In today’s reproductive medicine landscape, in vitro fertilization has opened many doors for individuals and families facing infertility. Among the most commonly asked questions is: can you choose gender with IVF? For gestational surrogates, understanding this process is essential, especially when carrying an embryo that has undergone preimplantation genetic testing and genetic screening. This guide is designed to walk surrogates through the gender selection process, what it means for their experience, and how IVF treatment supports informed, ethical, and successful journeys.
What Is Gender Selection?
Gender selection, also known as sex selection, is the process of identifying and choosing the sex of an embryo before it is transferred into the uterus. Through advanced genetic testing, specifically preimplantation genetic diagnosis and PGT-A (preimplantation genetic testing for aneuploidy), fertility specialists can identify the presence of two X chromosomes (female embryo) or an X and a Y chromosome (male embryo) in embryos created through IVF.
This allows clinics and patients to select embryos of a desired sex prior to transfer. While this is often done for medical purposes, such as preventing sex-linked disorders like hemophilia or Duchenne muscular dystrophy that affect the reproductive organs differently based on sex, it is also pursued for family balancing or personal preference in some cases.
The Gender Selection Process in IVF
During IVF treatment, mature eggs are retrieved from the ovaries and fertilized with sperm in a laboratory. The resulting embryos are cultured to the blastocyst stage, typically five to six days after fertilization. At this stage, an embryo biopsy is performed to remove a few cells from the outer layer (trophectoderm), which does not affect the part of the embryo that forms the fetus. This biopsy is then analyzed through preimplantation genetic testing to detect genetic abnormalities, chromosomal abnormalities, and the embryo’s sex.
This process ensures that only healthy embryos of the chosen sex, free of genetic diseases, are selected for transfer. The gender selection process allows clinics to identify embryos with either an X chromosome pair (female embryo) or one X and one Y chromosome (male embryos), enabling selection of embryos of one sex as desired.
Once testing is complete, the embryos are frozen. The embryo transfer into the surrogate’s uterus is scheduled as a frozen embryo transfer, using embryos that meet the health and gender criteria.
What Surrogates Should Know
As a surrogate, you will not be involved in the IVF or genetic testing stages. By the time you begin preparing for embryo transfer and potential pregnancy, the embryos have already undergone testing. However, the choice to transfer an embryo of a certain sex may affect your experience in the following ways:
You May Be Told the Embryo’s Sex
In many surrogacy arrangements, the surrogate is informed of the baby’s gender prior to transfer. This allows for transparency and informed consent. You have the right to ask whether the embryo was selected for sex, why that decision was made, and whether it was due to a medical condition or for nonmedical reasons.
Your Transfer Timeline May Be Influenced
Although most gender selection occurs before the surrogate is matched, the number of healthy embryos of the desired sex may be limited. If there are unused embryos or extra embryos that do not meet the gender preference, intended parents may delay the transfer or request a new IVF cycle to create embryos of the opposite sex.
Ethical Support Is Available
Surrogacy agencies and clinics provide counseling to surrogates who have concerns about gender selection. Whether you are carrying a child selected for medical reasons or family balancing, your emotional and ethical comfort are paramount.
Why Families Pursue Gender Selection
There are several reasons families may choose to pursue gender selection:
- Medical Need: To avoid sex-linked genetic disorders
- Family Balancing: Families with multiple children of one gender may wish to have a child of the opposite sex
- Personal Preference: Some families, including same-sex couples, may choose embryos of a specific sex based on emotional or cultural values
- Future Planning: To ensure diversity in the family or manage expectations for future children
While these motivations may differ, the scientific process behind gender selection remains the same: analyzing embryos through preimplantation genetic testing and selecting those that are both chromosomally normal and of the preferred sex.
Ethical Concerns and Guidelines
The ability to select a baby’s sex raises ongoing ethical concerns, particularly when done for non-medical reasons. Organizations like the American Society for Reproductive Medicine advise caution and encourage ethical review through an ethics committee, especially when there is no medical necessity.
As a surrogate, understanding these ethical implications helps ensure that you feel aligned with the embryo you are carrying. Agencies like Made in the USA Surrogacy support open conversations and only partner with clinics that prioritize ethical practices and full surrogate consent.
The Role of Preimplantation Genetic Testing (PGT-A)
PGT-A is the most common tool used in sex selection. It screens embryos for chromosomal abnormalities, including aneuploidy, and confirms the embryo’s sex. This process helps improve success rates, reduce infertility, and lower miscarriage risk.
When combined with PGT-M, which screens for single-gene disorders and genetic diseases, the process becomes a powerful safeguard for creating healthy babies. Fertility clinics often use both tests to identify embryos that are chromosomally healthy, free of known genetic disorders, and of the desired gender.
