Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Techniques for preimplantation sex selection

Kristin Bendikson, MD
Catherine Racowsky, PhD
Section Editor
Robert L Barbieri, MD
Deputy Editor
Kristen Eckler, MD, FACOG


Techniques for preimplantation sex selection are available, but the use of these procedures is controversial [1]. This topic will discuss the techniques used to identify the sex of the embryo prior to implantation.

Information on related topics can be found elsewhere. (See "Preimplantation genetic diagnosis" and "Preimplantation genetic screening for aneuploidy" and "In vitro fertilization" and "Pregnancy outcome after assisted reproductive technology".)


There are three major reasons why couples desire to control the sex of their progeny:

Personal preference for a child (or children) of a specific sex

To achieve a "balanced" family with children of both sexes


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Jun 25, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Puri S, Nachtigall RD. The ethics of sex selection: a comparison of the attitudes and experiences of primary care physicians and physician providers of clinical sex selection services. Fertil Steril 2010; 93:2107.
  2. Jesudason S, Baruch S. Sex selection: what role for providers. Contraception 2012; 86:597.
  3. Fathalla M. The missing millions. People Planet 1998; 7:10.
  4. Kristof ND. China: ultrasound abuse in sex selection. Womens Health J 1993; :16.
  5. Westley SB. Evidence mounts for sex-selective abortion in Asia. Asia Pac Pop Policy 1995; :1.
  6. Chan CL, Yip PS, Ng EH, et al. Gender selection in China: its meanings and implications. J Assist Reprod Genet 2002; 19:426.
  7. www.unfpa.org.in/publications/16_Map%20brochure_English.pdf (Accessed 3/7/05).
  8. Ethics Committee of the American Society for Reproductive Medicine. Use of reproductive technology for sex selection for nonmedical reasons. Fertil Steril 2015; 103:1418.
  9. Committee on Ethics, American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 360: Sex selection. Obstet Gynecol 2007; 109:475.
  10. Pennings G. Family balancing as a morally acceptable application of sex selection. Hum Reprod 1996; 11:2339.
  11. Grant VJ. Sex predetermination and the ethics of sex selection. Hum Reprod 2006; 21:1659.
  12. Martin, JA, Hamilton, BE, Ventura SJ, et al. Births: Final data for 2009. Natl Vital Stat Rep 2009. http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_01.pdf (Accessed on November 29, 2011).
  13. Lippert T, Skjaerven R, Salvesen KA. [Why do some women only give birth to boys or to girls?]. Tidsskr Nor Laegeforen 2005; 125:3414.
  14. Biggar RJ, Wohlfahrt J, Westergaard T, Melbye M. Sex ratios, family size, and birth order. Am J Epidemiol 1999; 150:957.
  15. Ein-Mor E, Mankuta D, Hochner-Celnikier D, et al. Sex ratio is remarkably constant. Fertil Steril 2010; 93:1961.
  16. Luke B, Brown MB, Grainger DA, et al. The sex ratio of singleton offspring in assisted-conception pregnancies. Fertil Steril 2009; 92:1579.
  17. Folstein SE, Rosen-Sheidley B. Genetics of autism: complex aetiology for a heterogeneous disorder. Nat Rev Genet 2001; 2:943.
  18. Stolkowski J, Lorrain J. Preconceptional selection of fetal sex. Int J Gynaecol Obstet 1980; 18:440.
  19. Shettles, LB. Factors influencing sex ratios. Int J Gynecol Obstet 1970; 8:643.
  20. A prospective multicentre study of the ovulation method of natural family planning. IV. The outcome of pregnancy. World Health Organization. Fertil Steril 1984; 41:593.
  21. Gray RH. Natural family planning and sex selection: fact or fiction? Am J Obstet Gynecol 1991; 165:1982.
  22. Joffe M, Bennett J, Best N, Jensen TK. Sex ratio and time to pregnancy: analysis of four large European population surveys. BMJ 2007; 334:524.
  23. Joffe M, Key J, Best N, et al. Studying time to pregnancy by use of a retrospective design. Am J Epidemiol 2005; 162:115.
  24. Smits LJ, de Bie RA, Essed GG, van den Brandt PA. Time to pregnancy and sex of offspring: cohort study. BMJ 2005; 331:1437.
  25. Beckett TA, Martin RH, Hoar DI. Assessment of the sephadex technique for selection of X-bearing human sperm by analysis of sperm chromosomes, deoxyribonucleic acid and Y-bodies. Fertil Steril 1989; 52:829.
  26. Lobel SM, Pomponio RJ, Mutter GL. The sex ratio of normal and manipulated human sperm quantitated by the polymerase chain reaction. Fertil Steril 1993; 59:387.
