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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Inside the embryology laboratory with the micromanipulation station in the foreground . 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 Christine Briton-Jones uses a fluorescent microscope to visualize the probes that bind specifically to the chromosomes we wish to study; in the cases of gender selection we are interested in the X and Y chromosomes. XX = a female XY = a male. 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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The images gained from the fluorescent microscope of the single embryonic cells are examined. A positive control probe is always included in the examination,  in this case a probe for chromosome 18. Two chromosome 18 signals show that the hybridization of the probe to the DNA within the chromosomes worked efficiently and that this cell is diploid (2 copies) for chromosome 18.  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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Two signals for the X chromosome indicate that the embryo from which this cell was biopsied is female.  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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One X signal and One Y signal indicates that the embryo from which this cell was biopsied is a male. 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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After 5 days of culture the human embryo will develop into an expanding blastocyst. This embryo shows signs of hatching from the zona pellucida. At this stage the embryo will be transferred to the future mother’s uterus in an attempt to establish a pregnancy or may be cryopreserved to be stored until the patients wish to thaw it to attempt a pregnancy in the future. 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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Any embryos that are not used to attempt to establish a pregnancy in this treatment cycle may be cryopreserved and stored in liquid nitrogen at a temperature of -190oC. At this temperature no biological processes can occur therefore the embryos can be stored for an indefinite period of time until the couples wish to use them to attempt to achieve a pregnancy in the future. 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, at his clinic in Encino on April 11. 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 baby with a 99% success rate.
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Dr. Jeffrey Steinberg, at his clinic in Encino on April 11. 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 baby with a 99% success rate.
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Dr. Jeffrey Steinberg, at his clinic in Encino on April 11. 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 baby with a 99% success rate.
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Dionne Smiegel at her mother's house in Camarillo, CA, on April 15, 2006. Dionne is 3 months pregnant with twins and used the services of Dr. Jeffrey Steinberg. 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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Dionne Smiegel at her mother's house in Camarillo, CA, on April 15, 2006. Dionne is 3 months pregnant with twins and used the services of Dr. Jeffrey Steinberg.  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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Dionne and Joe Smiegel with their daughters Riley,7, (R) and Emma,4, (L) in Camarillo, CA, on April 15, 2006. Dionne is 3 months pregnant with twins and used the services of Dr. Jeffrey Steinberg.  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, at his clinic in Encino on April 11. 2006, posing in front of pictures of the babies who were conceived with the help of his services. 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 baby with a 99% success rate.
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