For some IVF patients, a choice: Boy or girl?

CHICAGO – Natalia Fedulova always wanted to have at least two children, a boy and a girl.

By age 10, she had even picked out her babies’ names: Deana and Maxim.

Fedulova, 37, and her husband, Igor Fedulov, did indeed have a daughter – and another and another. So when, in the course of conceiving their next child with in vitro fertilization, they learned that they had produced two healthy embryos, one male and one female, they decided to implant the male one first.

“After having three girls, I definitely wanted to have a boy,” said Fedulova, who is saving the female embryo for her next pregnancy.

The Fedulovs represent a little-discussed aspect of gender selection with IVF, in which eggs are removed from the woman’s body for fertilization. While the controversial practice of undergoing IVF solely for the purpose of gender selection gets more attention, it may be more common to undergo IVF and gender-revealing genetic screening of the embryos to determine their viability, and then, as a bonus, get to choose gender.

“It’s kind of like icing on the cake,” said the Fedulovs’ fertility doctor, Dr. Elena Trukhacheva, of the Reproductive Medicine Institute in west suburban Oak Brook.

There’s no good data on this type of “icing on the cake” gender selection, or even an accepted name for it, but Trukhacheva said that in her practice, it’s more common than the better-known practice of seeking IVF solely for gender selection. She said that about 5 percent of IVF cycles, or pregnancy attempts, at her clinic are solely for gender selection, while 15 to 20 percent of IVF patients do genetic screening of the embryos for medical reasons.

Of her patients who do screening for medical reasons, about half do not want to know gender, and about half have a mild gender preference.

In 2013, the last year for which data was available, about 175,000 IVF cycles, or pregnancy attempts, were reported to the Society for Assisted Reproductive Technology, according to SART President Dr. Jim Toner. In 5,800 of those cases, genetic screening of the embryos was performed. Only about 800 of those genetic screenings were done solely to determine gender. It’s not known how many of the remaining 5,000 screenings led to “icing on the cake” gender selection, Toner said.

Embryo gender selection for nonmedical reasons has been banned in Canada and some European countries, and it’s controversial in the U.S., where a SART ethics committee recommends that individual doctors and clinics make their own decisions as to whether to offer it. A recent paper by the SART ethics committee points to arguments in favor of embryo sex selection, including privacy and reproductive freedom, as well as opposing arguments such as the potential for sex discrimination and gender imbalances in society.

“If you have a couple who wants to balance the family and have a girl after three boys, you can understand where that would be appealing, but that also means the boys are not going to be transferred (to the uterus),” Toner said.

“This is a medical and social issue – you’re allowing people to pick. What would be next, eye color? There’s a concern about a slippery slope.”

The Fedulovs, who live in Chicago, said they wouldn’t be interested in choosing characteristics other than gender. Trukhacheva said there are medical as well as ethical barriers to offering such choices: Human genetics are complex, she said, and selecting a desired characteristic (say, eye color) could lead to inadvertently selecting an undesired characteristic, as well.

“The technology is not there,” she said of selection for characteristics other than gender. “I don’t think anybody’s working on that kind of selection, and hopefully that will not happen.”

Fedulov, 40, who runs a mobile app company, and Fedulova, who owns a hair salon, turned to IVF fertility treatment to conceive their first child, Deana, now 9.

“It was close to 10 years before we had our first child, and Igor never expressed his emotions about how many kids he wanted to have and who he wanted to have – a boy or a girl. There was no conversation about it,” Fedulova said.

“And then when our first child was born, Igor kind of fell in love with kids and expressed his feeling that he wanted five kids.”

Fedulov smiled in the toy-studded living room of their airy town home, where the couple’s four children were playing quietly.

“It’s funny,” he said. “Right up to 3 years old, it’s hard, but I think kids after 3 change a lot. They grow, and they kind of absorb everything. You do something one way, and then you see them doing it the same way. It’s fun.”

The Fedulovs conceived their next two children, 6-year-old twins Sofia and Alexandra, with IVF fertility treatment as well. They did genetic screening of the embryos to detect abnormalities, as they had with Deana, and again there were no healthy male embryos.

With their fourth child, they ended up with two healthy embryos, a male and a female.

The male embryo became Maxim, now 2 , an engaging toddler with big blue eyes and a penchant for cars and trucks. The Fedulovs saved the female embryo for their next pregnancy attempt. They plan to have five children and already have picked out a name for the girl embryo.

During a recent visit, Maxim engaged a reporter in a wind-up car game, played with his sisters and distracted the grown-ups with a toy truck and a winning smile.

“Compared with girls his age, he is very straight-forward,” his father said. “He wouldn’t ask anybody (for permission); he’d just drop things. He would jump from the couch; the girls would sort of descend carefully. He would run and fall and run again; the girls would cry.”