Is it possible to select the sex of the baby in surrogacy using PGTA testing?
You are about to embark on a unique journey to parenthood through surrogacy. You already know the process, you’ve done your research, and the excitement is immense… but a key question arises:
Is it possible to choose the baby’s sex?
In this article, we analyze the role of the PGTA test, its relationship with baby sex selection, what can actually be achieved, what limitations exist, and what implications it has for prospective parents.
We will answer this question clearly, without unnecessary technical jargon, based on scientific evidence and in language everyone can understand. By the end, you will have a comprehensive overview that will allow you to make informed decisions about your surrogacy process, free from pressure or commercial bias: this content is purely informational.
What is surrogacy?
It’s a question we usually explain in detail to prospective parents who are trying to conceive and contact us for guidance. We do this in our in-person meetings, in informational documents, in our books, and in the articles we publish every week.
Surrogacy is a process in which a woman — the surrogate — carries a baby in her womb for another person or couple, who will be the legal parents and raise the child. The surrogate agrees to carry the pregnancy and hand over the baby at the end of the gestation period, as established in the contract agreed upon by both parties.
In this context, the intended parents actively participate from the beginning: they are involved in the selection of the embryo, the planning of the transfer and the monitoring of the pregnancy.
Surrogacy is usually carried out through in vitro fertilization (IVF) , especially when the intended parents cannot carry the pregnancy for medical or personal reasons. In this process, embryos are created in the laboratory and, once evaluated, one is selected for transfer to the surrogate’s uterus.
And it is precisely at this stage, during the creation and analysis of the embryos, where the PGTA test can be applied , a genetic technique that also opens the possibility of knowing — and in some cases selecting — the sex of the baby before the transfer.
What is the PGTA test?
The PGTA test (Preimplantation Genetic Testing for Aneuploidy screening) is a genetic analysis technique applied to embryos created through in vitro fertilization (IVF). Its objective is to identify whether the embryos have the correct number of chromosomes and to rule out possible abnormalities (aneuploidies) that could cause implantation failure, miscarriages, or genetic alterations in the baby.
During the PGTA test, a small biopsy is taken from the embryo when it reaches the blastocyst stage (at 5 or 6 days of development). A few cells are extracted from the outer layer, called the trophectoderm, for genetic analysis in the laboratory.
The main purpose of this technique is to improve implantation success rates, reduce the risk of miscarriage, and promote healthy births. Although it does not guarantee pregnancy or the complete absence of genetic diseases, PGTA is considered a very useful tool for increasing the chances of success in assisted reproductive treatments.
In addition, by analyzing all chromosomes, the test also identifies the sex chromosomes (X and Y), which allows the chromosomal sex of the embryo to be known (XX for girl and XY for boy), provided that the prospective parents decide to receive this information.
In the context of surrogacy, the PGTA test is frequently used to ensure the genetic quality of embryos and, in some cases, to determine or plan the selection of the baby’s sex, although its primary purpose remains medical.
What is baby sex selection?
Sex selection is the process by which prospective parents can choose the sex of their child (boy or girl) before embryo transfer. This requires either knowing the chromosomal sex of the embryo beforehand or having several embryos available and deciding which one to implant.
In the context of surrogacy, this process is more complex, as several parties are involved: the intended parents, the surrogate mother, and, in some cases, egg or sperm donors. Furthermore, legal, ethical, and medical factors come into play, which can vary depending on the country or clinic where the treatment is performed.
For sex selection of the baby to be possible, certain conditions must be met:
- Having several embryos created through IVF.
- Having a genetic technique that allows the identification of chromosomal sex, such as the PGTA test.
- That the legislation and the clinic’s policy authorize this type of selection.
- That the intended parents and the surrogate mother agree to the procedure.
Ultimately, selecting the baby’s sex is neither an automatic nor a guaranteed process. It requires planning, technical feasibility, and compliance with current legal regulations, although it is an option that more and more families are considering as part of their surrogacy plan.
