Embryo Project Encyclopedia

In June 2015, the Ethics Committee of the American Society for Reproductive Medicine, or ASRM, published “Use of reproductive technology for sex selection for nonmedical reasons” in Fertility and Sterility. In the report, the Committee presents arguments for and against the use of reproductive technology for sex selection for any reason besides avoiding sex-linked disorders, or genetic disorders that only affect a particular sex. When couples have no family history of a sex-linked disease, the use of reproductive technology for sex selection raises ethical questions about the application of sex selection technology to fulfill parental desires. “Use of reproductive technology for sex selection for nonmedical purposes” examines the ethical debate surrounding sex selection for nonmedical purposes and is an educational and ethical reference for physicians who are considering offering those services in their practices.

In 1973, Ronald Ericsson developed the Ericsson method, which is a technique used to separate human male sperm cells by their genetic material. Ericsson, a physician and reproduction researcher, developed the method while conducting research on sperm isolation in Berlin, Germany, in the early 1970s. He found that the sperm cells that carry male-producing Y chromosomes move through liquid faster than the cells that carry female-producing X chromosomes. As a result of his findings, Ericsson suggested suspending a semen sample in a viscous liquid made from albumin protein, and collecting only sperm that quickly pass through the liquid. Shortly after Ericsson described his method, researchers demonstrated that it was effective for sex selection. However, later studies contested those results. Despite that, the Ericsson method is still utilized by couples in 2018 as a means of sex selection and was the first sperm separation technique used in combination with artificial insemination to enable people to select the sex of their children.

In the book Your Baby’s Sex: Now You Can Choose, David Michael Rorvik and Landrum Brewer Shettles describe methods that couples can use prior to and during conception that will increase the chances of producing a child of their desired sex. Rorvik, a science writer, and Shettles, an obstetrics and gynecology researcher and physician, co-wrote the book. Shettles developed the methods detailed in the book during the 1960s. Although the authors claim a high success rate, some researchers have contested the validity of the methods proposed in Your Baby’s Sex: Now You Can Choose. Despite contradicting evidence for the effectiveness of the methods, the book itself has remained popular throughout its forty consecutive years in print. Since its original publication, Your Baby’s Sex: Now You Can Choose has reached a large audience, with over 1.5 million copies of the book sold worldwide, while adding to the controversy about the ethics of sex selection research.

Hans Peter Dietz and Judy Simpson published, “Levator Trauma is Associated with Pelvic Organ Prolapse,” in the journal BJOG: An International Journal of Obstetrics and Gynecology in 2008. In their article, Dietz and Simpson estimated the risk of pelvic organ prolapse in women who attained injuries to the pelvic levator muscles. The levator muscles, also known as the levator ani, are a major muscle group that comprise the pelvic floor. Along with other muscles, the pelvic floor supports organs in a woman’s pelvis, such as the bladder, uterus, and rectum. Vaginal childbirth can cause a weakening of the pelvic muscles. That can lead to pelvic organ prolapse, which results in the descent of the pelvic organs towards a woman’s vaginal opening. In, “Levator Trauma is Associated with Pelvic Organ Prolapse,” Dietz and Simpson found that women were more likely to have pelvic organ prolapse if they had levator trauma, and called for further research to understand the relationship between levator ani trauma and pelvic organ prolapse.

By questioning methods of sex selection since their early development, and often discovering that they are unreliable, scientists have increased the creative and technological capacity of the field of reproductive health. The presentation of these methods to the public, via published books on timing methods and company websites for sperm sorting, increased interest in, and influence of, sex selection within the global society. The purpose of explaining the history, interest, development, and impact of various sex selection methods in the mid-twentieth century based on the information that is available on them today is to show couples which methods have failed and provide them with the knowledge necessary to make an informed decision on how they choose to go about utilizing methods of sex selection.

