What is Gender Selection?
Sex selection is a method of IVF treatment that allows expectant parents to determine the sex of their baby. With this treatment method, embryos of the desired gender are transferred to the uterus of the expectant mother. In this way, expectant parents can have a baby of the gender of their choice.
In IVF treatment, the egg cells of the expectant mother and the sperm cells of the expectant father are combined in a laboratory environment and turned into embryos. Biopsies are taken from the embryos for genetic diagnosis. The biopsy cells taken by PGD (Preimplantation Genetic Diagnosis) and NGS (Next Generation Sequencing) are evaluated by genetic specialists. In this way, genetic disorders in the embryo, genetic carrier diseases and gender can be determined.
Non-medical methods used for sex determination (nutrition, Chinese calendar, etc.) are not conclusive. Only by applying biopsy to embryos formed during IVF treatment (PGD) and methods such as FISH -NGS, 99.9% of the results are accurate. However, this certainty should not be understood as a guaranteed pregnancy. The pregnancy rate of each expectant mother varies. This varies depending on the number of eggs, egg quality, embryo quality, age and uterine condition. This rate (99.9%) is the accuracy rate of the result if conception is achieved.
For whom is sex selection performed?
Gender selection through IVF treatment is a controversial issue due to ethical reasons and is prohibited in many countries including Turkey. However, in case of medical necessity, it can be done with the condition of obtaining permission for genetic screening. In this method, which is highly preferred especially for the prevention of gender-related diseases in the family, it is not mandatory to have a child to apply for treatment, but having a child before is also an important factor in achieving success.
Another reason why gender selection is preferred is the desire of prospective parents to create the family plan they desire.
For some prospective parents, the situation is very different and they have a psychological need due to social pressures.
Sometimes prospective parents may want to choose the gender of their first baby because they feel more ready.
Gender Selection Methods
1.Gender Selection with PGD Method
2.MicroSort Method for Gender Selection;
3.Shettles method:
4.CVS Method
Sex Selection by PGD
The most preferred Fish method starts with a biopsy of the embryos on day 3. The biopsy cells are analyzed in the genetic laboratory. According to the result, appropriate embryos are transferred on day 5. Since a limited number of chromosomes are scanned, it gives results in a shorter time and is a more cost-effective procedure. Embryos are tested for chromosomes 13, 18, 21, X and Y (X and Y are sex chromosomes).
Tests Requested for Gender Selection Treatment:
Tests Requested from the Expectant Mother:
FSH, LH, E2, Progesterone (to be done on the 2nd or 3rd day of menstruation)
AMH (In expectant mothers with a value below 0.5, an insufficient number of eggs may not develop and this may prevent successful completion of the treatment. If pregnancy occurs, there is a risk of miscarriage)
TSH, T3, T4, prolactin (morning on an empty stomach)
Complete Blood Count, blood type
Fasting Blood Glucose (morning on an empty stomach)
Urea, SGOT, SGPT
PTT, INR, APTT
Vit B12 and Vit D
HBsAg, Anti-HCV, HIV, VDRL (Infectious diseases test)
Karyotype (according to condition)
USG (Vaginal Ultrasonography) is preferred to be between 14-20th days of the menstrual period. The appearance of the intrauterine lining, fluid accumulation, adenomyosis (the structure that looks like a black hole in the endometrium), fibroids, polyps are detected more accurately by ultrasound. The thickness of the intrauterine lining (endometrium) is particularly important and is preferably 8 mm or more. Fluid accumulation in the endometrium is usually due to intrauterine operations such as cesarean section and suggests adhesions. In addition, fluid accumulation may also develop due to enlargement of the tubes called hydrosalpenx. The ovaries (ovaries) are also evaluated with USG. It is checked whether the egg reserve is suitable for this procedure. In order to have a high chance of success, a target of 10-15 mature eggs is desired. In cases where the egg reserve is low, the pool method is applied. In the pool method, egg collection is usually performed 2-3 times. This method can be time-consuming as well as a bit costly and tedious. In such cases, egg donation may sometimes be preferred.