Embryo Freezing and Future Use
Many families undergoing gender selection choose to freeze embryos not selected for the current cycle. These unused embryos may be saved for future use. This means that the embryo you carry may have been part of a previous cycle, chosen because it matched both health and gender criteria.
Freezing and storing embryos offers families flexibility in planning their future children, and it ensures that healthy embryos are not discarded due to their baby’s sex.
What Questions Should Surrogates Ask?
Before accepting a match involving gender selection, surrogates are encouraged to ask questions such as:
- Was the embryo’s sex selected? If so, why?
- Was gender chosen for medical or non-medical reasons?
- Has this embryo been screened for genetic abnormalities and chromosomal health?
- What support is available if I have ethical concerns about gender selection?
These questions promote transparency and allow surrogates to make informed decisions about their role in a family’s journey.
Global Context and IVF Trends in 2025
As of 2025, the possibility of selecting a baby’s gender through IVF continues to grow. International interest in gender selection has led to increases in fertility tourism, where families travel to the U.S. to access reproductive services not available in their home countries. In places like Canada, the UK, and Australia, gender selection is banned or heavily restricted for nonmedical reasons.
In the U.S., where IVF and reproductive medicine are more flexible, fertility clinics accommodate patients from around the world. This means that U.S. surrogates may be matched with international families pursuing sex selection for their child.
Advances in Non-Invasive Testing
One exciting development is the rise of non-invasive preimplantation testing, which involves sampling the culture fluid around the embryo rather than performing an invasive biopsy. This method, while still in research, could reduce the risk associated with traditional embryo biopsy and make the gender selection process even safer.
The Surrogate’s Emotional Experience
Being a surrogate involves not just physical commitment but emotional investment. Carrying a child whose sex was selected can carry personal meaning, especially when it relates to family balancing or avoiding serious genetic disorders. Surrogates are encouraged to explore their feelings, ask questions, and lean on support systems provided by the agency and clinic.
You deserve to feel completely informed about every aspect of the embryo you’re carrying, including its gender, genetic background, and health. Your voice and comfort matter.
Frequently Asked Gender Selection for Surrogates Questions
Can you choose gender with IVF?
Yes, gender can be selected during IVF treatment through preimplantation genetic testing, specifically PGT-A. This test identifies the embryo’s sex chromosomes before embryo transfer, allowing for selection based on medical need or personal preference.
Is gender selection legal in the United States?
Yes, gender selection is legal in the U.S., but its use is guided by ethical standards. Some fertility clinics and reproductive medicine professionals recommend it only for medical reasons, such as preventing sex linked disorders. Other clinics allow it for family balancing or personal preference.
Does gender selection affect my role as a surrogate?
Not physically. The gender selection process happens before you begin medical preparation. However, you may be informed about the embryo’s sex, and you have the right to ask questions or decline a transfer if it does not align with your values.
Why would someone want to choose a baby’s gender?
Families may pursue gender selection to prevent genetic diseases, balance their family, or for personal reasons. In cases involving same sex couples, gender preference may be based on emotional significance or family structure.
How accurate is the gender selection process?
Preimplantation genetic testing is highly accurate, with more than 99 percent certainty in identifying a baby’s sex. The process also ensures that embryos are screened for chromosomal abnormalities and other genetic disorders.
What happens to the unused embryos?
Unused embryos, including those of the opposite sex or those not selected for health reasons, are typically frozen for future use. Families may choose to transfer them later or store them depending on their plans for future children.
Will I know if I am carrying a male or female embryo?
Yes, in most cases. Surrogates are typically informed if the embryo’s sex has been identified during genetic testing, especially when it is a key part of the family’s IVF plan.
Does choosing gender improve IVF success rates?
Selecting chromosomal normal embryos through preimplantation genetic testing may improve success rates by reducing the risk of miscarriage and ensuring healthy embryos are used for transfer.
Are there emotional or ethical implications for surrogates?
Yes. While the physical process remains the same, some surrogates feel strongly about the ethics of selecting a child’s sex. It’s important to reflect on your feelings and discuss them with your agency or care coordinator before moving forward.
Final Thoughts: Empowering Surrogates Through Knowledge
Can you choose gender with IVF? Yes, you can. And while the decision is made before the surrogate’s medical involvement, it still has an impact on the surrogate journey. Understanding the gender selection process, knowing your rights, and receiving support from a transparent, ethical agency are all critical to a positive experience.
At Made in the USA Surrogacy, we believe in the power of informed decisions. We support our surrogates through every step of the IVF treatment process, including embryo selection, transfer, and the emotional aspects of carrying a baby chosen for gender. Whether you’re matched with a family pursuing family balancing or hoping to avoid genetic diseases, we’re here to ensure your voice is heard, respected, and protected.
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You are doing something extraordinary. We are here to make sure it is informed, empowered, and ethical, every step of the way.
