IS it going to be a boy or a girl? This is a common question on the minds of couples who are expecting a baby.

It is natural for couples to think of their baby’s gender whenever they want to start a family or have more children. Some would wish for a son after having several daughters in succession and vice versa.

However, the preference for males in some cultures, coupled with advancements in medical technologies, has led couples to resort to “selecting” the gender of their future child.

According to a Reuters report (July 16, 2014), hundreds of women from mainland China, Hong Kong and Australia flock to Bangkok, Thailand, each year for In-Vitro Fertilisation (IVF) with the option of choosing the child’s gender by discarding fertilised eggs, or embryos, of the unwanted sex.

Thailand is the last place in Asia where gender selection treatment is available and breaks no law.

The only other countries where this technique is permitted and available are the United States and South Africa — in both cases at a higher financial cost.

(IVF is a procedure of removing the eggs from a woman’s body to be fertilised with her partner’s sperm in a laboratory before it is re-transferred to her womb.)

The procedure is made possible by a technique to screen for possible genetic defects in embryos, called pre-implantation genetic diagnosis (PGD).

However, the process can also reveal the embryo’s sex, leading to potential abuse.

Fertilised eggs of the desired gender are selected while those of the unwanted sex are rejected.

In Malaysia, the cost for an IVF at a private hospital or clinic range from RM10,000 to RM18,000, depending on the type of procedure undertaken and also the amount and type of medication used.

Those who opt for PGD will often have to pay double, as the cost of PGD alone is equivalent to a whole IVF procedure.

In Malaysia, Malaysian Medical Council (MMC) guidelines released in 2006 specifically prohibit PGD “to create ‘designer babies’ (those with specific physical, social or specific gender characteristics and not for the reason of avoiding serious medical illnesses)”. (http://www.mmc.gov.my/v1/docs/Assisted%20Reproduction.pdf).

Dr Natasha Nor, of KL Fertility Centre in Damansara, says that there have been requests for the PGD procedure from her patients — ranging from as young as 23 to as old as 47.

“But the majority are for sex selection for non-medical basis.

“Currently our clinic does not offer the procedure as the main demand in this country is for sex selection for social reasons and this is against the MMC guidelines,” says Dr Natasha.

The issue has given rise to legal and ethical concerns.

Some 400,000 foreigners are healthcare tourists in Malaysia, generating a revenue of US$101.65 million (RM322 million) in 2010, according toThe International Medical Travel Journal.

The Department of Statistics revealed that the fertility rate among Malaysians declined by half from 4.8 in 1970 to 2.3 in 2007 — giving rise to the possibility that more may seek the IVF procedure.

This dilemma is faced by Zaharah (not her real name), who has been married for seven years and is trying hard to conceive.

She has tried traditional methods and also IUI (intrauterine insemination which is fertilisation by direct insertion into the womb to maximise the chances of pregnancy) but has not had any good news so far.

“IVF is too expensive for me. If money is not an issue, I would have done it.” says Zaharah.

“I do think that it is morally wrong to throw away a potential life. But I don’t see any reason for denying couples a chance to select the sex of their baby if they have the means to do so.

“Fate is cruel for those who are infertile, and more so when the years pass by.

“If people like us have one shot at trying and may never get another (baby), shouldn’t we be allowed to choose?” she says.

Three acts governing medical practice — The Medical Act (1971), The Human Tissues Act (1974) and the Private Healthcare Facilities & Services Act (2006) — do not specifically address the potential misuse of PGD.

Dr Natasha believes that the possible evolution of PGD may make it necessary for more defined rules regarding such issues.

“With the advancement in technology, PGD may actually be a routine part of IVF treatment in the future.

“However, there are important and potentially technical, ethical and medico-legal issues with serious implications that need to be addressed prior to implementing PGD in Malaysia,” she says.

A senior medical officer at a renowned government hospital in the Klang Valley says that IVF had been offered at selected government hospitals since 2006.

“PGD is not offered at government hospitals. It is available in private hospitals and medical centres, but I heard that they tend to bend the rules a little,” says the officer.

“That is why an act governing PGD is being devised.

“Legal advisers are studying all aspects of the issue now.”

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