieval.

There are some ethical issues related to this. First, Microsort is currently seeking FDA approval and their protocol requires that the procedure be performed for “family balancing.” That means a couple must have at least one child before seeking the procedure to balance with a child of the opposite sex. Second, if not enough sperm are available for insemination and IVF would be required for that reason only, the question of whether to do IVF, in others, just for sex selection raises an ethical dilemma since IVF is more risky, invasive and costly. If you want sex selection for whatever your situation, you will likely find differing answers among different doctors to all the ethical issues raised by sex selection.

Sex Ratio/Identical Twins in Blastocyst Transfer

WFWW-Sex Ratio and Identical Twinning in Blastocyst Transfer


One of the most frequent questions I am asked is whether IVF treatment, and blastocyst transfer in particular, increase the number of offspring of one sex.

According to a compilation of four studies published in the June 2009 issue of Fertility & Sterility, a higher male-female ratio after Day 5 blastocyst transfer compared with Day 3 cleavage-stage ET was 1.29:1 in favor of male offspring. This is not high enough to recommend this as a sex selection technique, but will be somewhat reassuring to those wanting a male child.

The study also looked at the chance of identical twins (monoztgotic twinning-MZT) in Day 5 transfers which has been said to be increased over Day 3 transfers or natural conception. They reviewed the results of nine studies incorporating almost 41,000 cycles and found the risk of MZT after blastocyst transfer was significantly higher compared with cleavage-stage transfer by a factor of 3.04:1. MZT is not a desirable result as it can create a more risky pregnancy for the babies, especially if they are in the same amniotic sac.