HSG (Hysterosalpingography) is the most important and indispensable test in investigating the causes of infertility. It is a kind of x-ray that allows the uterus and tubes to be visualized, a special device is inserted into the uterine entrance and a contrast fluid is given and taken. Another name is uterine film. Since it can be painful due to the pressure, we recommend that it is performed under anesthesia. Although it is performed with X-rays, the radiation dose is very low. With this X-ray, conditions such as swelling in the tubes (fallopian tubes), polyps, fibroids, adhesions in the uterus, which are known to adversely affect pregnancy and cause ectopic pregnancy, especially due to the fluid in the fluid touching the embryo, are detected. In principle, HSG is performed within 2-3 days following the end of menstruation. In cases where it is certain that there is no pregnancy, there may be flexibility on the day of the filming. In the presence of infection, the filming is postponed. The uterine film is valid for 2 years and if surgical intervention has been performed, it is recommended to repeat the film in terms of adhesions etc.
Information Requested from the Expectant Mother:
Any diseases and medications that may adversely affect the treatment or pose a risk to her health must be reported to us in order for us to take the necessary precautions. In particular, blood thinners, diabetes medications, blood pressure and heart medications, as well as the use of harmful substances such as smoking and alcohol are also important information for us.
Tests Requested from the Prospective Father:
Spermiogram (3-5 days of sexual abstinence)
HBsAg, Anti-HCV, HIV, VDRL (Infectious diseases test)
FSH, LH, Testosterone hormone analyzes (on a case-by-case basis)
4.Karyotype (according to condition)
Information Requested from the Prospective Father:
We should be informed if he has a disease that prevents him from giving sperm (such as diabetes) or if he is unable to give sperm due to stress. In such cases, supportive medication may be given or it may be necessary to remove the sperm from the testicles with a small operation. The presence of heart disease may pose a risk due to complications of the medication. Blood thinners may also pose a risk for the operation. Again, the information about whether he has undergone sperm-related treatment or operation (Tese, Tesa, varicocele, etc.), whether he has used harmful substances such as smoking and alcohol should be made to us fully as it will shed light on the course of treatment.
Gender Selection Therapy
Based on the examination, tests and examinations, a treatment plan is prepared for the expectant mother who is deemed suitable for this treatment method. Sometimes, if the planned treatment period is very important for the expectant parents, oral contraceptives are used as a pre-treatment and negative developments such as cysts are prevented. This prepares the ground for the definitive start of the actual treatment.
The treatment is started on the 2nd or 3rd day of the expectant mother’s menstruation. If there are no conditions such as asynchronous egg development, cysts, etc. as a result of the examination, treatment is preferably started by performing hormone tests such as Estradiol-Lh-Progesterone. A treatment protocol is determined according to the age, weight and egg reserve of the expectant mother. The most preferred of these protocols is the antagonist protocol known as the short protocol. In this protocol, egg enlarging and multiplying hormone injections are started at the dose deemed appropriate. This treatment, which lasts approximately 9-15 days, is completed by performing ultrasound every 2-3 days and checking hormones according to the situation.
In this treatment, it is also possible to have examinations in your country. If you have one, you can be under the control of your own doctor or a doctor we recommend.
When the eggs reach a sufficient number and size (18-20 mm), the egg collection process is planned after 34-36 hours by giving a hatching needle.
The last needle of the treatment is the hcg needle, known as the hatching needle. The day and time of the injection is very important and affects the success of the treatment. The time difference between countries should also be taken into consideration when determining the time of the injection. In cases where more than 20 follicles develop in the ovaries and the E2 (estrogen) hormone is 3000 or more, a special ligation needle is used to prevent the development of the complication known as OHSS. OHSS (Ovarian Hyperstimulation Syndrome) is a very serious complication in which the ovaries overgrow and fluid outflows out of the veins. In this case, embryos are frozen and transfer is planned in the following months.
Usually the trip to Cyprus starts on the morning of the hatching needle, i.e. the day before the egg collection.
Treatment of Gender Reassignment in Cyprus
Day 0
Since it will be convenient for you to come to Cyprus 1 day before the egg collection process, your travel is planned with the organization carried out by our transportation team. At the end of your journey, which starts under the control of our team, you will be welcomed with our private vehicle when you land at Cyprus Ercan Airport. After your transfer to the hotel of your choice in Kyrenia or Nicosia, you can spend your day resting. During your journey in Cyprus, you will notice that the traffic is on the left lane and the steering wheel is on the right side. For this reason, crossing rules are also different and you need to be careful when crossing the road. Our team will call you or send you an information message to remind you about the points you need to pay attention to before the transaction. In particular, it is the most important issue that you should be hungry and thirsty 8 hours before your transaction time so that your transaction is not delayed or canceled. It is usually requested to fast after 00.00 (you should not eat or drink anything, just like fasting).
