Cross Border Sex Selection

Abstract:

Contemporary, “high-tech” forms of sex selection (elective sperm or embryo sexing) used with assisted reproduction technologies have often been framed as a new local, “western” and U.S. practice against longer-standing sex selection practices stemming from the East.  Yet, a close look at the actual practices reveals significant movements across clinical sites and information networks between the U.S. and several countries such as Mexico, the U.K., Canada, Australia, China, and Nigeria. This talk explored some of the routes of cross-border sex selection and explain how it functions institutionally.  It seeks to displace a dichotomous framing of global sex selection practices that polarizes western from eastern practices with the more varied and complex movements that take place in cross-border sex selection.

Presentation:

My topic builds on the idea that sex selection is not a local, Asian issue, not a culturally or geographically bound issue, but rather a transnational, increasingly global phenomenon. Specifically I’ll address how sex selection has joined other cross-border ART practices. I draw from my dissertation research. During the data collection phase I visited two U.S.-based fertility clinics, and interviewed their directors, lab techs, embryologists, and nurses. My research centers on two methods. Briefly, one called MicroSort, is a sperm sorting technology, that identifies X or Y bearing sperm based on the amount of DNA they contain (X sperm contain more), and then sorts out concentrated samples of either X or Y sperm, and uses these along with either insemination or in vitro to increase the probability of having a boy or girl. The other, known as PGD, is an embryo sexing technology. A single cell is extracted from embryos created via IVF, once they are three days old and have 8 cells. The cell is analyzed for the sex chromosomal combination XX for a girl or XY for a boy before embryo transfer. Very often,the sex test is combined with screening for aberrations in chromosome numbers or with other applications of PGD.

Without numbers to back them up, much of mainstream news and popular media that
announced these technologies in the late 90s and early 2000s gave us a narrative, sometimes
accompanied with images, of a self-determined woman racialized and nationalized as a white-
American with several sons who holds deep desires for a daughter. Lisa Belkin’s influential
piece in The New York Times Magazine from 1999 called “Getting the Girl” highlighted in
bold, “Unlike much of the rest of the world, Americans do not prefer boys.” Other articles
followed suit: “So You Want a girl?” (Wadman in Fortune, 2001); “Going for the Girl” (des
Jardins in Parenting, 2001; “I’ll Have a Girl, Please” (American Public Media/Marketplace,
2006). The question is, who counts as American in these narratives? This new subject was
juxtaposed against India and China, infanticide and sex selective abortion, all lumped together as counter examples to this newly emerging, “western” practice.

While the CDC regularly collects data on IVF success rates, none is collected on sex selective
ARTs in the U.S. Very few clinics have published information that profiles the background
of their patients along with their sex preferences. One 2007 study published sex preferences
of 92 couples who underwent PGD, a few along with MicroSort, at The Center for Human
Reproduction (New York City) between January 2004 and December 2006. Of those 92, 36
selected for girls and 56 for boys. The study concluded, “Gender selection choices were to a
statistically significant degree dependent on the couple’s ethnicity (P<0.001)….”(Gleicher and
Barad 2007). I mention this study because it counters the idea long repeated in mainstream
media that those serviced by U.S.-clinics overwhelmingly prefer girls, and because it does
not draw data primarily from MicroSort, which because of the technology’s better rates of
effectiveness in producing X sorts is likely sought more by those who wish to have girls.

Patients Cross Borders

According to one of the directors, 60%, that is more than half of his sex selection patients
come from abroad, mostly Canada, then, China, and then England. When I probed for more
information the director explained that the Canadians seeking his services were often immigrants stemming from China, Armenia and Albania. He also mentioned Nigeria as a strong departure site for his services. A Nigerian couple I encountered at this clinic had a referral letter from a physician, stating that the couple had no access to a PGD facility in their country. However, most patients traveling to the U.S. do so because the practice is expressly prohibited in their own countries.

