Capron: Doctors have been diagnosing diseases and sex in developing fetuses for quite a while using amniocentesis. The difference here is it's done before implantation. So for people who would be bothered by abortion, but who don't have the same problems with the decision to implant one embryo rather than another, in some ways this may seem more appealing.

The question in my mind is how far one goes from something which is directly connected with a disease, again sex selection for the so-called x link diseases like hemophilia, as an example, diseases that show up in men but don't show up in women, has been a reason why geneticists and obstetricians have been willing to do even selective abortions for quite some time.

Zavala [host]: So is it fine to choose the sex of your child, depending on why? Is it a matter of motivation that determines the ethics?

Elders: Well, you know, I think it really is probably more than that. What most parents want is just a healthy child. But if you're talking about someone making a pre-selection because of a disease or because of fear of breast cancer or whatever, then I think that that becomes a little bit different than just "I want a boy" or "I want a girl".

Marlow [host]: But the mother who's pressured to have a boy by a husband who says, "I want a boy."

Elders: Well, you know, I think most fathers, if they get a girl, they love them just as much.

Zavala: Well, let's say they've already had, say, three girls and they want a fourth child and the only reason they want a fourth is because they want a boy. That's not sexist.

Capron: Well, you know, the question, I think, is whether we believe this is something that only an individual can decide about, that there should be medical standards, the doctor should or shouldn't do it. The view among most fertility doctors, up until now, has been that they will not use sex selection just as a social preference. But they recognize that people will try to get around that in various ways, as do people who do amniocentesis, and who report people coming in saying they have a family disease, they do the workup and then, if it turns out it's a girl, they end up aborting the girl, although logically they would only be screening to avoid an illness in men.

Marlow: But if hospitals and physicians deny this service to a couple, is there a legal issue here?

Hiepler: It depends, but when you --

Marlow: -- could you sue and insist that they be given this technology?

Hiepler: Probably not. Again, anything expensive, an insurance company doesn't want to pay for. So the trivial decision posed to Dr. Elders of, you know, I've got three boys and three girls, I'd like to now have another boy, is going to come down to a pocketbook decision.Tthe family's going to have to pay for this. An insurance company isn't going to cover it to begin with. They don't cover --

Capron: -- just because someone is willing to pay for it doesn't mean that it's right. And, in fact, most fertility services have not been paid for by insurance. The insurance companies have been very slow to cover it, so most of this has been done as patient payment and because we don't have any federal research dollars. This is the one area, unlike, say, heart treatment or cancer or whatever, which has not been driven by the academic centers and by the national institutes of health because we've had a ban on any federal funding for anything that has to do with embryos.

Therefore, the whole fertility field has been funded by patient dollars, which gives an extra impetus to doctors being agreeable if people come along and start saying, "I want this, I don't want that". We know from studies for years that, if people could choose the sex of their child, an overwhelming majority would choose males as the first child. and if they don't have a second child, then we get into this kind of imbalance of having many more boys than girls.

Zavala: But Dr. Elders, is there simply a clear-cut moral issue that the sex should be left to luck, nature, god, whatever?

Elders: Well, you know, I think that -- I don't know how to answer that question, to tell you the truth. You know, in the countries that, you know, like abort the girls so they could have boys, what it's done in many cases has given more power to the women because there are fewer women. Say in Japan, women are beginning to have more power. And countries like India, if there are fewer women, they've got the power now. (laughter) so it's not all bad, but morally, again, I think most parents --

Zavala: -- does it sit right with you, though, morally?

Elders: I want a healthy child.