CAIRO: Is the issue of sex selection that has recently captured public attention simply a media flash in the pan, or does it warrant serious debate because the science meant to determine sex in the conception stage is likely to disturb social balance in years to come?According to Egyptian myth, the female-carrying sperm is stored in the left testicle, while male sperm is in the right one and so men would tie up either one during intercourse depending on whether they wanted to beget a boy or a girl. The plethora of research on the subject includes suggestions that a woman's diet plays a role in determining the baby's sex: items containing high rates of sodium and potassium induce the egg to attract male-reproducing sperm as opposed to magnesium and calcium which attract female-reproducing sperm. But in Egypt the controversy is first and foremost a religious one.Some believe that an Al-Azhar fatwa approving the practice under certain restrictions should be reconsidered. Medical specialists, religious scholars and parents contested the fatwa on the grounds that gender selection challenges the will of the Almighty who, according to Quran "blesses whoever wants with girls and whoever he wants with boys. In a country where male is the gender of preference, critics underline that, besides being in outright violation of the will of God, the scientific progress in this field will be skewed towards the selection of boys that will eventually lead to a lopsided male to female ratio that create fertile ground for evils like homosexuality. The newest techniqueOn the medical front, the high success rate of the Pre-implantation Genetic Diagnosis (PGD), the most advanced technique in the field which is based on identifying the sex of a tube baby before it is implanted in the womb, has created ripples upon its introduction in Egypt three years ago.Originally meant to identify and avoid genetic disorders through the testing of the embryo's cells, PGD has with time come to serve a different purpose when the diagnosis revealed, besides congenital deficiencies, the sex of the embryo.Couples therefore began to undergo PGD tests to fulfill their desire of having a boy or a girl. But specialists warn that the success in identifying the sex of embryo through this technique does not necessarily mean that the couple will end up having the desired gender."Correct sex-identification that involves lengthy, complex and costly procedures is only one step in a long process that starts with in-vitro fertilization ( IVF), also known as test tube babies, and ends with a hazy pregnancy, the success rate of which ranges between 15 and 20 percent, Dr Osama Shaeer, andrologist at Cairo University's Faculty of Medicine, told Daily News Egypt. "We attend to 15 cases every year, four of which achieve pregnancy. There is no guarantee, however, that even those four pregnancies would be eventually crowned with a newborn. Shaeer explained that with PGD, the woman has to take special medication to activate ovation. "The wife then produces several eggs each of which is injected with sperm. This process, he continued, results in a number of random male and female embryos, each an eight-cell entity takes shape following five days of incubation. One cell from each embryo is extracted and subjected to a genetic examination that determines gender. The right embryo is then injected into the uterus.But the andrologist stressed that all the acquired embryos could be of the undesired gender and the entire process has to be repeated. The extraction of the cell is difficult and it often weakens the embryo, which is why there is a high possibility of miscarriage once the embryo is implanted in the womb. Baseless media propaganda?Despite a general lack of knowledge about the medical intricacies of sex selection, most people reject the practice outright. Egyptian weekly Akhbar El Hawadith, a widely-circulated crime tabloid, recently highlighted the issue with a cover story sounding the alarm that sex selection will threaten social balance in the decades to come.The story criticizes Al-Azhar's approval of what the tabloid believes is a return to the condemned pre-Islamic practice in the Arabian Peninsula of burying girls alive for fear that they would bring shame to their families or become prostitutes if the family falls prey to poverty and destitution.While failing to fully indicate that gender selection was approved by Al-Azhar under almost prohibitive conditions, the tabloid also undermines the cost factor and raises doubts about the health of the resulting newborns without identifying the specialists who were quoted as saying that such babies regularly exhibit certain abnormalities. The gender-biased models of both India and China, where the technology is believed to have resulted in a ratio of 100 girls to 113 boys in India and 100 girls to 120 boys in China, do not bode well for a country like Egypt where boys are preferred for many reasons.What critics fail to realize, however, is that the respective ratios in both sizeable countries are the result of legal abortion rather than sex selection, where female fetuses were aborted to increase the number of males that are considered a better asset in bringing about progress. Implications of sex ratios in EgyptIn Egypt abortion is illegal which means that a sex selection technique can never endanger gender balance. "However perfect the technology, cost will always be prohibitive, said Dr Osama Azzmi, head of the Reproductive Health Research Department at the National Research Center in Cairo ( NRC). In-vitro fertilization, he explained, costs between LE 10, 000 and LE 15, 000. Add to that LE 1, 000 for each process meant to identify the sex of each of the several embryos created through PGD to select the desired sex.A couple would easily spend no less than LE 20, 000 for procedures that could be repeated in case of miscarriage or failure to obtain the required gender despite the presence of several embryos."Half the population of Egypt's almost 80 million is made up of married couples, continued Azzmi. "Some 20 million of those are women, 10 percent [two million of the total reproducing females] of whom could have problems. "With many living under the poverty line, only two percent of those women will be able to afford the costly and hardly guaranteed sex selection process. "How can such a poor success rate, which is no more than 1 in a 1,000, influence gender balance? Talking about imbalance is sheer media propaganda. One can't speak of any gender imbalance in the US and Europe that have used sex selection since the 1980s. From the West to EgyptAccording to a survey produced in 2004 by the Genetics and In-Vitro Fertilization Institute in Fairfax, Virginia, of the more than 3,000 sperm-sorting cycles requested by patients, 77 percent have been seeking to give birth to a girl. Most parents want to use related technologies to achieve family balancing, that is, to have a child of the opposite sex to the first one, or to balance out families that have all girls or all boys. Al-Azhar's conditions on the use of PGD include the need for a male in a family consisting of several girls as well as genetic cleansing in cases involving certain consanguine diseases in male or female lines.But Dr Adel Ashour, a pediatrician at the NRC in charge of awareness programs related to genetic diseases, told Daily News Egypt that PGD can never be a useful tool in the battle against consanguinity because congenital defects more often appear equally in boys and girls. Specialists are skeptical of whether doctors would abide by Al-Azhar's restrictions, especially when there is little chance of monitoring such cases. Shaeer, however, dispels these fears. "We carefully examine each case before we accept it, he says. "Once we are sure it's free of prejudice against a certain sex, we proceed to point out the difficulties and the low success rates. He continued: "The majority of couples are discouraged but we prefer to refer those who are ready for the procedures to the Mufti for approval. The approval isn't obligatory in other clinics but we make it essential for our work so that the patients would press ahead with a clear conscience. Is the fetus alive?The debate over whether sex selection constitutes the killing of a living soul has been ruled out because, according to doctors and religious scholars, an embryo becomes alive with a soul 120 days after its inception. However, whether the selection of a desired fetus is a sacrilegious act committed against the will of God is still a point of contention. Sheikh Youssef Al-Qaradawi, a respected Egyptian Azhar scholar based in Qatar, once said that a fatwa on this issue should have been avoided since it would distract people from more important issues and open the gates of hell. "Who knows? Scientists could be confronted with obstacles that would make it difficult for them to press ahead with experimentation, wrote Al-Qaradawi. "In spite of sex selection technology, knowledge of the contents of the womb isn't restricted to the fetus's sex. .Only God knows whether it will live or die, be strong or weak, smart or stupid, happy or miserable. It isn't all about gender. Echoing Al-Qaradawi's words Azzmi said: "It's true that we fertilize the egg but it's the will of God that develops it into male or female. We implant it in the womb but it's also the will of God whether or not it survives. Throughout history, couples have always consumed certain substances to induce male or female children, why wasn't that seen as an intervention against the will of God?