In 1997, physicians and researchers Ambre Olsen, Virginia Smith, John Bergstrom, Joyce Colling, and Amanda Clark published, “Epidemiology of Surgically Managed Pelvic Organ Prolapse and Urinary Incontinence,” in the journal Obstetrics and Gynecology. In their article, the authors retrospectively analyzed data from patients who underwent surgery for pelvic organ prolapse or urinary incontinence two years prior in 1995. Often due to a weakening of or damage to their pelvic muscles, women with pelvic organ prolapse can experience a descent of pelvic organs into the lower pelvis and vagina. People with urinary incontinence can experience bladder control issues and urinary leaks. According to the authors, an estimated fifty percent of women who have previously given birth have had a prolapse. In their article, Olsen and colleagues analyze factors such as race, age, and weight in women who had surgery to treat pelvic organ prolapse and ultimately advocate for a standard assessment for the severity of those conditions.

In 1996, a team of researchers associated with the International Continence Society published “The Standardization of Terminology of Female Pelvic Organ Prolapse and Pelvic Floor Dysfunction” in American Journal of Obstetrics and Gynecology. Pelvic organ prolapse is characterized by the descent of the pelvic organs into the lower portion of the pelvis and is often caused by a weakening of the muscles and ligaments that normally hold the organs in place. The authors concluded that physicians and researchers needed to develop a system of standardized terms to use to describe the anatomical position of pelvic organ prolapse in women. They propose using terms that emphasize the location of the prolapse rather than just the involved organ. They also suggest that the system utilizes a series of examinations and imaging to uniformly describe and quantify pelvic organ prolapse. The article by Bump and colleagues was one of the first to call for a standardized system using specific terms to communicate findings about pelvic organ prolapse systematically across clinical and academic research settings.

In 2007, physicians John Jelovsek, Christopher Maher, and Matthew Barber published, “Pelvic Organ Prolapse,” in The Lancet. In their article, Jelovsek and colleagues provided an overview of pelvic organ prolapse in women and described the epidemiology, risk factors, symptoms, and management of the condition. Pelvic organ prolapse occurs when a woman’s pelvic floor is weakened or damaged from stress or trauma such as vaginal childbirth. The pelvic floor is a group of muscles that provides support to organs within the lower abdominal region of the body, including the bladder, uterus, and rectum. Disorders of the pelvic floor disrupt its normal function, often causing a feeling of uncomfortable pressure or pain, and incontinence, which is involuntary leakage of urine or feces. In their article, Jelovsek and colleagues reviewed the known information about pelvic organ prolapse as of 2007 and research teams who further studied the causes and management of pelvic organ prolapse in women later used the article as a reference.

Pelvic organ prolapse is a common condition in women that causes the pelvic organs to descend, often resulting from a weakened pelvic floor. Pelvic organs supported by the pelvic floor, such as the bladder, bowel, or uterus, can descend to such a degree that they project out from a woman’s body typically via the vagina. Pelvic floor stress or trauma, like vaginal childbirth, can cause pelvic organ prolapse. Women with pelvic organ prolapse also often experience other conditions, such as incontinence or the involuntary leakage of urine or fecal matter. As a result, while many women experience pressure or fullness from the prolapse itself, other common symptoms of pelvic organ prolapse are those involving the bladder or the bowel. Treatments for prolapse depend on the woman’s symptoms, and include pessaries, surgery, and pelvic floor exercises. As of 2021, researchers and physicians continue to study pelvic organ prolapse to determine how different treatments can be tailored to specific causes or symptoms.

David Michael Rorvik is a science journalist who publicized advancements in the field of reproductive medicine during the late twentieth century. Rorvik wrote magazine articles and books in which he discussed emerging methods and technologies that contributed to the progression of reproductive health, including sex determination, in vitro fertilization, and human cloning. During that time, those topics were controversial and researchers often questioned Rorvik’s work for accuracy. Rorvik contributed to the field of reproductive medicine by communicating methods of reproductive intervention and contributing to the controversy around new developmental medicine technologies.