  27. Vidal F, Moragas M, Català V, et al. Sephadex filtration and human serum albumin gradients do not select spermatozoa by sex chromosome: a fluorescent in-situ hybridization study. Hum Reprod 1993; 8:1740.
  28. Han TL, Flaherty SP, Ford JH, Matthews CD. Detection of X- and Y-bearing human spermatozoa after motile sperm isolation by swim-up. Fertil Steril 1993; 60:1046.
  29. Wang HX, Flaherty SP, Swann NJ, Matthews CD. Assessment of the separation of X- and Y-bearing sperm on albumin gradients using double-label fluorescence in situ hybridization. Fertil Steril 1994; 61:720.
  30. Wang HX, Flaherty SP, Swann NJ, Matthews CD. Discontinuous Percoll gradients enrich X-bearing human spermatozoa: a study using double-label fluorescence in-situ hybridization. Hum Reprod 1994; 9:1265.
  31. Reubinoff BE, Schenker JG. New advances in sex preselection. Fertil Steril 1996; 66:343.
  32. Beernink FJ, Dmowski WP, Ericsson RJ. Sex preselection through albumin separation of sperm. Fertil Steril 1993; 59:382.
  33. Cui KH, Matthews CD. X larger than Y. Nature 1993; 366:117.
  34. Kaneko S, Oshio S, Kobayashi T, et al. Human X- and Y-bearing sperm differ in cell surface sialic acid content. Biochem Biophys Res Commun 1984; 124:950.
  35. Sumner AT, Robinson JA. A difference in dry mass between the heads of X- and Y-bearing human spermatozoa. J Reprod Fertil 1976; 48:9.
  36. Steeno O, Adimoelja A, Steeno J. Separation of X- and Y-bearing human spermatozoa with the sephadex gel-filtration method. Andrologia 1975; 7:95.
  37. Quinlivan WL, Preciado K, Long TL, Sullivan H. Separation of human X and Y spermatozoa by albumin gradients and Sephadex chromatography. Fertil Steril 1982; 37:104.
  38. Brandriff BF, Gordon LA, Haendel S, et al. Sex chromosome ratios determined by karyotypic analysis in albumin-isolated human sperm. Fertil Steril 1986; 46:678.
  39. Check JH, Katsoff D. A prospective study to evaluate the efficacy of modified swim-up preparation for male sex selection. Hum Reprod 1993; 8:211.
  40. Ericsson RJ, Langevin CN, Nishino M. Isolation of fractions rich in human Y sperm. Nature 1973; 246:421.
  41. Dmowski WP, Gaynor L, Rao R, et al. Use of albumin gradients for X and Y sperm separation and clinical experience with male sex preselection. Fertil Steril 1979; 31:52.
  42. Evans JM, Douglas TA, Renton JP. An attempt to separate fractions rich in human Y sperm. Nature 1975; 253:352.
  43. Ross A, Robinson JA, Evans HJ. Failure to confirm separation of X- and Y-bearing human sperm using BSA gradients. Nature 1975; 253:354.
  44. Jaffe SB, Jewelewicz R, Wahl E, Khatamee MA. A controlled study for gender selection. Fertil Steril 1991; 56:254.
  45. Kaneko S, Yamaguchi J, Kobayashi T, Iizuka R. Separation of human X- and Y-bearing sperm using percoll density gradient centrifugation. Fertil Steril 1983; 40:661.
  46. Watkins AM, Chan PJ, Patton WC, et al. Sperm kinetics and morphology before and after fractionation on discontinuous Percoll gradient for sex preselection: computerized analyses. Arch Androl 1996; 37:1.
  47. Flaherty SP, Matthews CD. Application of modern molecular techniques to evaluate sperm sex selection methods. Mol Hum Reprod 1996; 2:937.
  48. Johnson LA, Welch GR, Keyvanfar K, et al. Gender preselection in humans? Flow cytometric separation of X and Y spermatozoa for the prevention of X-linked diseases. Hum Reprod 1993; 8:1733.
  49. Pinkel D, Lake S, Gledhill BL, et al. High resolution DNA content measurements of mammalian sperm. Cytometry 1982; 3:1.
  50. Fugger EF, Black SH, Keyvanfar K, Schulman JD. Births of normal daughters after MicroSort sperm separation and intrauterine insemination, in-vitro fertilization, or intracytoplasmic sperm injection. Hum Reprod 1998; 13:2367.
  51. Ashwood-Smith MJ. Human sperm sex selection. Safety of human sperm selection by flow cytometry. Hum Reprod 1994; 9:757.
  52. Munné S. Flow cytometry separation of X and Y spermatozoa could be detrimental for human embryos. Hum Reprod 1994; 9:758.
  53. Cran DG, Johnson LA, Miller NG, et al. Production of bovine calves following separation of X- and Y-chromosome bearing sperm and in vitro fertilisation. Vet Rec 1993; 132:40.
  54. Johnson LA, Flook JP, Hawk HW. Sex preselection in rabbits: live births from X and Y sperm separated by DNA and cell sorting. Biol Reprod 1989; 41:199.
  55. Matsuda Y, Tobari I. Chromosomal analysis in mouse eggs fertilized in vitro with sperm exposed to ultraviolet light (UV) and methyl and ethyl methanesulfonate (MMS and EMS). Mutat Res 1988; 198:131.
