In later years, sex selection has become of importance for prevention of X-linked diseases in families at risk. There is today a potential to perform sperm selection before fertilization by taking advantage of the chromosomal heterogamy of spermatozoa, and before implantation by preimplantation genetic diagnosis (PGD). The methods of sex determination by separating spermatozoa are, in our opinion, still not safe enough for routine clinical use. Apart from the technical problems and possible associated risks, which first must be better evaluated, the most critical questions are ethical or legal. We support the use of sex selection by PGD in X-linked severe disease, but due to the potential risks of misuse, we are not prepared to support a more liberal attitude as long as the discriminated sex in nearly all parts of the world are women.
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