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Can Preimplantation Genetic Testing Be Used for Sex Selection?

Dr. Senai Aksoy · · Updated · 9 min read
Medically reviewed on 30 October 2026 - Dr. Senai Aksoy
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Key Takeaways

Some types of preimplantation genetic testing (PGT) can show an embryo's chromosomal sex. Using that to avoid a serious sex-linked disease is a medical decision. Choosing a boy or a girl for personal preference is different. It is ethically controversial and laws differ between countries. Turkish rules do not allow it, so our clinic does not offer it.

Key evidence: ACOG Committee Opinion No. 799 on Preimplantation Genetic Testing (2020) ASRM Ethics Committee Opinion on Non-Medical Sex Selection (2022) Turkish Assisted Reproduction Regulation, Annex 17

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How PGT Examines Embryo Genetics and Sex

Preimplantation genetic testing (PGT) looks at a few cells taken from an embryo created by in vitro fertilisation (IVF). Some types of PGT read the sex chromosomes, X and Y, so the laboratory may be able to tell an embryo’s chromosomal sex. Technical possibility is not, by itself, a medical reason to choose an embryo.

There are three main types of PGT (ACOG Committee Opinion No. 799, 2020):

The sample is usually a few cells from the outer layer (trophectoderm) of a blastocyst, an embryo about five or six days old. The result describes those cells, not every cell of the embryo. Whether the report shows the embryo’s sex depends on the test, the medical reason for testing, local law and the laboratory’s policy.

Dr. Senai Aksoy’s Approach

When this question comes up, I first separate two very different aims: reducing the risk of a serious inherited condition and choosing a sex for personal preference. The first may justify a carefully designed PGT-M pathway after genetic counselling. The second is not a medical indication and is not offered by our clinic. In Turkey, treatment must remain within the applicable legal and regulatory framework.

When Sex Selection Is Medically Indicated

Embryo sex can matter medically when a family has a documented risk of a serious sex-linked condition. Even then, the usual first choice is PGT-M designed around the family’s confirmed variant, not selection by sex alone.

Some inherited conditions are linked to the X chromosome. They differ in how they are passed on and how severe they are. In some of them, males, who have one X chromosome, are more likely to be affected. Females may be carriers, mildly affected or sometimes significantly affected. Examples include:

When the family’s variant is known, the genetics team checks whether a targeted PGT-M test can be developed. In a few cases a reliable disease-specific test is not possible, and sex may then become part of the risk assessment. Sex still cannot show whether each embryo is affected.

PGT does not replace tests during pregnancy. All patients should be offered prenatal screening and diagnostic testing options, even after PGT. Screening estimates a risk; diagnostic testing checks for a condition. Being offered these options does not mean that every patient must have an invasive test (ACOG Committee Opinion No. 799).

Non-Medical Sex Selection and Ethical Concerns

Non-medical sex selection means choosing an embryo only because it is male or female, without a medical reason to choose one sex over the other. It is often called “family balancing” when parents who have children of one sex want a child of the other.

The American Society for Reproductive Medicine (ASRM) describes the practice as ethically controversial. Its 2022 ethics opinion says it should not be encouraged for non-medical reasons. Clinicians are not ethically obliged to offer it or to refuse it. Clinics should make their policies available (ASRM Ethics Committee Opinion, 2022).

Supporters point to parents’ reproductive freedom. The concerns the opinion discusses include:

  1. Gender bias: choosing a sex for non-medical reasons can reflect or reinforce discrimination and unfair social expectations.
  2. Medical risk without medical need: a woman who could conceive without IVF still faces its risks. PGT adds embryo biopsy, laboratory analysis and usually embryo freezing (see IVF treatment risks and considerations).
  3. Use of medical resources: IVF and PGT use medical resources even when there is no medical need. Access may be limited to those who can pay.

Laws on sex selection differ from country to country:

At our clinic in Istanbul, PGT needs a documented medical or genetic reason. The right test depends on the family’s history, the genetic finding and what the laboratory method can show.

Clinical Perspective: Prioritising Embryo Health Over Sex Selection

Embryo sex is not a marker of embryo quality. Whether an embryo implants and leads to the birth of a baby depends on many factors, and no PGT result can promise either.

