Gender Benders

*This post discusses a very sensitive topic. Reader discretion is advised* 

Even though Husband is hoping that we have a girl if I ever manage to get pregnant again, he was reluctant to designate a gender preference with our PGD testing. "I think there are somethings you still have to leave to chance" he advocated. In theory, I concurred. If we had conceived spontaneously or even with an IUI, we were planning to keep the gender a surprise until the birth. However, we weren't in Kansas anymore, Toto. We were in the middle of our first IVF cycle with plans to go PGD testing for the primary purpose of avoiding the transfer of an aneuploid embryo. Advance knowledge of the gender would only be a secondary benefit. Yet, as I know my heart's desire for a girl, I felt I couldn't pass on the opportunity to make that dream come true. If we were having to go to such extremes to have a baby, then we might as well take advantage of the perks! I thought the process would amount to slipping the embryologist twenty bucks to get her to thaw a girl. Unfortunately, it doesn't work that way. We both had to sign the consent forms indicating a gender preference. Shamefully, I pulled the uterus card and coerced Husband into signing the forms.

Recently, my medical assistant was rooming my new OB patient, I started looking through her chart. She was 26 and this was her second pregnancy. I found a phone message she sent to her primary care provider; she just learned that she was pregnant and wanted to know how soon she could know the baby's gender. Oh, how nice when that's your primary thought process. No worries about whether or not this pregnancy will be viable or euploid... I bitterly acknowledged, as I once again reminded myself that these women live in a different world. My medical assistant emerged from the room. "She's ready." she announced. "She really is quite eager to know the baby's gender!" ...and I know why... I thought to myself.

Sure enough, the couple didn't say much during her interview or exam. Her ultrasound revealed a single viable intrauterine pregnancy measuring 9 weeks and 3 days. She didn't ask what her due date was. She didn't want to know the heart rate. They didn't inquire about the baby's size, as most couple tend to do; usually just after I've cleared the screen with the measurements. She only had one question: could I tell if it was a boy of girl? I replied that it was too early. I knew what was coming next. They wanted to know the gender as soon as possible as they plan to terminate the pregnancy if it were another girl.

My stomach flipped a bit as I looked at their absolutely gorgeous two year old daughter. She had perfect curls in her hair and her bright eyes were framed with long lashes. Due to my patient's age, she's not eligible for NIPT testing. The lab we use holds to the evidence that the test was only studied in high risk populations (Advanced Maternal Age, Personal history of a fetus with chromosomal abnormality, or abnormal serum screening or ultrasound findings) and will only perform the test for women who meet that criteria. Even if a couple is willing to plunk down a few grand in cash, they will be turned away if they're not appropriate candidates, which really makes me respect the integrity of the lab. The perinatologists in our area won't perform Chorionic Villi Sampling (CVS) or an Amniocentesis for a couple who only is looking for gender confirmation, unless they're carriers for an X-linked disorder such as haemophilia. Her best option was to do a 3-D gender scan, which could be performed before her anatomy scan at 18 weeks. "It's not covered by your insurance and would be an out of pocket expense." I informed them as I acknowledge that it sounded a touch bitchy.

When I worked at a reproductive options clinic, we would periodically engage in values clarification exercises. Various aspects surrounding abortion were proposed and participants would be divided into groups that would answer the questions either supporting or refuting the position statement. Then the groups would swap papers and would defend the other team's answer. The purpose of the exercise is to try to see things from someone else's point of view. Yet in all my time working at this clinic, the issue about doing an elective termination for gender selection was the one question that many struggled to argue for the supporting position. Even the most ardent pro-choice banner carriers admitted that gender selection made them feel a little uncomfortable.

Meanwhile, the consent forms for PGD testing were still sitting on our dinning room table. I was waiting until I had a department meeting in a few weeks, which would bring me in proximity to my RE's office and we wouldn't need to make a separate trip. I was also stalling as I had been re-thinking my intention for a gender preference. As Husband has a limited attention span and twice missed an initial and a signature on the forms for our first IVF cycle, my new tactic is to spread them out on the table and use 'sign here' stickers. I told them the latest batch was ready to sign. When he got to the question about whether or not we wanted to know the gender and if we had a preference, he dropped the pen when he saw my initials next to the option "I DO NOT want to know the gender" and came over to embrace me in his arms. "This is the right call Jane" he whispered to me. I know. We're not in Kansas anymore, but we've been in Oz long enough to understand what really matters.