Getting The Girl

By Lisa Belkinfrom, The New York Times Magazine

There is nothing sleek or high-tech about this third-floor conference room in Fairfax, Va., except, perhaps, the bright red laser pointer that skitters across the eerie greenish slide of phosphorescent sperm.

The projector jams periodically during the hourlong presentation, and the central air-conditioning can't keep up with the late-spring heat, so some very low-tech fans are brought in to move the muggy air around in circles.

The crowd -- about 40 people, mostly couples, mostly in their mid-30s, nearly all of them paying a baby sitter so they can be here -- shifts and rustles in the hodgepodge of chairs. One very pregnant woman in the second row (planning ahead, for the baby after this one) fans her face with the cardboard information packet, creating a breeze in the most old-fashioned way.

There is, to be sure, a very high-tech laboratory downstairs, but it is highly unlikely that any of these people (What shall I call them? Clients? Patients? Research subjects?) will ever be allowed to see it.

At its center is a flow cytometer, a beige box of a machine about the size of an L-shaped office desk that spends all day, every day, sorting sperm. Using fluorescent dyes followed by zaps from an ultraviolet laser, it separates sperm that carry X chromosomes (which create female embryos) from those that carry Y chromosomes (which create male embryos).

It is a sensitive and delicate piece of technology, and the slightest change in room temperature, even the breeze created by too many people walking about, can alter the results. So no one, other than the masked-and-gloved lab technician, is allowed in the room while the sorting is going on.

The process -- known and now trademarked as Microsort -- has been used in cattle for more than a decade. The Genetics and IVF Institute, an infertility clinic with a reputation somewhere between cutting edge and maverick, is the only place in the world authorized to use it on humans.

Scientists don't like the word ``experiment,'' with its Frankensteinian overtones, but that is precisely what is under way here. On this day in late May, only 111 pregnancies and 46 births have resulted from the Microsort method, and that means there is not yet enough data to declare it safe for widespread use and to bring it to a for-profit clinic near you.

To reach that statistical comfort level, Edward Fugger, the Texas native who runs Microsort, estimates that he will need to engineer several hundred more births. These 40 people, like the hundreds of others who have called and E-mailed and scheduled appointments since the clinical trial became public last fall, have come to this conference room to learn how to sign up.

They are here for a constellation of reasons: Perhaps they want a little girl, to balance a houseful of boys; or maybe they want a little boy, to carry on the family name. Could be they are carriers of genes for diseases that can be inherited only by boys.

But whatever the specifics of the yearning, it all boils down to the same thing: They want to help dismantle one more barrier of nature, to be among the first to cross yet another Rubicon of science, to make a breathtaking leap in the evolution of human reproduction.

They want to do what generations before them have sought to do, and what generations after them may routinely do. They want to choose the sex of their next child.

And why am I here? The simpler of my answers is that I am a reporter. I specialize in subjects like these -- stories about the collision between what technology can and should make possible. I have written a book about medical ethics, and I know all the arguments against this manipulation of nature, arguments that are rallied increasingly as this dizzying decade transforms so much of science fiction into fact.

Along the way, I have developed a healthy fear of the ``slippery slope'' -- if we allow parents to choose the sex of their child today, how long will it be before they order up eye color, hair color, personality traits and IQ?

I understand the risks of tampering with nature, as they do in China, where the population has been so drastically skewed (through abortion and infanticide) that at one point there were 153 boys to every 100 girls. I cringe at the idea of treating human beings as a commodity -- pay Microsort $2,500 (per try, not per pregnancy; the average pregnancy takes three tries) and purchase the sex of your choice.

And I am all too aware that to people with real problems -- couples who cannot have children, couples whose children are injured or ill -- this talk of sperm sorting sounds shallow and vain.

I know all this ... and yet, I am also the mother of two sons. I love my boys fiercely and I cannot imagine the world without them. But I always thought -- always assumed -- that I would have a daughter. Emma, I called her during our silent conversations. Emma, or maybe Emily. And her middle name would be Penina. It means ``pearl'' in Hebrew, and that was my favorite grandmother's name.