  56. Duran, RE, Olive, PL. Cytotoxicity, mutagenicity and DNA damage by Hoechst 33342. J Histochem Cytochem 1982; 30:11.
  57. Catt SL, Sakkas D, Bizzaro D, et al. Hoechst staining and exposure to UV laser during flow cytometric sorting does not affect the frequency of detected endogenous DNA nicks in abnormal and normal human spermatozoa. Mol Hum Reprod 1997; 3:821.
  58. Vidal F, Blanco J, Fugger EF, et al. Preliminary study of the incidence of disomy in sperm fractions after MicroSort flow cytometry. Hum Reprod 1999; 14:2987.
  59. Treff NR, Scott RT Jr. Methods for comprehensive chromosome screening of oocytes and embryos: capabilities, limitations, and evidence of validity. J Assist Reprod Genet 2012; 29:381.
  60. Fiorentino F, Bono S, Biricik A, et al. Application of next-generation sequencing technology for comprehensive aneuploidy screening of blastocysts in clinical preimplantation genetic screening cycles. Hum Reprod 2014; 29:2802.
  61. Lai-wan CC, Blyth E, Hoi-yan CC. Attitudes to and practices regarding sex selection in China. Prenat Diagn 2006; 26:610.
  62. http://updateox.com/india/district-wise-sex-ratio-in-india-2011-census/ (Accessed on June 15, 2011).
  63. Van Balen F. Attitudes towards sex selection in the Western world. Prenat Diagn 2006; 26:614.
  64. Missmer SA, Jain T. Preimplantation sex selection demand and preferences among infertility patients in Midwestern United States. J Assist Reprod Genet 2007; 24:451.
  65. Gleicher N, Barad DH. The choice of gender: is elective gender selection, indeed, sexist? Hum Reprod 2007; 22:3038.
  66. Dahl E, Gupta RS, Beutel M, et al. Preconception sex selection demand and preferences in the United States. Fertil Steril 2006; 85:468.
  67. Sills ES, Palermo GD. Preimplantation genetic diagnosis for elective sex selection, the IVF market economy, and the child--another long day's journey into night? J Assist Reprod Genet 2002; 19:433.
  68. Egan JF, Campbell WA, Chapman A, et al. Distortions of sex ratios at birth in the United States; evidence for prenatal gender selection. Prenat Diagn 2011; 31:560.
  69. Meseguer M, Garrido N, Remohí J, et al. Gender selection: ethical, scientific, legal, and practical issues. J Assist Reprod Genet 2002; 19:443.
  70. Dawson K, Trounson A. Ethics of sex selection for family balancing. Why balance families? Hum Reprod 1996; 11:2577.
  71. Ethical considerations of assisted reproductive technologies. By the Ethics Committee of the American Fertility Society. Fertil Steril 1994; 62:1S.
  72. Preconception gender selection for nonmedical reasons. Fertil Steril 2004; 82:232S.
  73. Robertson JA. Sex selection for gender variety by preimplantation genetic diagnosis. Fertil Steril 2002; 78:463.
  74. Ethics Committee of the American Society of Reproductive Medicine. Sex selection and preimplantation genetic diagnosis. Fertil Steril 2004; 82 Suppl 1:S245.
  75. Human Fertilisation and Embryology Authority. Sex selection: options for regulation: A report on the HFEA’s 2002-2003 review of sex selection including discussion of legislative and regulatory options. Human Fertilisation and Embryology Authority, London 2003.
  76. Dondorp W, De Wert G, Pennings G, et al. ESHRE Task Force on ethics and Law 20: sex selection for non-medical reasons. Hum Reprod 2013; 28:1448.
  77. Avent ND, Chitty LS. Non-invasive diagnosis of fetal sex; utilisation of free fetal DNA in maternal plasma and ultrasound. Prenat Diagn 2006; 26:598.
  78. Lo YM, Tein MS, Lau TK, et al. Quantitative analysis of fetal DNA in maternal plasma and serum: implications for noninvasive prenatal diagnosis. Am J Hum Genet 1998; 62:768.
  79. Lo YM, Zhang J, Leung TN, et al. Rapid clearance of fetal DNA from maternal plasma. Am J Hum Genet 1999; 64:218.
  80. Birch L, English CA, O'Donoghue K, et al. Accurate and robust quantification of circulating fetal and total DNA in maternal plasma from 5 to 41 weeks of gestation. Clin Chem 2005; 51:312.
  81. Martinhago CD, de Oliveira RM, Tomitão Canas Mdo C, et al. Accuracy of fetal gender determination in maternal plasma at 5 and 6 weeks of pregnancy. Prenat Diagn 2006; 26:1219.
  82. Bianchi DW. At-home fetal DNA gender testing: caveat emptor. Obstet Gynecol 2006; 107:216.
  83. Johnson KL, Dukes KA, Vidaver J, et al. Interlaboratory comparison of fetal male DNA detection from common maternal plasma samples by real-time PCR. Clin Chem 2004; 50:516.
  84. www.fda.gov/medwatch/safety/2006/safety06.htm#Genetic. (Accessed on August 03, 2006).