When planning a transfer, the clinical team looks at:

Limiting transfer to one sex can leave fewer embryos to choose from. The embryos that remain are not more likely to implant because of their sex.

Frequently Asked Questions for Dr. Aksoy

Can PGT show whether the baby will be a boy or a girl?

Yes. Depending on the type of genetic test used during PGT, it is possible to learn about the embryo’s sex chromosomes. For example, when PGT-A examines the embryo’s chromosomes, it can also identify an XX or XY pattern. But this information does not have to be reported to the patient with every test.

There is an important distinction here. The purpose of PGT is to look for specific genetic problems in embryos. In Turkey, performing PGT and selecting a sex simply to have a girl or a boy is prohibited. However, some sex-linked genetic diseases can create a medical need.

I explain PGT to my patients not as a method for choosing a baby’s sex, but as a test that allows embryos to be assessed genetically in appropriate medical situations.

Can we choose the baby’s sex with IVF in Turkey?

No. In Turkey, selecting embryos simply to have a girl or a boy is not permitted. Genetic testing during IVF can identify an embryo’s sex, but being technically possible does not mean the sex can be chosen by personal preference.

Medical necessity, such as preventing a serious sex-linked inherited disease from passing to the child, can be an exception. In that case the situation has to be assessed with genetic counselling and within the relevant regulations.

Does an embryo grade such as 4AA or 3BB show whether the embryo is a boy or a girl?

No, it does not. Patients sometimes think that a very good-quality embryo such as 4AA might be a boy and an embryo such as 3BB a girl. But these codes have no direct link with sex.

The number in an embryo grade shows the blastocyst’s stage of development and expansion. The letters rate how two parts look under the microscope: the inner cell mass, which will form the baby, and the outer cell layer, which will contribute to the placenta.

Some studies have reported small differences between male and female embryos in their average speed of development or in their morphological features (Alfarawati et al., 2011, observational study). But these differences do not allow us to predict the sex of a single embryo.

In short, we cannot tell whether an embryo is a girl or a boy by looking at a 4AA or 3BB grade. These grades give information about the embryo’s development and its potential for transfer; they do not show its sex.

Can timing intercourse, the Shettles method or diet influence the baby’s sex?

Many suggestions about this have circulated for years. The Shettles method, for example, claims that intercourse close to ovulation makes a boy more likely, while intercourse a few days earlier makes a girl more likely.

Scientific research does not confirm this. Intercourse close to ovulation can increase the chance of pregnancy, but it does not reliably change the baby’s sex (Wilcox et al., 1995).

Similarly, we have no strong evidence that eating particular foods, changing salt or mineral intake, or trying to change the acidity of the vagina allows the baby’s sex to be chosen (ASRM guidance on diet and natural fertility). Practices such as vaginal douching in particular can do more harm than good (Office on Women’s Health: douching).

When I advise patients to track ovulation, the reason is to improve the chance of pregnancy, not to choose a boy or a girl. We cannot say that natural methods reliably determine a baby’s sex.

FAQ: more questions about PGT and embryo sex

Is “family balancing” considered a medical indication?

No. Family balancing means wanting a child of one sex after having children of the other. It is a non-medical request, and Turkish rules do not allow sex selection for this reason.

Does choosing embryo sex improve IVF success rates?

No. An embryo’s sex is not a way to improve the chance of success. The outlook depends on the whole clinical picture, and even an embryo reported as euploid after PGT-A cannot guarantee implantation or a live birth.

Sources

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Dr. Senai Aksoy

Dr. Senai Aksoy studied and trained in France before returning to Turkey, where he was a member of the ICSI team at Sevgi Hospital, Ankara — the country's first ICSI centre (1994-95) — and a co-author on the first Turkish ICSI publications produced in collaboration with the Brussels Van Steirteghem group (Human Reproduction, 1996; PMID 8671323). He helped build the IVF programme at the American Hospital Istanbul and has been running his own fertility practice since 1998.

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Please note that certain services, such as sperm donation, egg donation, surrogacy and gender selection (without medical necessity), are not permitted under Turkish law.

We would like to inform you that our clinic strictly adheres to these regulations and does not offer any of these services.

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