Can surrogacy use the PGTA test to achieve sex selection of the baby?
Now we come to the key point: is it possible to use the PGTA test to achieve sex selection of the baby within a surrogacy process?
The short answer is yes, technically, it can be done, but it is not always permitted and it does not guarantee results. Below, we explain exactly what that “yes, but” means.
What is technically possible
- The PGTA test allows you to determine the chromosomal sex of embryos created through IVF. Embryos with XX chromosomes correspond to girls, and those with XY chromosomes to boys.
- Although its main objective is to detect genetic abnormalities, the same analysis can reveal the sex of the embryo, so, in environments where the law allows it, it is possible to choose which embryo to transfer based on sex.
- Recent studies show that some parents use this option especially when they are looking to balance the family; for example, those who already have a child of a certain sex often opt for the opposite in the next pregnancy.
- In summary, in a surrogacy arrangement, if IVF is performed, an embryo biopsy is done and the PGTA test is applied, the sex of the embryo can be determined and that information used to decide which one to transfer.
What is not always allowed or guaranteed
- Legislation: In many countries, sex selection is only permitted for medical reasons (such as preventing sex-linked hereditary diseases), not for personal preference.
- Ethics and clinical policies: Organizations such as the American Society for The American Society for Reproductive Medicine (ASRM) recommends caution and transparency in sex selection policies. Some clinics choose not to offer it.
- Availability of embryos: The PGTA may reveal that there are no healthy embryos of the desired sex, or that they are scarce, which limits the possibility of choice.
- Internal policies: In certain countries or clinics, even if the sex is known, selecting or disclosing this information is not permitted. For example, in the United Kingdom, it is prohibited to use PGTA for sex selection purposes.
- Additional factors: In surrogacy, legal and contractual variables are added, since the surrogate mother is also involved and local regulations can directly influence what is permitted.
Why this matters in surrogacy
Choosing surrogacy involves a more complex process than conventional IVF. When considering sex selection through preimplantation genetic testing (PGT ), several aspects must be taken into account:
- Confirm that the clinic allows you to select the embryo according to its sex.
- Verify that the legislation of the country or state where the pregnancy takes place authorizes it.
- Ensure that there are enough viable embryos of the desired sex.
- It is important to understand that the main objective of surrogacy and assisted reproductive technology (ART) is to achieve a successful pregnancy and a healthy baby; sex selection is an optional complement, not a guarantee.
- Be aware that, even when all conditions are met, there may be inherent risks in IVF, and the final result will not always be as expected.
Step by step: what the process would be like in surrogacy with a focus on selecting the sex of the baby
Let’s say you’re considering surrogacy and, in addition to wanting a healthy baby, you’d like it to be of a specific sex. Below, we explain how the PGTA test and baby sex selection work together within this process, step by step, clearly:
Initial consultation and evaluation
First, you contact a surrogacy agency or clinic to confirm if the program allows for sex selection of the baby. Then, the intended parents undergo the necessary medical evaluations (eggs, sperm), and donors are selected if required. Next, the clinic explains the possibility of IVF with embryo biopsy and the preimplantation genetic test (PGT), detailing costs, risks, legality, and options. Finally, the terms of the contract are agreed upon with the surrogate, including whether or not she agrees to undergo embryo transfers based on sex.
Ovarian stimulation, egg retrieval, fertilization (IVF)
The woman providing the eggs — whether the intended mother or a donor — begins ovarian stimulation treatment, which involves administering hormonal medication to stimulate the development of multiple follicles in her ovaries. Once these follicles reach the appropriate size, the eggs are retrieved through a minor procedure under sedation. The retrieved eggs are then placed in the laboratory, where they are fertilized with selected sperm (from the intended partner or a donor) using techniques such as conventional insemination or intracytoplasmic sperm injection (ICSI). From there, the fertilized eggs…
Embryo biopsy and PGTA test
When embryos reach approximately 5 or 6 days of development, in the blastocyst stage, a small biopsy is performed: between 3 and 10 cells are extracted from the trophectoderm (the outer layer that will give rise to the placenta) for genetic analysis. These cells are sent to the laboratory, where they are examined to check the number of chromosomes in the embryo (detecting any aneuploidies) and, at the same time, it is possible to identify the chromosomal sex (XX versus XY).
