How They Chose the Gender of the Baby in IVF – Medical, Legal and Ethical View
Many couples who hear about IVF and fertility treatments naturally ask: “Can we choose to have a boy or a girl?”
Some other couples are curious about how they chose the gender of the baby in IVF and whether this is really possible in a safe and ethical way.
Some people have this question because of curiosity, while for others, it deals with family balancing-for example, a family with two girls that would like a boy-or a deeply medical and genetic concern, such as the risk of passing on a disease linked to one gender.
In this article, we explain in simple language:
- From a scientific point of view, how gender selection works in IVF
- When it is indicated for medical reasons and when it is only a personal preference
- What legal and ethical questions are involved
- And how you can discuss this topic with your fertility doctor
What does gender selection in IVF mean?
In natural conception, the gender of the baby is set at the point of fertilization, based on the combination of the X and Y chromosomes, about which we have no control.
In IVF with genetic testing (such as PGT), embryos are created in the laboratory and can be checked genetically before they are transferred to the uterus. It is at this stage that it is possible to **identify whether each embryo is genetically male or female.
In other words,
During in vitro fertilization, eggs are collected from the woman’s ovaries.
The eggs are fertilized with sperm in the lab to form embryos.
- A very small sample of cells is taken from each embryo after a few days of growth and sent for genetic testing.
- In this test, doctors are able to tell whether each embryo is XX (female) or XY (male)
- Then, a decision on which of the embryos to transfer can be made.
This does not mean changing the baby’s gender inside the womb. This means choosing one embryo with the desired gender from the available embryos and transferring that embryo to the uterus.
Is it really possible to choosing the gender of the baby with IVF?
Scientifically speaking, it’s better to say that IVF enables you to select the embryo to be transferred and not to design a baby from scratch. But to many couples, it will feel like they can choose their baby’s gender through IVF; they are offered a list of embryos that have already been tested and labeled either male or female.
This option usually comes with important conditions. In many countries, gender selection is only allowed when there is a strong medical reason, such as a serious sex-linked genetic disease. In other countries, it may also be allowed for so-called “family balancing”, for example when a family with three boys wishes to have a girl. In every case, couples should be fully informed about the medical steps, the legal rules and the ethical questions before deciding to choose their baby’s gender with IVF.
Medical vs. non-medical reasons for gender selection
Gender selection is not always based on simple personal preference. It can usually be divided into two main categories:
1. Medical reasons
Some genetic disorders in certain families predominantly affect one gender, or are more serious in males or females. Many X-linked disorders are good examples.
In such cases:
- The family is concerned that the future child could inherit the condition.
- IVF with PGT can be used to check embryos for genetic problems and in some cases also select an embryo with the gender having lower risk of disease.
Here, gender selection becomes more of a medical decision than a cosmetic one.
2. Non-medical reasons (personal preference or “family balancing”)
Sometimes, couples just want to:
- Have a boy after several girls
- Or have a girl after several boys
This is commonly referred to as **family balancing
Generally speaking, in such cases, the selection of gender is not a strict medical need but rather more of a personal or cultural preference.
How They Chose the Gender of the Baby in IVF Step by Step
How does gender selection work in IVF?
Standard IVF consists of several steps:
ovarian stimulation, egg retrieval, fertilization in the lab, embryo culture, and embryo transfer.
When adding in gender selection, there is an additional key step in the process:
1. Embryo creation in the lab
To understand how they chose the gender of the baby in IVF, we first need to look at how embryos are created and tested in the lab.
Fertilization of the eggs by sperm is done in the embryology laboratory after ovarian stimulation and egg retrieval.
Several embryos may develop, and are grown in special incubators until day 3 or day 5.
Embryo biopsy for genetic testing
A few very small cells are carefully removed from each embryo.
This procedure is performed with high precision by an experienced team to ensure that the embryo remains viable.
3. Chromosome analysis and gender identification
The sampled cells are sent to a genetics laboratory where:
The number and structure of chromosomes are checked.