According to the second clinic director, 50% or half of his sex selection patients come from
abroad, mainly from Australia, England, India, China, South Korea, and Canada. He gave me
three patient profiles. One consisted of mainly Caucasians, women in their 30s with several boys who want a girl. A second mainly of 1st generation immigrants residing in the U.S. or Canada who stem from China, sometimes Japan, Korea, India, Pakistan, other South Asian countries and Central Asian Republics such as Turkmenistan and Kazakhstan. A smaller group of patients include extremely wealthy, upper class citizens coming from the global South. Wealthy Nigerians with oil money, for example, sometimes travel to his clinic in their own jets and stay as long as necessary to get a boy, even through several failed attempts. Even more complexity undergirds these movements. For example, a clinic in Thailand refers patients to him, but the clinic is owned by Sydney IVF. Australian patients, who cannot for legal reasons access sex selection in their own country, first travel to Thailand, and if their attempts at the procedure fail, they may then be referred to the U.S.. Thus, the patient stream from Thailand to the U.S., in this case, actually is Australian by citizenship, if not origin.

How does this take place?

Cross-border sex selection takes place through carefully constructed provider networks that
reach across national borders. According to one director his clinic works with about 140 clinics
abroad. When patients approach them from, say Surrey, England, they ask, how can we do
this? Most often a nurse coordinator will put them in contact with physicians and clinics in their
own locales where they can do their preliminary testing and blood work. Once the testing is
complete, results are faxed to the U.S. clinics, U.S. directors put in orders for the fertility drug
that kick off the cycle, and the patient takes these and continues to get monitored by ultrasounds for ovulationby the departure site clinic. Once the patient has several maturing follicles, they travel to the United States for the procedural aspects of the treatment, egg retrieval, IVF, PGD, and then embryo transfer, which all take place in about 10-12 days. It is mainly nurses that interface with these clinics abroad, but communication is kept at a minimum. One nurse told me that she advises her patients that they are not obliged to disclose to their departure clinic that they are going abroad for sex selective PGD.

Providers Crossing Borders

U.S. fertility clinics who are providers of sex selection for many foreign patients are now also
moving their services abroad. A little of MS history… 1993 the trial begins, 1995 MicroSort
invents “family balancing,” a policy designed to allow married, heterosexual couples to use
MS for social reasons, so long as they select the sex least represented among their offspring.
FB patients make up bulk of all s.s. patients ( 92%). In 1999, the FDA extends its authority
over the trial. Trial reaches sample size limit in 2008 and ends, but still the FDA has made no
determination on its safety and efficacy. A year later GIVF begins to commercialize MicroSort
abroad, opening two labs in Mexico. Recently, MicroSort advertised for a lab technician willing
to relocate to Dubai and has announced on their new MicroSort International website the opening of a lab in Cyprus. With these changes, cost can be added as a new motivation underlying cross-border sex selection. In Mexico, the technology is offered at nearly a third of its cost in the United States.

Another reason given to me by one provider of sex selective PGD for opening a satellite
clinic in Mexico was to reach patients who could not easily get visas to the United States.
Synchronizing the cycles of many patients, the director travels from his U.S.-based site along
with a team of embryologists to the satellite clinic about every 7 weeks. They stay in Mexico for
one week, and conduct a large volume of cases (e.g., 47 cases on his last trip he told me). But,
the PGD lab is not duplicated in Mexico, so embryologists fix the extracted embryonic cell onto
a slide and overnight it to their labs in the U.S. for analysis. Thus, unlike a handheld ultrasound
device, these technologies can’t simply be shipped and applied abroad, but because they are
lengthy, complex processes, they are also divisible, and can be broken down into moving parts
that cross borders: moving cells, test results, frozen sorted sperm, patients, and providers.

Conclusion

Until we have a more accurate picture of who goes for sex selection and why, we should
question the East/West binary created within mainstream narratives that has produced a
hierarchy of good vs. bad sex selection practices. It is minimally important, therefore, to the
demand more transparency, and the collection of better information and statistics related to
supply and demand of sex selection, in conjunction with other services provided at fertility
clinics in the U.S.