Sex Selection and Autism

A new report by the Human Fertilisation and Embryology Authority recommends that sex selection should be banned except for serious medical reasons. The 44-page document, Sex Selection : options for regulation, outlines the consultation process in which organisations and members of the public were asked to give their views. It notes :


These non-medical reasons include family balancing, where parents already have children of one sex, and want one of the opposite sex to complete the family. Social and cultural reasons, such as families who want sons in order to avoid paying the dowry on a daughter, were also considered not to be sufficient reason to justify sex selection.

So which disorders are considered serious enough for parents to be allowed to choose the sex of their offspring? The current list is:

Duchenne Muscular Distrophy
Fragile X
Haemophilia
Hunters Syndrome
Muscular Dystrophy
Sensory Motor Neurone diseases

According to the HFEA press office, "... this list has the potential to expand based on a case-by-case basis, but current policy states that any disease would have to be debilitating and life-threatening." In other words autism is not included, and sex selection in order to avoid autism is unlikely to be approved in the near future. Even in severe cases, autism is only indirectly life-threatening, because some autistics have little sense of danger.

Choosing the sex of your baby is no longer the stuff of science fiction. It's increasingly possible using various methods, some of which are safer and more successful than others. Preimplantation genetic determination (PGD) means the fertilisation of embryos, testing their sex, and then destroying the ones that are the wrong sex. Flow cytometry involves staining sperm with dye and then using lasers to sort the girls from the boys. As the report notes, "Laser energy ... is known to have the potential to cause DNA damage". However the extent or likelihood of this damage has been very little studied. Gradient methods are safer for the embryo, but less reliable than other techniques.

It's clear that the scientific advances of recent years could have made selecting their child's sex a possibility for many parents, although ethical problems remain. This is especially true for autism, a condition that affects four times as many males as females. In its mildest form, autism is more of a social than a medical condition. The report does not mention autism specifically.

If prospective parents with a family history of autism were allowed to choose to have only daughters, what would happen to the minority of autistics who remain? This is one of the concerns that has informed the decisions of the HFEA:


In effect, by agreeing that sex selection is appropriate for certain medical conditions, would we be saying that the lives of those who have these disabilities are worth less than those of others? And are we in danger of simply terminating certain illnesses rather than making the effort to find effective treatments or to make accomodations? Whilst couples that want the treatment badly enough will be able to travel to the USA for it, this ethical dilemma is one that will keep coming back.