Sex selection with IVF is often called gender selection, by clinics and patients alike. What’s being selected is chromosomal sex, XX or XY, which is what a lab can read from an embryo. Gender isn’t something an embryo has.
In the United States it’s legal, unregulated, and offered by most fertility clinics. It also requires a full IVF cycle, whether or not there’s any fertility problem to begin with.
How it works
A genetic test known as PGT-A checks whether an embryo has the right number of chromosomes. The 23rd pair is the sex chromosomes, so sex comes back as part of a test designed to look at chromosome count. There’s no separate procedure and no separate fee. Anyone doing PGT-A gets this information. Choosing an embryo for transfer on that basis is what sex selection is, and people arrive at it from two very different starting points.
Medical
One group is already doing IVF for medical reasons, with PGT-A as part of it. The sex of each embryo simply arrives with the results.
Elective
One group has no medical need for IVF and is doing it purely to choose sex. That means taking on the full cost and physical demands of a cycle electively, with the testing on top.
Some clinics will let you factor sex into which embryo to transfer, while others will not. There are no federal laws about this and ASRM recommends each clinic set their own policies.
Accuracy
Clinics quote sex determination as 99.9% accurate since the test reads the sex chromosomes directly. Errors are rare but not impossible. What the figure describes is the test though, not the outcome. PGT-A tells you which embryos exist and their sex. It cannot create an embryo that isn’t there.
The odds of having at least one embryo of a particular sex follow from how many viable embryos there are.
| Viable embryos | Chance of at least one |
|---|---|
| 1 | 50% |
| 2 | 75% |
| 3 | 88% |
| 4 | 94% |
| 5 | 97% |
The chance that at least one embryo is the sex you want, assuming an even split. Having a suitable embryo isn’t the same as a birth, since the transfer still has to work.
Sperm sorting
An alternative method to selecting sex is to sort sperm before fertilization rather than testing embryos after. X-bearing sperm carry about 2.8% more DNA than Y-bearing sperm, and a flow cytometer can separate them on that difference. If you want a girl, you separate out more X-bearing sperm.
The best-known version, MicroSort, ran as an FDA clinical trial in the US for over a decade. The study closed in March 2012, ending US availability, and MicroSort was never FDA-approved. But it remains available in some other countries. Some US-facing clinic websites still market sperm sorting. Worth asking directly whether a clinic offering it is providing it in the US, referring abroad, or describing something else entirely.
Accuracy was also well short of what patients assume: roughly 92% for selecting female, and 82% for male.
What it costs
On top of the full IVF cycle (including retrieval, medications, freezing, and transfer), PGT-A itself is about $3,000 to $6,000. Our Understanding Costs page covers cycle pricing and our Add-Ons evidence browser covers PGT-A, both with sourced figures.
Coverage for PGT-A is patchy. Many plans exclude it even when they cover IVF, usually classifying it as not medically necessary or investigational. That applies whether or not sex is a factor in the decision.
Where it’s legal
The United States is an international outlier in broadly permitting non-medical sex selection. No state prohibits it and ASRM’s survey data indicate most US clinics offer it. In its 2022 opinion, the ASRM Ethics Committee holds that non-medical sex selection “should not be encouraged,” while also stating that practitioners are under no ethical obligation either to provide or to refuse it.
Most comparable countries do not allow it, including Canada, Australia, the United Kingdom, and much of Europe. China and India have rules against non-medical sex determination because of a documented history of “missing” girls. A few countries permit it under conditions, such as a family already having several children of the same sex.
Restrictions don’t remove demand, they relocate it. Similar to Americans going elsewhere for cheaper care, patients from countries that ban non-medical sex selection sometimes travel to destinations that permit it, including the US. In some countries, sex selection is the most common reason patients pursue PGT at all.
We cover which countries allow what on our Countries to Consider for IVF Abroad page.
The ethics
ASRM sets out both cases and doesn’t resolve them.
The case in favor rests on autonomy and reproductive freedom. People already make reproductive decisions without justifying them, the technology is being used anyway in the course of screening, and preventing sex-linked genetic disease is uncontroversially accepted.
The case against is that it assigns value to sex, may reinforce gender stereotyping, uses medical resources for non-medical ends, and in some populations contributes to skewed sex ratios.
Public opinion in the US leans against the practice. ASRM cites survey data in which roughly two-thirds of Americans disapproved of using elective PGT for sex selection alone. There’s also a broader concern that its availability in the US legitimizes the practice in places where sex-ratio imbalance is a real problem.
Worth noting separately: someone pursuing IVF purely for sex selection is undergoing ovarian stimulation, egg retrieval, embryo transfer, and anesthesia without a medical indication. Those risks are small but not zero, and they’re usually absent from the conversation when the topic is framed as a choice rather than a procedure.
Bottom line
Selecting an embryo’s sex is a straightforward extension of PGT-A: the information arrives with the test, and the transfer follows your choice. If you are already doing PGT-A for genetic screening purposes, the only variable is your clinic’s policy. If you would start IVF solely to choose sex, you take on the full cost and burden of a cycle you do not medically need. It is legal across the US, controversial as a matter of ethics, and banned in much of the rest of the world.
Related reading
Sources
- American Society for Reproductive Medicine, “Use of reproductive technology for sex selection for nonmedical reasons: an Ethics Committee opinion (2022)”
- Human Fertilisation and Embryology Authority, “HFEA statement on sex selection”
- Reproductive Biology and Endocrinology, “The effectiveness of flow cytometric sorting of human sperm (MicroSort®) for influencing a child’s sex”
- Fertility and Sterility Reports, “Preimplantation sex selection via in vitro fertilization: time for a reappraisal” (2023)
- Journal of Law and the Biosciences, “Regulating Preimplantation Genetic Testing across the World: A Comparison of International Policy and Ethical Perspectives”