From the moment she announced her pregnancy on Instagram last fall, Chrissy Teigen has remained refreshingly unfiltered about everything, including the in vitro fertilization techniques she and John Legend used to conceive. So on Wednesday, when the outspoken model revealed in an interview that she had picked her child’s gender with IVF—“Not only am I having a girl, but I picked the girl from her little embryo”—the sudden wave of Internet controversy must have caught her off guard.
Criticisms ranged from disappointment that Teigen would prefer a specific gender at all to accusations she and Legend had “thrown away” all the male embryos in pursuit of a girl. “I think I made a mistake in thinking people understood the process better than they do,” Teigen shared on Twitter. “Hard to explain such a complicated process here.”
It’s true that the science behind IVF, and gender selection in particular, is not often discussed. According to Jeffrey Steinberg, M.D., a leading IVF specialist, the 18-year-old technology of gender selection arose from the chromosomal analyses used to screen for genetic diseases. From there, doctors began offering genetic profiles to determine whether embryos were missing chromosomes, which makes them unviable, and, as a by-product of those tests, were able to inform couples of each embryo’s gender.
“If I’ve got a tool that can raise the chances of getting pregnant by 25 to 30 percent, I’m going to use the tool,” Steinberg explains. “The side effect of that tool is that you happen to learn gender.” When put that way, gender selection becomes a clinical offshoot of modern IVF for couples like Teigen and Legend, who screen their embryos to offset fertility issues. But there is a growing number of couples—some 70 percent of the patients in Steinberg’s practice—who use IVF specifically so that they can choose a son or a daughter, raising a question around a certain moral debate: Is that going too far? Clearly, it triggers stronger emotions than in vitro itself. “What is that difference though?” Teigen wrote on Twitter. “I’ve already created embryos with a doctor. Only after must it be random?”
She’s right, of course—once you’ve started IVF, the distinction becomes arbitrary, to some degree. But experts like Arthur Caplan, head of NYU Langone Medical Center’s division of medical ethics, argue that the moral issue is rooted on a basic principle. “It’s very simple: Gender is not a disease,” he says. “There’s nothing related to illness about it, so if you’re picking gender, you’re indulging a taste or preference, and normally medicine doesn’t respond to that.” Or, as Robert Klitzman, M.D., director of the masters of bioethics program at Columbia University and author of Am I My Genes?, points out, it raises questions about how much control we should have over another life. “Children should have an open future and be able to flourish, and if we plan too much what we want in a child, is that fair to the child?” he asks.
That being said, both Caplan and Klitzman make an allowance for couples like Teigen and Legend, who pursued IVF due to their infertility. “If you want to pick, you can pick, you’re there anyway,” Caplan says. “What I find ethically objectionable are people who use IVF to pick gender, which gets into sexism”—as well as for couples who might have had six girls and would like one boy. The chief concern lies with the future direction of genetic selection: a world in which traits like sexuality and left-handedness become selectable, or traits like albinism may be screened. What happens then? “You can see how the slope begins,” Caplan says. “Gender is not the only issue we’re going to have to wrestle with down the road.”
Going one step further, there are worries that wealthier individuals will be able to design their children to have highly specific traits like height, intelligence, and health, to the point where certain illnesses, like breast cancer, could exist only for lower-income families, who cannot afford the standard base cost of $12,000 for IVF and $4,000 for genetic screening. The fact that earlier this month the British government approved research on editing embryonic genes brings these seemingly futurist concerns screeching into the here and now. “We’re developing these technologies, and it’s important for people to be aware that these larger issues are going to become increasingly present,” Klitzman says. “This should be an opportunity to think about the larger issues, rather than this particular person.”
In other words, gender selection is a deeply complex matter that demands reflection and frank, open discussion—the kind that Teigen herself is advocating. “You’d be surprised at how many people you know go through this,” she said on Twitter. Now, if only they, too, would speak out.
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