A balancing act: sex selection after pre-implantation genetic testing for aneuploidy for first versus second baby
Authors: Bayefsky M J , Shaw J , Hamer D , Martel R , Reich J , Blakemore J K 
Published: May 2023

Abstract

STUDY QUESTION
How often do patients undergoing frozen embryo transfer (FET) after preimplantation genetic testing for aneuploidy (PGT-A) choose to select for sex and do sex selection rates differ before and after successful delivery of a first baby?

SUMMARY ANSWER
When a choice was available between male and female embryos, patients selected the sex more frequently when trying to conceive the second child (62%) as compared to the first child (32.4%) and most commonly selected for the opposite sex of the first child.

WHAT IS KNOWN ALREADY
Sex selection is widely available in US fertility clinics. However, the rate of sex selection for patients undergoing FET after PGT-A is unknown.

STUDY DESIGN, SIZE, DURATION
This is a retrospective cohort study of 585 patients that took place between January 2013 and February 2021.

PARTICIPANTS/MATERIALS, SETTING, METHODS
The study took place at a single, urban academic fertility center in the USA. Patients were included if they had a live birth after single euploid FET and returned for at least one subsequent euploid FET. The primary outcomes were the rates of sex selection for first versus second baby. Secondary outcomes were rate of selection for same versus opposite sex as first live birth and overall rate of selection for males versus females.

MAIN RESULTS AND THE ROLE OF CHANCE
Five hundred and eighty-five patients underwent a total of 1560 single euploid FETs resulting in either one or two live births. A choice between male and female euploid embryos was available for 919 FETs (first child: 67.5% (519/769) versus second child: 50.6% (400/791), P &lt; 0.01). When a choice was available, patients selected the sex more frequently when trying to conceive the second child (first child: 32.4% (168/519) versus second child: 62.0% (248/400), P &lt; 0.01). When sex was selected after first live birth, the opposite sex of the first child was selected 81.8% (203/248 FETs) of the time. Of transfers that involved sex selection, rates of male and female selection were similar for the first child, but selection for females was greater for the second child (first child: 51.2% (86/168) male versus 48.9% (82/168) female, second child: 41.1% (102/248) male versus 58.9% (146/248) female, P &lt; 0.04).

LIMITATIONS, REASONS FOR CAUTION
The study was performed at one urban academic medical center in the Northeastern US, which may limit generalizability to other settings where PGT-A may be performed less frequently, or sex selection may be limited or not permitted. In addition, we could not reliably account for whether patients or their partners had prior children and if so, of what sex.

WIDER IMPLICATIONS OF THE FINDINGS
Patients undergoing PGT-A with both male and female euploid embryos were more likely to select for sex when attempting a second child and usually selected for the opposite sex of their first child. These findings highlight the potential for family balancing for patients who undergo PGT-A in settings where sex selection is permitted.

STUDY FUNDING/COMPETING INTEREST(S)
This study received no funding. The authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER
N/A.