- The sex chromosomes, X and Y, are differentiated
- The lab determines whether each embryo is genetically male or female
4. Selecting the embryo to be transferred
Based on:
Genetic health
- Embryo quality
- And, where legally allowed, the family’s preference for gender
the team selects one or sometimes two embryos for transfer to the uterus.
This technique has an accuracy of well over 99% in most instances but is never considered to be absolutely 100% accurate in a medical context.
Is gender selection legal in every country?
The answer depends strongly on the laws of each country and policies of individual fertility clinics.
Generally speaking:
- In some countries, gender selection is allowed for medical reasons only, for the prevention of serious genetic diseases, for instance.
In others, it may be permissible for family balancing also.
- In some countries, gender selection of any type is strictly forbidden-even through IVF
For couples considering IVF and gender selection in a particular country, it is relevant to:
Information: * Check local regulations
- Clearly explain the problem to the fertility clinic or medical tourism team
Ensure that the treatment is done within the appropriate legal and ethical framework
Benefits, limitations and ethical concerns
Benefits
- Potential to avoid specific sex-linked genetic diseases
- A way to support families who have long wished for a child of a particular gender
- A sense of “balance” in the family, as recognized by some parents
Limitations and risks
- The couple has to undergo IVF and more invasive procedures to reach the stage of gender selection, even when they might conceive naturally.
PGT and genetic testing add to the cost; IVF with PGT is generally more expensive than standard IVF.
It is always possible that in any one cycle, there will be few or no healthy embryos of the desired gender.
Ethical questions
Besides the medical side, there are important ethical concerns:
- Worries about moving toward “designer babies” as more and more traits get selected
Social pressure by family or friends to have a boy or girl
- Potential imbalance in the male-to-female ratio of a society should gender selection become widely unrestricted
Based on these reasons, many countries and clinics prefer to work within strict guidelines and only allow gender selection in well-defined and responsible situations.
Is gender selection in IVF the right choice for us?
Of course, there isn’t one right answer for everyone. Each family has to honestly consider:
- What is our real reason for wanting gender selection?
- A medical/genetic issue?
- A personal wish?
- Pressure from relatives or cultural expectations?
- Are we ready financially, emotionally, and in terms of time to go through IVF plus PGT?
- Is this procedure legal in the country where we plan to have treatment?
- Does this decision feel compatible with our religious beliefs, values and conscience?
International fertility societies such as the American Society for Reproductive Medicine (ASRM) provide guidance on when genetic testing and gender selection may be considered medically appropriate.
An open discussion with a specialist in fertility, and when necessary a counsellor or psychologist, may make the final decision more informed and much less stressful.
How to talk to your doctor about gender selection
If gender selection is important to you, it’s better to discuss it openly and clearly with your medical team. You can:
Ask during the initial consultation:
- Do you provide gender selection in your clinic?
- Under what conditions? Only for medical indications, or also for family balancing?
- How is PGT performed here? What is the approximate cost for IVF + PGT? For couples who are worried about the financial side, we also provide a detailed breakdown of IVF cost in Iran, including medication, lab work and add-ons such as PGT.
- What are the main risks and limitations?
- Can you explain both the advantages and disadvantages, not only the positive side?
- Is there someone in your team who can offer counselling if we feel unsure about our decision?
- You should also:
- Bring all previous test results and medical history, so the doctor can advise appropriately.
If you are still at the beginning of your journey, you can first read our main guide on IVF in Iran for international couples, which explains the full process from consultation to embryo transfer.
From a scientific point of view, IVF with genetic testing can, in many situations, make it possible to identify and select the gender of embryos before they are transferred to the uterus.
This is not just a laboratory decision, however. It is closely linked to:
- The medical situation of the family
- The laws of the country where treatment is performed
- Ethical and religious values
- The preparedness of the couple, both emotionally and financially
If you are considering IVF and gender selection, the following is important:
- Gather accurate, science-based information
- Be upfront with your fertility doctor about your questions and concerns
- Make sure the treatment is legal and ethically acceptable in your situation
And finally, choose an option that feels right both from the medical point of view and from that of your own heart and values.
In the end, understanding how they chose the gender of the baby in IVF is not only about science, but also about values, laws and your family’s unique situation.