Global sex selection techniques for family planning: a narrative review.

OBJECTIVE: To document the varying methods of sex selection, both primitive (traditional) as well as advanced forms available around the world.

CONTEXT: With the increasing desire of couples to choose the gender of their offspring, scientific sex-selection methods and techniques have evolved over time; unfortunately, the medical and social consequences have remained poorly emphasised.

METHODS: We searched electronic search engines and grey literature that included research articles from journals, books, websites and news articles in English until August 2016. We comprehensively compiled the findings such as underlying principles, time of use in relation to conception and others.

RESULTS: We classified the techniques into natural methods that rely on physiological conditions and artificial methods, including manipulation of seminal fluid for sex selection. Natural methods include Shettles technique, Whelan Method, Billings Ovulation Method, pre-conception diet, and gender selection kits such as GenSelect and Smart Stork, which rely on timing of intercourse, the vaginal environment, a selective diet and nutraceuticals. More advanced and artificial methods include sperm sorting or Ericsson's method, Microsort, Preimplantation Genetic Diagnosis and Urobiologics PreGender test. The markets for these techniques are prevalent in India where the birth of a son is desired. There is also widespread use of indigenous medicines for sex selection. The review reports side effects such as vaginal infections, hyperstimulation syndrome, multiple pregnancies, birth defects and stillbirths.

CONCLUSION: We conclude that sex-selection practices need urgent intervention in view of the social harm, unwarranted gender bias, and diversion of resources from genuine medical need.