Dr. Jeffrey Steinberg, inside the operating room at his clinic in Encino on April 14. 2006. Dr. Steinberg, founder of  the Fertility Institutes, uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.

Fertility Institutes

Couples have attempted to choose the gender of their off-spring back to prehistoric times according to Dr. Jeffrey Steinberg, founder of the Los Angeles based Fertility Institutes. Attempts to select the sex of a child are depicted on cave walls dating back 10,000 years. "I'm wondering if trying to balance a family is part of human nature."

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Dr. Steinberg's Institute – with offices in Los Angeles, Las Vegas, and Mexico have taken the uncertainty out of the process with Preimplantation Genetic Diagnosis (PGD). The technology is a laboratory procedure used in conjunction with in-vitro fertilization. The technology was originally stumbled upon in an effort to screen genetically transmitted diseases in embryos, which are sometimes linked to gender.

"Initially we weren't sure what to do with it," said Dr. Steinberg. There had been sex selection for years with the separation of x and y sperm with an overall success rate of 58%. With PGD the success rates are nearly 100%.

The success rate of in-vitro fertilization ranges from 65%-80% with a 99% chance of getting the gender desired. The procedure costs from USD18,000 to USD19,000.

The woman's eggs are harvested in a surgical procedure and fertilized with the father-to-be's sperm in a laboratory. Embryos are then separated by sex and implanted in the mother via in-vitro fertilization.

The procedure is criticized by some as going too far. In a country where everything seems to be for sale, is selecting the sex of a child the beginning of a slippery slope? The technology is so controversial that it is illegal in many parts of the world, including most European countries.

"Gender selection is a commodity for purchase," said Steinberg. "If you don't like it, don't buy it."

"When I was approached for this job I was initially uncomfortable about using this technology for choosing the gender," said Dr. Christine Briton-Jones, who runs the laboratory end of the Fertility Institutes operation.

But Briton-Jones felt differently after she embarked on a study of what motivated couples to resort to PGD. She published her findings in medical journals in 2005, based on interviews with 175 couples. Many of couples already had kids of one sex and were holding onto a dream of parenting a child of both sexes. They were not saying that one gender was better than another," reflected Briton-Jones whose fear was that PGD would be used in a discriminatory manner.

Many societies already practice gender selection, pointed out Steinberg, using China as an example. "Is it better to leave a baby girl by the side of the road or never to have had her at all?"

Which is ethically more palatable questioned, Briton-Jones, PGD or the traditional Indian method of gender selection, slipping the mid-wife some money to kill a female child?

Dionne and Joe Smiegel have two girls. "Girls are everywhere in our both our families," said Dionne. Joe's farther died when he was 13 years old and the couple really wanted a boy to carry one the family name. Dionne first heard about the Fertility Institutes in the media and looked up the Institute on the worldwide web. "I added the web-site to my favorites and looked at it for three years before deciding to do it," said Dionne.

Today, Dionne is 12 weeks pregnant with twin boys. "You've got to really want it, before you sign up for it," warned Dionne. The early days of Dionne's pregnancy were not like her other two pregnancies. She described feeling ill and bloated from the fertility drugs, which she had to take for four- month duration into the first trimester of her pregnancy. "I didn't like it," said Dionne but in retrospect thinks it was worth the discomfort. "Hang in there," she added, "because the rewards are great."

"People should be motivated. It's not like getting a Starbuck's coffee," said Steinberg "We spend a lot of time educating families prior to the procedure," and have even recommended a couple of families for therapy when he has felt that they wanted the procedure for the wrong reasons.

Fifty percent of Steinberg's patients are from countries other than the United States. Gender selection ends up being fifty-fifty. Canadians favor girls, while Japanese, Chinese and Indians want boys. Americans and Latin Americans are split down the middle. Furthermore, women tend to want girls, and men boys, said Steinberg.

Steinberg and Briton-Jones are performing 20 PGD's a month . The number has risen four-fold in the last three years. Despite the growing popularity of PGD, with its hefty price tag "it's not going to change the social balance for the world," points out Steinberg.

Are we on our way to creating designer babies, ponders Briton-Jones. PGD does not alter embryos. "I firmly believe that we are hundreds of years away from perfecting this technology."

But the ethical questions do not stop with pregnancy. A by-product of the PGD procedure is the production of extra embryos. Couples can choose to donate their extra embryos for stem cell research, freeze them for there own future use, or donate them to other couples. Briton-Jones estimates that 72% of the left over embryos are donated to stem cell research.

"There is very little controversy in the medical community over stem cell research. It has huge promise for the entire human race," said Steinberg. However, there is some debate in the general community over using embryos for this type or research.

"I actually do feel the potential of these cells makes them precious. They deserve the highest respect. I will not create an embryo that won't be used to create a pregnancy. That's where I draw the line. I will not create an embryo just for research," said Briton-Jones.

"Twenty-eight years ago I did my first in-vitro baby. There was a note on my windshield that said test tube babies have no souls," remembers Steinberg. "Today I go to a party and half the people in the room have had a baby by in-vitro fertilization. New things are controversial. It's appropriate. After a while everyone calms down."


