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Of the arguments in favor of PGD and sex selection, only the one based on the prevention of transmittable genetic diseases is strong enough to clearly avoid or override concerns regarding gender equality, acceptance of offspring for themselves and not their inessential characteristics, health risks and burdens for individuals attempting to achieve pregnancy, and equitable use and distribution of medical resources. These concerns remain for PGD and sex selection when it is used to fulfill nonmedical preferences or social and psychological needs. However, because it is not clear in every case that the use of PGD and sex selection for nonmedical reasons entails certainly grave wrongs or sufficiently predictable grave negative consequences, the Committee does not favor its legal prohibition. Nonetheless, the cumulative weight of the arguments against nonmedically motivated sex selection gives cause for serious ethical caution. The Committee’s recommendations therefore follow from an effort to respect and to weigh ethical concerns that are sometimes in conflict – namely, the right to reproductive freedom, genuine medical needs and goals, gender equality, and justice in the distribution of medical resources. On the basis of its foregoing ethical analysis, the Committee recommends the following:

1 Preimplantation genetic diagnosis used for sex selection to prevent the transmission of serious genetic disease is ethically acceptable. It is not inherently gender biased, bears little risk of consequences detrimental to individuals or to society, and represents a use of medical resources for reasons of human health.

2 In patients undergoing IVF, PGD used for sex selection for nonmedical reasons – as in (a) through (c) above – holds some risk of gender bias, harm to individuals and society, and inappropriateness in the use and allocation of limited medical resources. Although these risks are lower when sex identification is already part of a by‐product of PGD being done for medical reasons (a), they increase when sex identification is added to PGD solely for purposes of sex selection (b) and when PGD is itself initiated solely for sex selection (c). They remain a concern whenever sex selection is done for nonmedical reasons. Such use of PGD therefore should not be encouraged.

3 The initiation of IVF with PGD solely for sex selection (d) holds even greater risk of unwarranted gender bias, social harm, and the diversion of medical resources from genuine medical need. It therefore should be discouraged.

4 Ethical caution regarding PGD for sex selection calls for study of the consequences of this practice. Such study should include cross‐cultural as well as intracultural patterns, ongoing assessment of competing claims for medical resources, and reasonable efforts to discern changes in the level of social responsibility and respect for future generations.