While the Meissners wished to avoid passing on a genetic disease, 86% of the MicroSort's clients so far have used the method for "family balancing," with most of them seeking girls.
It's the idea of choosing a baby's gender for personal satisfaction that is most controversial. England forbids the use of preconception sex selection for nonmedical reasons, and the governing body for infertility specialists in the U.S. frowned on the practice until 2001, when the group softened its stance.
The American Society for Reproductive Medicine's new position reflects changing attitudes about technology as people become more comfortable with it, says Dr. Daniel A. Potter, medical director of MicroSort's West Coast center. Some couples, he adds, will keep having babies naturally, trying to get the gender they desire, a behavior that also raises ethical questions.
"When you have new technology, there will always be questions. But this is technology that couples can use, so they won't use methods that don't work," Potter said. Still, some reproductive health doctors will not perform sex selection for nonmedical reasons, said Susan Benoff, president of the Society for Male Reproduction and Urology.
And, said Lipshultz, "It's also a question of utilizing resources that could be best used for couples who can't have any children at all. Some people question whether doctors should be spending their time on that."
MicroSort officials, however, said their goal is to establish the method's safety, efficacy and cost-effectiveness so that it becomes "a routine part of family planning."
Right now, MicroSort costs $2,300 plus fees for artificial insemination, which are usually about $200. (Under the clinical trials protocol, the company is waiving fees for couples who use the technique to avoid passing on an inherited disease.)
Pre-implantation genetic diagnosis requires in-vitro fertilization, which can cost $10,000 or more per cycle. The new technique can also be used with in-vitro fertilization, which greatly increases its price. Using artificial insemination, couples have a 15% to 20% chance of pregnancy per attempt compared to an IVF pregnancy success rate of about 25% per attempt.
"For people who really want to do this, using pre-implantation genetic diagnosis is the more secure way to go" because of its near-100% accuracy and higher pregnancy rate, said Dr. Richard Paulson, an infertility specialist at USC. "I wonder if PGD will end up being more cost-effective."
According to Paulson, doctors have questioned whether the sperm-sorting technique can provide a large enough sample to ensure a decent chance of pregnancy. A typical sample contains 3 million to 5 million sperm. But after going through sorting, the sample size is usually about 200,000 to 300,000 sperm, which, Blauer concedes, has traditionally been viewed as too small to produce a good chance at pregnancy via insemination.
However, the company has gathered data showing that the sample is large enough to maintain pregnancy rates that equal nature's, he said. That data will be presented later this year at a meeting of the Pacific Coast Reproductive Society.
The company needs 364 live births but needs 750 plus follow-up safety and efficacy data before it can request that the FDA approve the technology. Blauer predicts the clinical trial will be completed in about two years -- an accelerated schedule now that the company has two MicroSort labs in operation.
Couples who want to choose the gender of their baby for nonmedical reasons should first have counseling, says the American Society of Reproductive Medicine. It should ensure that they:
* Know the risk of failure.
* Can fully accept children of the opposite sex if the procedure fails.
* Don't have unrealistic behavior expectations for the preferred gender.
* Are offered the chance to participate in research to track the safety, efficacy and demographics of preconception gender selection.