Text by Mimi Rohr
© 2006 Mimi Rohr

Note: Fertility Institutes' website is at www.fertility-docs.com

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Dr. Jeffrey Steinberg, inside the operating room at his clinic in Encino on April 14. 2006. Dr. Steinberg, founder of  the Fertility Institutes, uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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The lobby of the Fertility Institutes in Encino, CA. The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex  of their future baby with a 99% success rate.
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Embryologist Queenie Yeung prepares the culture media that will be placed in an incubator the day before any scheduled patient treatment to allow the media to equilibrate to the correct temperature and pH by the time of the patient treatment.  The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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Dr. Jeffrey Steinberg gets ready to place a sterile cover over the vaginal ultrasound probe. This probe allows the visualization of the ovarian follicles and guides the needle through which the follicular fluid containing the oocyte will be collected from the patient. Dr. Steinberg, founder of  the Fertility Institutes, uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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Operating on a patient: Dr. Jeffrey Steinberg washes the vaginal wall through which the needle will reach the ovary. Dr. Steinberg, founder of  the Fertility Institutes, uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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Operating on a patient: Dr. Steinberg has the ultrasound probe with the attached needle in place. He pierces the ovarian follicles with the needle and uses a monitor to guide the needle.. A suction pump draws the follicular fluid from the follicle. Dr. Steinberg, founder of  the Fertility Institutes, uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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Dr. Jeffrey Steinberg looking at the monitor that helps him to guide the needle. The vertical white rectangle shining in the center of the image shows the tip of the needle as the follicular fluid is aspirated from the follicle. Dr. Steinberg, founder of  the Fertility Institutes, uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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An ultrasound view of  the patient's ovary. The volumes appearing in black are filled with fluid and are the follicules. In order for a follicle to develop, an egg must be present but the egg may not be isolated in every follicle due to the developmental process of oocyte maturation and normal degeneration. The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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The follicular fluid being aspirated from the follicle is collected into a sterile test tube that is kept at a constant temperature of 37oC (98.6 oF). The test tube is then immediately passed by an assistant (back) to another one into the embryology laboratory and placed into a heating block to maintain ‘body’ temperature.  Dr. Steinberg, founder of  the Fertility Institutes, uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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Embryologist Queenie Yeung in the laboratory monitors the same image Dr. Jeffrey Steinberg sees in the operating room so she can get ready to receive the follicular fluid through the communicating trap and process it immediately. The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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Embryologist Queenie Yeung receives the test tube containing the follicular fluid through the communicating trap between the lab and the operating room. The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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Oocytes are identified from the follicular fluid in sterile culture dishes. At this stage the oocytes are surrounded by specialized granulosa cells called cumulus cells, which have direct contact with the oocyte.    The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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Embryologist Christine Briton-Jones uses a dissecting microscope to identify the oocytes while embryologist Queenie Yeung waits in the background for more test tubes to be passed from the treatment room. The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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Prior to culture, the oocytes with their surrounding cumulus cells are washed in a pH stable culture media in order to remove any follicular fluid and red blood cells. The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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Human oocytes after isolation from the follicular fluid that are clearly visible with the naked eye due to the surrounding cumulus cells. This is termed the Oocyte Cumulus Complex (OCC). The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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The Oocyte Cumulus Complex (OCC) is placed in culture media that will maintain the correct pH in a 6% Carbon dioxide environment. The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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Prior to insemination by Intra Cytoplasmic Sperm Injection (ICSI),  the surrounding cumulus cells are removed with enzymatic digestion and washing.  The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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Embryologist Christine Briton-Jones with culture dishes containing numerous aliquots of media that are quickly returned to the incubators to minimize any changes in temperature, osmolarity and pH. The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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Embryologist Christine Briton-Jones uses a microscope and micromanipulators to perform a  biopsy on the 8-cell stage embryo in order to single out one embryonic cell that will be analyzed for sex determination. The embryos are cultured for 3 days post insemination and at this time healthy embryos will have grown to the 8 cell stage. The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future baby with a 99% success rate.
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This photograph shows the micromanipulators attached to the microscope stage that allows the movements of the embryologist’s hands to be reduced to microscopic movements. They will be used to perform a  biopsy on the 8-cell stage embryo in order to single out one embryonic cell that will be analyzed for sex determination. The embryos are cultured for 3 days post insemination and at this time healthy embryos will have grown to the 8 cell stage.  The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future baby with a 99% success rate.
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First stage of the biopsy procedure. This shows a day 3 eight cell embryo with the holding pipette on the right and the partial zona dissection (PZD) pipette on the left. The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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The PZD pipette is pushed through the zona pellucida in two points. The section of zona pellucida between the two points is cut to make a thin slit opening in the zona pellucida.  The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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The PZD pipette is replaced with a blastomere biopsy pipette, shown on the left. Suction pressure is applied to the biopsy pipette and a single embryonic cell is drawn into the biopsy pipette. The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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The single embryonic cell is shown at the top of the photo, with the nucleus visible as a centrally located circle. The chromosomes contained within this nucleus are studied to reveal the gender of the embryo. The biopsied cell is quickly replaced by the rapidly dividing embryo. The Fertility Institutes uses Preimplantation Genetic Diagnosis (PGD) technology in conjunction with in-vitro fertilization to help couples to choose the sex of their future babies with a 99% success rate.
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