Finally, the clinic provides a report indicating which embryos are euploid (correct chromosome complement) and what its chromosomal sex is. For example: “Embryo A: euploid , XY; Embryo B: euploid , XX; Embryo C: aneuploid , XX”, etc.
Embryo selection for transfer based on sex
If more than one sex is available within the group of euploid embryos, and if both clinical practice and regulations permit it, then the embryo of the desired sex can be transferred. However, it is essential to prioritize embryo quality: a lower-quality embryo, even if it is of the desired sex, could have a lower implantation rate than a higher-quality embryo of a different sex. In fact, one study showed that 54.5% of patients chose the embryo based on quality compared to 45.5% who chose it based on sex.
Likewise, the surrogacy contract coordinates with the surrogate mother the optimal time for the transfer of the selected embryo, so that it aligns with her cycle, her health and the agreed protocol.
Embryo transfer to the surrogate
Once the appropriate embryo has been selected, it is transferred to the surrogate’s uterus. The embryo is carefully inserted using a catheter under ultrasound guidance, in a brief and minimally invasive procedure.
Surrogacy process: the surrogate mother receives specialized medical supervision, obstetric follow-up, journalistic analysis, ultrasounds, and emotional support to ensure the best development of the pregnancy.
Birth of the baby
The pregnancy is achieved, the gestation is completed, and the baby is born. If all goes well, the intended parents check that the baby is healthy, and the handover takes place according to the surrogacy agreement.
Advantages and benefits of using the PGTA test in surrogacy (and for selecting the sex of the baby)
General Benefits of the PGTA
- It improves the probability of successful implantation by transferring a euploid embryo.
- It reduces the risk of miscarriage by discarding embryos with chromosomal abnormalities.
- It allows the prospective parent to have more information about the available embryos.
- In the context of surrogacy, it provides greater security: by having embryos analyzed, the surrogate and the intended parents can have greater peace of mind.
Specific benefit in the selection of the baby’s sex
- If legally permitted, it allows for having information about the chromosomal sex of the embryo before transfer, giving the option to select the sex of the baby, a highly desired issue for some couples/families.
- It can contribute to “family balance” when you already have children of one sex and want another. Studies show that many patients use it for this purpose.
- In surrogacy, this desire to select the sex of the baby can coincide with the family planning of the intended parents.
In summary: combining surrogacy + PGTA + baby sex selection can offer a personalized route to the baby they want, in terms of chromosomal health and, in some cases, sex.
Advice for those considering this option
If you are in the exploration phase (as this blog is for level 1), and you are analyzing the surrogacy + PGTA + baby sex selection route, here are some practical tips to keep in mind:
- Ask the agency or clinic clearly: Do you allow sex selection of the baby in your surrogacy program? Under what conditions? What is your policy regarding prenatal therapy and embryo sex selection?
- Check local legislation: depending on the country of the surrogate or the country in which the contract is signed, there may be regulations that allow or do not allow the selection of the baby’s sex.
- Review the contract: Make sure the surrogacy contract specifies what happens if pregnancy is not achieved or if there are no embryos of the desired sex. Have a plan B.
- Find out about additional costs: PGTA, embryo biopsy, analysis, embryo freezing, storage, all of this can increase the cost.
- Question about embryo quality: In many studies, embryo quality is as important as, or even more important than, sex. An excellent quality embryo of the undesired sex can yield better results than a mediocre embryo of the desired sex.
- Keep an open mind: even if you want a specific sex, the embryo profile may not offer the desired option. Be realistic and work with your team to prepare for different scenarios.