I bought Emma clothes during my first pregnancy. A dusty pink dress, falling in folds from the lacy Peter Pan collar, which stirred a memory of something I think I wore when I was a toddler. Also a blue-and-white polka-dot number, with matching navy leggings, because rearing my strong, feminist daughter would mean freedom to climb and freedom from pink.

I tucked Emma's outfits into the far reaches of the closet, and over the years -- it has been eight years now -- I have found them during periodic cleaning sprees. I always hesitate for a moment, then brush them lightly with my fingers and hang them back in place.

A family of two children was always our plan, our goal, the symmetrical box within which my husband and I have built our life. We are comfortable in there. And yet ... I've always said -- always joked -- ``If someone could guarantee me a girl ...''

Now here stands Fugger, with his crew cut and cowboy boots, aiming his laser pointer at slides of glowing sperm and claiming a 93 percent success rate for couples seeking to conceive a daughter. That is not a guarantee, of course, but it is as close to one as the world has ever been offered.

Microsort is not an absolute, but it takes choosing the sex of a child out of the realm of how-to books and old wives' tales and hurtles it into the realm of available and quantifiable science that is affordable to many.

We care about the sex of our children. Some of us care more than others, but we all care. It is the first question asked about a baby, almost from conception, certainly at the moment of birth. Any preference has always been but a wish, a dream, sometimes a throbbing unspoken regret. Now those of us who choose to take the controls are being handed them.

And that is why I am here, scribbling, hiding behind my notebook. I want to explore what this means for science, for society. And I need to explore what it means for my family and myself.

It is striking how quickly the medical establishment responded to the news of Microsort. Not all doctors approve of the technology, and most want to know much more, but from the first announcement of the earliest results, they have considered Microsort to be real science.

``It's in a different category from everything else,'' says Dr. Alan Copperman, director of reproductive endocrinology at the Mount Sinai Medical Center in Manhattan. ``It is not a scam.''

He is reassured, he says, by the fact that the first Microsort results were published in Human Reproduction, ``a reputable peer-reviewed journal,'' but he notes that it was only one study and a small one at that. Of 14 couples using Microsort to conceive a girl, 13 were successful.

``I hope that over the years we can see numbers large enough to call it safe,'' Copperman says, adding that he does not foresee ever offering it to his own patients. ''But you can definitely call it science.''

Like much technology, this science began with a narrow, lofty goal -- to help couples who are carriers for a specific subset of genetic flaws. There are 350 ``X-linked'' genetic disorders _ conditions such as hemophilia and Duchenne's muscular dystrophy, which are most prevalent in boys. If an affected couple can be guaranteed a girl, they can be spared the wrenching decision of whether or not to terminate a second-trimester pregnancy.

The first human Microsort baby arrived in 1995. She was a girl, born to a woman who had lost two brothers and two sons to X-linked hydrocephalus, a fatal swelling of the brain that occurs only in boys. For several years, nearly all Microsort babies were much like her -- born to families that used technology to prevent nature's deadly mistakes.

But word spread and the clinic began receiving requests from couples who simply preferred children of a certain sex. Fugger calls this ``family balancing,'' and he struggled for months with criteria that he could use to evaluate those requests.

It was dogmatic, he says, to restrict the procedure only to carriers of genetic disorders. (Nor, it should be noted, was it good for business.) But he was equally uncomfortable with the appearance that anyone could come in and order up a baby. This was, as he describes it, a practical struggle as much as a philosophical one, in that it was conducted with an emphasis on what the institutional review board would permit, rather than what was best for society.

The resulting policy -- a couple must have at least one child to be eligible for the program, and they may select a child only of the ``nondominant'' sex in their family -- addresses potential ethical objections, but leaves the door open for expansion.

Keith Blauer, a reproductive endocrinologist at Microsort, says: ``That is the policy for the clinical trial. What will happen in 5, 10 years will depend on what society wants.''

Microsort's decision to accept requests to balance families led to several surprises. The first was the discovery that the technique is better at producing girls than boys. While the success rate for daughters is 93 percent, it is only 73 percent for sons.

The second surprise was that Americans, unlike much of the rest of the world, do not prefer boys. Of the first 111 Microsort attempts, 83 were for females and 28 were for males. True, the process began as a way to select for girls, and true, because it is better at selecting girls it is more likely to attract couples who want them.

