Wednesday morning, the phones at The Fertility Institute were ringing off the hook. Dr. Jeffrey Steinberg knew exactly who to thank for the influx of calls: the Kardashians.
Kim had just announced that she and Kanye were expecting a second child, a boy conceived through In Vitro Fertilization. Kim reportedly had only male embryos implanted; as you may have heard, she and Kanye already have a girl. Now they’re having a boy. (Update: Kardashian has since denied those reports, though she has confirmed she’s expecting a boy.)
Steinberg founded The Fertility Institute in 1986. The technology rumored to be utilized by the Kardashian-Wests isn’t brand new, he pointed out — sex-selection is about 20 years old, IVF near 35 — but “people call us up, and they can’t believe it’s available.” After the Kim and Kanye news came out, the center was “blitzed” by calls, Steinberg said.
“We’ve already dipped our toes into the water on physical characteristics,” he said. “We’re working on eye color. So that’s going to be the next step.”
And this is where the science gets dicey, if not medically, at least intellectually. General consensus is on board with screening out genetic disorders and disease, of sparing pain where pain can be spared. But sex is a more provocative call, maybe made more so by the vision of Kanye and Kim — were two humans ever more inclined to customize the universe to their personal tastes? — ordering a boy to round out the set. The clan they’ll have, should all go according to plan, is “a millionaire’s family”: a husband, a wife, a daughter, a son. Is there anything ethically questionable about giving parents the power to select the sex of their child?
“In America, autonomy reigns supreme,” said Dr. John D. Loike, the director for special programs for the Center for Bioethics at Columbia University College of Physicians and Surgeons. “People who are educated have the right to choose their destiny, their medical care, what they want to do with their bodies: from euthanasia to therapy.”
Frances Kissling is president of the Center for Health, Ethics and Social Policy and is a visiting scholar at the Center for Bioethics at the University of Pennsylvania. She allowed that there are “definitely ethical questions” about sex selection but “it’s also pretty accepted in the ethical community.” With sex selection through IVF, as with any technology, she said, you can’t lose sight of one question: “What harm comes of this?”
There are different circumstances that might render the ostensibly innocuous choice a discriminatory one. “Generally speaking, within that kind of selection, people aren’t saying they want girls,” said Kissling. “They’re saying: a son is necessary because sons are of greater value than girls.” In the rumored case of Kim and Kanye, “They wanted a boy because they wanted a boy and a girl. So the question really is: what do we think about that? And who gets to think about that? Who gets to decide what we do about that?”
The knee-jerk rejection of sex selection, she said, comes from the traditional attitude that “you should take what you get in life. There’s something wrong with deliberately choosing characteristics. It smacks of the ‘designer baby’ idea. Then you have to examine that: why do you think that is a problem? Is there something wrong with a couple wanting to plan their family to that extent? And then you have to say: why do you think there’s something wrong with a couple wanting to plan their family? You get into a whole series of ideas about things like spontaneity, accepting what is given to you. Is this a desire for perfection?”
Among “most mainstream ethicists,” Kissling said, “They don’t see anything inherently wrong in making decisions about planning family around balance.”
“I’ve long believed the worst thing in the world you can do is put handcuffs on a scientist,” said Steinberg. “The biggest misconception is that we’re playing God: we’re making decisions about who boys and girls are going to be. But that’s genetic engineering: you can’t make boys and girls. Once you’ve made them, we are allowed to study what you’ve done and see what you’ve got.” Which is to say: if all the fertilized embryos are female, there’s nothing the doctor could do to change that. But if some are male and some are female, a doctor can provide that information and hopeful parents can use that information as they choose.
“So are we playing God?” Steinberg asked. “Well, doctors play God every day. If you get appendicitis, God says you’re dead. A surgeon can save your life and you’re not dead.”
Popular acceptance for sex-selection, Steinberg thinks, isn’t far away. “Because the Kardashians, for better or for worse, are revered. It’s a phenomenon… And the public seems to not take them as a threat, so everything that they do is generally well-accepted by the public, even when they do something the public doesn’t like.”
“As more and more word gets out about it, this will really set the world on fire,” said Steinberg. “When I did IVF from the very beginning, I walked through the parking lot and someone put a note on my windshield that said ‘Test tube babies have no soul.’ That was 35 years ago. So society is slow and new things are scary.”
“One of the things you learn in reproductive medicine is, you can’t impose your will on other people,” Steinberg said. “The government and physicians have no place in that, other than to steer people away from things that might be dangerous. I’ve had deaf couples come in and ask to have a deaf baby, and I draw a line. Genetically, we can prevent that from happening, and they want just the opposite. We don’t do that, because it has the potential for harm. So as long as we’re on the side of doing good, I really don’t have any qualms about it.”
Potential patients at The Fertility Institute undergo consultations that last about three and a half hours, said Steinberg, and about 15 percent are referred to a psychologist before the procedure can begin. Much of that consult is devoted to keeping certain hopes under control. “There are people with unrealistic expectations,” Steinberg said. “Famous athletes come in and want someone who can throw a baseball really fast, and I say, what if your son can’t do that?”
