We choose our career paths, our partners, our shoes… and now people are choosing whether their children will be born with a penis or a vagina. Gender selection is a quickly growing practice in fertility medicine, with patients paying tens of thousands of dollars and enduring weeks, months and sometimes even years of pricking, prodding and various other procedures to ensure that they get the little Dick or Jane they so eagerly want. And as technology sharpens, the trend may only continue, with some private fertility clinics even exploring science that would allow the parent to choose physical traits such as hair or eye color.

This painstaking process is called in vitro fertilization (IVF) with preimplantation genetic diagnosis (PGD). IVF is the manual fertilization of an egg and a sperm in a laboratory dish, then the transfer of the embryo to the uterus. PGD refers to the reproductive technology used during the IVF cycle to detect genetic disease before the embryos are implanted.

There are two different reasons for gender selection, explains LivingHealthy expert and Beverly Hills-based OB-GYN Suzanne Gilberg-Lenz, MD. A medical reason, such as avoiding gender-specific diseases or abnormalities that favor one sex or the other, is the first and most socially supported. The other reason is family balancing, which is the act of choosing a child’s sex to even out the number of boys and girls in a family. “If you are choosing the gender to avoid certain gender-specific fatal diseases or autism, then I’m all for it, but if you are doing it just because you only want a girl or a boy specifically, then that is where the line blurs. I think all of us involved in this field are sensitive to the fact that gender selection is not a slippery slope—it is something we are already sliding down, into the mud puddle,” Gilberg-Lenz admits. Even patients themselves are less inclined to be honest about it when it’s more of a preference, she says. “It’s something a lot of people, even my patients, are doing and not talking about because it is so controversial. I wouldn’t feel comfortable doing it.”  

And it is indeed controversial, even among the medical community and larger establishments. In the 10 years since the technology was introduced, gender selection has already stirred up a whole lot of debate. Groups like the United Nations and World Health Organization, the religious sector, bioethicists and many doctors (who take issue with the concept of “playing God”) are opposed to it. The procedure is even banned in countries such as Canada, China, India, Australia and the UK for ethical reasons. In fact, the United States is one of the few countries where gender selection for nonmedical purposes is legal—and there’s even a new industry dubbed “reproductive tourism,” in which couples or individuals from around the world are traveling to the U.S., Italy, Thailand and Mexico in order to choose their child’s gender.

Gilberg-Lenz refers many of her patients who struggle with conception to renowned fertility specialist Andy Huang, MD, MBA, FACOG. Huang’s name may sound familiar to Keeping Up With the Kardashians fans, as Kim Kardashian made several visits to his office on the show during her very public struggle to conceive a second child with Kanye West.

According to Huang, the surge is primarily due to the simple fact that technology has advanced, making gender selection much more accessible. In the past, you were limited when testing chromosomes as part of the IVF process, so most people would prioritize testing for conditions that would ensure a healthy baby, like Down syndrome. But with the efficiency of the modern-day developments, tests can now be run on all 23 pairs of chromosomes with little risk, making gender part of the package. “Most of the women I see who do this sort of testing are struggling to conceive, so their primary purpose is finding the healthiest embryo to implant via IVF. While some of them do have a preference of sex during this process, about half to three-quarters of my patients opt to have me choose the embryo with the greatest chance of survival,” says Huang.

Though it is not an encouraged or promoted practice at Reproductive Partners Medical Group, where Huang practices, he admits that more patients are coming in with the sole desire of choosing the sex of their child, whether it’s because there is familial pressure to have a boy to “carry on the family name,” or they simply prefer one sex or want to balance out a family of all boys or girls. The average client tends to have an abundance of financial resources, be technologically savvy, not be particularly religious and, more recently, come from foreign countries where gender selection isn’t available. They are also willing to put their bodies through the uncomfortable and inconvenient process of IVF, which most women without fertility issues will avoid if possible.

This IVF process includes taking birth control medication to regulate hormones; stimulation of the ovaries in order for sufficient egg growth by small, twice-daily needle injections; several visits to the fertility clinic for ultrasounds and blood tests; and another ovulation-preventing shot once all the eggs come in. Then comes the egg harvesting, which takes 20 to 30 minutes and is done under anesthesia, with the doctor going in through the back wall of the vagina and into the ovary to suction out the eggs via a needle-guided aspiration (a type of biopsy). The eggs are paired up with sperm and grown for five to six days. This is referred to as the “natural selection” phase, as the abnormal embryos often don’t fertilize or grow and select themselves out. At this time, when there are about 100 cells, the PGD testing process begins, with results returning within a few days. Implantation is the easy part, performed without an anesthetic and with little downtime. Two weeks later, it’s judgment day.

Now here are the numbers and stats: The cost of IVF usually falls between $12,000 and $15,000 per cycle, with PGD testing costing an additional $3,000 to $5,000. Many insurance companies may cover a portion of the treatment if it’s for infertility or medical purposes. But when it comes to the “gender selection” portion, you will most likely be responsible for 100 percent. After the eggs and sperm are collected and the embryo is fertilized and tested, there is also no guarantee that the remaining healthy embryos will be of the desired sex— sometimes you’ll have all male or all female remaining. If that’s the case, you have to start all over again. If your boy or girl survived the testing process with a stamp of approval and is implanted in your uterus, it has a 65 to 75 percent shot at making it to fruition. In a nutshell: The process can be very long, vigorous as well as expensive.

So will “designer kids” be the future of fertility? Most likely not, according to Huang, who maintains that most of his patients prefer to make babies the old-fashioned way, and more often than not will opt for the healthiest embryo and leave the decision up to nature. But if you are seriously on the market for your little dream boy or girl, he suggests asking your OB-GYN or friends for referrals to find a great fertility clinic. “Be sure to ask about success rates and how often they do IVF and gender selection, and make sure you meet the doctor, visit the center and feel totally comfortable there,” Huang urges. “I would also be hesitant about places that market the gender-selection angle.”

Or you could just leave it up to fate. There’s a 50/50 chance you will get what you want, after all.