But there is something else going on as well, something that actually was learned a long time ago. ``More want girls,'' says Landrum B. Shettles, 89, an ob-gyn who has sold more than one million copies of ``How to Choose the Sex of Your Baby,'' first published in 1970. ``Definitely we heard more from women who had many boys and wanted a girl.''

Ronald J. Ericsson, 64, agrees. He has licensed the Ericsson method of gender selection, which is practiced in 28 fertility clinics in the United States and 15 more around the world. ``We see more requests for girls,'' he says. At some Ericsson clinics, the ratio is as high as 2 to 1, despite Ericsson's own statistics showing a higher success rate for boys. It is, he says, a gap that has been growing since he first introduced his method 25 years ago.

In a lopsided, counterintuitive way, he insists, this is a streak of feminism, although it hardly appears that way at first, what with all the talk of ponytails, dresses and bows.

``Women are the driving force, and women want daughters,'' he says. ``And they're not apologizing about it anymore. They used to call and there would be this qualification: 'I love my two boys to death, but... .' Now ... there's no apology.''

I opted for surprise with my first pregnancy, and long after the birth I was numb that Emma was a boy. When I looked at my son, adorable though he was, I saw a stranger. Where was the daughter I had been talking to for nine months? The surprise was layered with guilt and stirred by hormones, an explosive combination. I cried on and off for weeks.

I approached my second pregnancy determined not to be surprised. I was still in my bathrobe the morning the geneticist called with my amnio results. Yes, I asked first if the baby was healthy. Then I found out it would be a boy, and crawled back into bed, mourning my daughter. Ultimately, when Alex was born, they put him in my arms, and the bonding was as the books said it should be. Not ''Who are you?'' but ``I know you.''

Medical ethicists as a group are troubled by selfish acts _ and choosing the sex of a child is a selfish act. ``Because I want to'' is never good enough. Their next question is always ``What if everyone uses it?'' or ``What if the wrong people use it?'' or ``What if well-meaning people use it in the wrong way?''

Ethicists, not surprisingly, are troubled by Microsort, and their reasons are global.

``Any new biotechnology is not simply confined within one nation,'' warns Lori Knowles, the associate for law and bioethics at the Hastings Center, in Garrison, N.Y. Although the limited experience of Microsort shows a preference for girls within the United States, she says, ``it will be used in cultures where women are oppressed, and it will be used to select for male children. That will further institutionalize the discrimination against women.''

Lori Andrews, a professor of law at Chicago-Kent College of Law and the author of ``The Clone Age,'' describes the 258 clinics in Bombay that advertise prenatal screening as a way to end a pregnancy and avoid a dowry: ''Spend 700 rupees now and save 700,000 rupees later.'' One study of 8,000 abortions, she writes, found that 7,999 of the fetuses were female.

The United States is not free from abortions performed on the basis of sex. Although numbers are not available, such abortions are known to exist, albeit to a much lesser extent than in other parts of the world. Even if it is not used here as it might be in India, ethicists say, there is potential for abuse.

This fear of the slippery slope, of a slide into eugenics, is why many countries have prohibited technologically assisted sex selection. The draft guidelines on bioethics of the World Health Organization warn that ``sex is not a disease,'' and nations such as Austria, France, Germany, Norway, Spain and Sweden ban the practice.

However, all these prohibitions were put in place before Microsort published its results last fall, and none who object think there is a chance that their objections will keep it from being used in the United States.

``People want it,'' says Dr. Benjamin Younger, executive director of the American Society for Reproductive Medicine. ``And when people want things, science finds a way to make it happen.''

Indeed, if Microsort had been an option five years ago, I might have used it for my second child. Which would mean there would be no Alex. How could there be no Alex?

I look over at him. He has finished with his frozen hot chocolate and is pretending to be Anakin Skywalker. I try to picture Emma, but she fades. She has been fading a lot lately.

Today I know that I can have my daughter if I want her. I am not too old; the technology exists. But I decide I will not do this. I have two boys because I chose to. Microsort opened the door to something else. I chose not to walk through it.

c.1999 Lisa Belkin

(Lisa Belkin, a contributing writer to The New York Times Magazine, is the author of ``Show Me a Hero: A Tale of Murder, Suicide, Race and Redemption.'')