And what is the psychological impact on a person who finds out that they are the sex they are because their parents insisted upon it? Is there some added, unquantifiable pressure to behave or present in a way that is stereotypically male or female when you know that your parents selected your sex? What if that person is biologically male but identifies as female? It’s still too soon to tell, said Steinberg, as studies haven’t been done yet on if and how parents reveal that information to their kids, and how kids respond to that intel once they have it. “I almost want to do the paper myself,” he said. “I don’t know of any paper that’s looked at this.”
“The thing we try to do, as an ethicist, is avoid making assumptions or judgments about people’s motivations and how they would behave based on certain things,” said Kissling. “A natural bias that we would have is, if somebody went to the trouble of deliberately creating a boy, you would think that they would be more likely to be disappointed if, having had a boy, the boy then rejected the gender because they had chosen that gender. But you don’t really know that, because people are infinitely unpredictable. They might be just as happy.”
“Family balance is a human instinct,” said Steinberg. “And the use of modern technology made it happen. And maybe it’s a survival instinct: we need women and we need men. The paths have merged, but there’s a still a difference between boys and girls. They’re equally and critically important. I’ve seen families walk in with seven boys, and they want a girl. I don’t think any story is telling them to do it. It’s something built in to human beings.”
The Fertility Institute has a database of about 8,000 people. Add up the entire thing, and you’ll find that 50.5 percent of parents request female babies, and 49.5 percent want male. It varies a great deal by region: Canada and France are heavy on the girls, most of Asia, Germany and Britain on the boys. Now that laws in China forbidding multiple children have been lifted, “they’re all pouring in for girls,” said Steinberg, as many already have boys. “They’ve become very traditional.” A study cited by Loike found the male/female ratio in sex selection on the east coast was “exactly fifty-fifty.”
Steinberg claims most of his patients have “total acceptance of outcome regardless of what it is,” but he also admits that “we’ve never gotten the wrong gender,” so it’s not like he’s had to test the theory.
As for the brave new world of, as Kissling put it, “designer babies,” that dystopic (or utopic, depending on your point of view) future may be closer than you think.
“I get about five to seven requests a month for eye color,” Steinberg said. “We know the gene and what it takes. It won’t be long.”
“I’m not judgmental about a person” who wants to select a child’s physical traits, said Kissling. “I don’t think, ‘Oh my God, that’s a terrible thing to want. It’s terrible to want to have an attractive child. We should be content with healthy children, ten toes and ten fingers.’ I’m not prepared to look at it that way.”
The risk of this technological development might be more societal than personal. IVF is expensive; it’s not always covered by insurance. As individuals who seek it out are able to essentially be architects of the next generation, and “if the government isn’t going to pay for it and make it available to a wider socioeconomic class of people, and [IVF is] only privately available, what’s the potential social harm that comes from allowing rich people, or people of means, to create many people who have a much better chance of success?” Kissling asked. “Do we exacerbate class differences within society?”
This technology “makes us nervous because we don’t trust the goodness of people,” Kissling said. “We’ve seen how these technologies have been misused,” said Kissling. “Maybe sex selection is the first step along the way and each of these steps: if you accept sex selection, then you accept the next thing, which is intelligence selection, and then you have nothing but designer people… And maybe we have no business interfering in procreation. [That’s the other] end of the spectrum: trusting everything to God. If you should have a boy and a girl, God will give them to you, and if not, you just take what you get. But that’s unsatisfactory, too.”
People tend to feel a kind of revulsion at the idea of programming ideal offspring, Kissling said. “We know there’s a predisposition against people who are trying to create perfect children.” But she referenced philosopher-bioethicist Julian Savulescu, a man “at the edge of some of this discourse” who believes that “parents have an obligation to have the best children they can.”
Savluescu’s theory, as explained by Kissling: “We live in a very complex, threatened world, and we need very bright, skilled people to deal with the challenges we face. We need to work on things like curing diseases, solving climate change, figuring out how to feed the people of the world, and an important element of that is having people who have the capacity to solve these problems. Therefore, if you really care about the future of humanity, and if we have this ability to produce children who are more likely to be able to solve these problems, then it is imperative — it’s a moral obligation — to do that.”
I ask about Steinberg about the worst case scenario: is he worried about some master race thing, where all the richest people ask for Aryan Barbie-babies, all blonde hair and blue eyes, a pack of Third Reich poster kids?
“When I hear you say it like that, it worries me,” he said. “But practically, when I’m sitting with patients, you’d think everyone wants blue eyes and they don’t. They want everything under the sun. The variety is there, just like boys and girls.” And he can’t create genes that aren’t there. “Everybody wants what they can’t have. Most requests for green and blue eyes come from brown-eyed people. [But] if they don’t have the genes, they can’t have the baby. Most people end up not being able to get what they want.”