- Talk to a genetic counselor or reproductive doctor: they can clearly explain the PGTA test, its advantages, limitations, costs, risks and expectations.
- Consider the emotional and ethical aspects: talk to your partner or companion about what choosing the baby’s sex means to you, what your motivations are, and make sure you are comfortable with the possible outcomes.
- Verify the surrogate and her support: surrogacy involves a woman carrying the pregnancy. It is crucial that she is well-selected, informed, and advised, has a good physical and psychological profile, and has adequate medical and legal support.
Quick summary
To put it simply:
- Surrogacy involves a pregnant woman carrying a pregnancy for another person or people.
- The PGTA test is a genetic analysis of embryos that allows you to know if they have chromosomal abnormalities and can also reveal the chromosomal sex (XX or XY).
- Baby sex selection is the possibility of choosing whether the baby will be a boy or a girl through the transfer of an embryo of the desired sex.
- Yes, in many cases surrogacy can be combined with PTSD to try to select the sex of the baby, but only if the clinic allows it, the legislation accepts it, there are embryos of the desired sex and it is understood that it is not an absolute guarantee.
- It is essential to assess costs, risks, ethics, embryo quality, and have a plan B.
- On your journey as prospective intended parents, this knowledge prepares you to ask the right questions when initiating conversations with the agency, clinic, or surrogate.
FAQs (Frequently Asked Questions)
Does the PGTA test guarantee that we can choose the baby’s sex?
No. The PGTA test reveals the chromosomal sex of embryos, but it doesn’t guarantee that there will be embryos of the desired sex, nor does it guarantee pregnancy. It’s a tool, not a guarantee.
When can the sex be determined using PGTA?
After the embryo biopsy (usually day 5-6 of development) and genetic analysis, the clinic can report the chromosomal sex of the embryo (XX/XY) if policy allows.
Do all countries allow sex selection in surrogacy?
No. It depends on the legislation of each country or region. In many places, sex selection is only permitted for medical reasons (sex-linked diseases) and not based on preference.
Does surrogacy complicate the selection of the baby’s sex?
It can. Because it adds factors such as the surrogate’s contract, jurisdiction, embryo availability, and clinic policy, making it necessary to review all aspects in detail beforehand.
Does embryo quality matter more than sex?
Yes. Studies show that many patients prioritize embryo quality (and viability) over sex, as the main goal is a successful pregnancy and a healthy baby.
How much does it cost to add preimplantation genetic testing (PGT) and sex selection to the surrogacy process?
It depends on the country, the clinic, the number of embryos, genetic testing, and other factors. Some reports indicate that PGT can cost several thousand dollars extra.
Are there risks involved in using the embryo biopsy technique?
Yes, although the risks are low. There may be damage to the embryo, implantation failure, or diagnoses that do not correspond to the transferred embryo (a very rare error). The technique should be performed by experienced teams.
Can we choose twins of opposite sexes using this technique?
In theory, it could be possible if several embryos of different sexes are available and more than one is transferred, but most clinics recommend transferring only one embryo to reduce risks. Furthermore, selecting twins of opposite sexes adds ethical and medical complexity.
What happens if there are no embryos of the desired sex?
Then you will have to decide whether:
● Transfer an embryo of the opposite sex,
● Freeze the embryos and wait,
● Repeat a stimulation cycle to obtain more embryos,
● or Waive sex selection. It’s important to have a backup plan in your surrogacy agreement.
What questions should I ask the clinic/agency before signing everything?
Some key questions:
● Do you allow sex selection of the baby in your surrogacy program?
● What is your specific policy regarding PGTA, embryo sex, and sex-based transfer?
● In your experience, how many embryos are usually obtained and how many euploid embryos are typically achieved?
● What happens if there are no embryos of the desired sex or if the selected embryo does not lead to pregnancy?
● What is the exact additional cost of PGTA and baby gender selection in your package?
● What is their success rate, legal support, and contract with the surrogate?