Day 1
You will be transported from the hotel to our clinic with our private vehicle at the time we tell you. Due to the importance we attach to information security, all transactions are carried out with great care and confidentiality. After the interview with our doctor, you will be examined according to the situation. After the preliminary preparation (insertion of an IV drip, wearing a gown, signing information and consent forms), your egg collection (OPU- oocyte pick up) takes place in 10-15 minutes under anesthesia. The sperm sample taken from the father-to-be and the eggs are combined with the microinjection (ICSI) method by our expert embryologists in our laboratory. Our specialist nurses will start you on additional medication for the remainder of your treatment. If your treatment includes an injection procedure, our nurses will arrange for it to be performed at your hotel.
day
The egg and sperm cells are combined in the laboratory by microinjection and it is checked whether they are fertilized or not, or if so, how many of them are fertilized. We call the cell formed from this combination an “embryo”. Your phone should be on during the day as you will be informed by our embryologists after the controls.
Day 3
Day 2 of your embryos. While you enjoy your vacation in the unique nature and beautiful sea of Cyprus, your embryos will be safely monitored by our expert embryologists.
Day 4
On the 3rd day, the quality and number of your embryos are evaluated. A biopsy is performed on the embryos deemed suitable using the PGD method. The cells are sent to the genetics laboratory and the results are awaited. Both chromosomal diseases and gender are screened for each embryo. The result is usually known the next day or at the latest on the day of transfer. In the meantime, all medications are continued.
Day 5
It is the 4th day of your embryos and you do not need to come to the clinic again. You will be informed by our nurses during the day about your transfer time and the things you need to pay attention to before the transfer.
Day 6
Transfer day To achieve high success and reduce the risk of multiple pregnancy or increase the chance of multiple pregnancy, embryo transfer is usually done on day 5. We call this blastocyst embryo transfer. On the day of transfer, your emotions such as excitement and anxiety may peak. Our team is always with you in this process. In order for the embryo transfer to take place more easily, you need to urinate and therefore you are asked to drink about 1 liter of water 1 hour before the transfer. After the pre-transfer preparations are completed, you will be informed about your embryos and the transfer of embryos of the desired gender will be completed. The embryo transfer process will take 10 minutes in total, and after 30 minutes of bed rest, you will be informed about your treatment and the issues to be considered after transfer.
If you have remaining embryos, freezing is applied after the information. In this way, if there is any negative situation, you will have the chance to try again at a lower cost.
Day 7
Now it’s time to return, hoping that your transaction went well. Our private car will pick you up from your hotel and transfer you to the airport in comfort.
The Process After Gender Reassignment Treatment
We hear so many times that 12 days is worth 12 years. We are as excited as you are and we sincerely hope that this process will be successful. If your pregnancy test is positive, we recommend that you make an ultrasound appointment 10 days later. Depending on the result, you may sometimes be asked to repeat the pregnancy test 2 days later. If your pregnancy test is negative, the medication will be discontinued and a repeat test may sometimes be requested.
Gender Selection with MicroSort Method
It is a method in which sperm cells carrying male (Y) and female (X) chromosomes are separated by a device developed by a US company and the sex is selected before combining with the egg.
It is known to provide a rate of 70% in the selection of a baby boy and 90% in the selection of a baby girl, but it is not a method that can make 100% gender separation.
For this reason, it is not preferred and its cost is quite high.
CVS (Chorionic Villus Biopsy)
It is a test performed between the 9th and 14th weeks of pregnancy and is also called placenta biopsy. It is performed to examine the baby’s chromosomes, gene structure and whether there are some genetic disorders (Down syndrome, Edward Patten Syndrome, Turner Syndrome, Klinefelter syndrome) and is also called chorionic villus sampling.
The accuracy of Chorionic Villus Sampling (CVS) test results is 99.5% and it is safely applied in twin and triplet pregnancies. However, it is not preferred and not recommended due to the fact that the probability of choosing the desired gender is around 70% and the termination of pregnancy in the opposite case may cause trauma for the mother.
Gender Selection with Sheetles Method
It is a method known as the “timing method” developed by a doctor named Landrum Sheetles. It is based on the speed and durability of sperm carrying X (girl) and Y (boy) chromosomes. Sperm cells carrying the Y (male) chromosome are thought to be less durable and die earlier than sperm cells carrying the X (female) chromosome. Based on this logic, it is recommended that the spouses should be together 2-4 days before ovulation for a girl and 1 day before or shortly after ovulation for a boy. This thesis is very common among the public and is not recommended as it is not medically proven.
