Gender Selection with IVF: Treatment Details & Cost

Many families have personal, cultural, or medical reasons for wanting to choose the sex of their next child. Thanks to advances in reproductive medicine, gender selection through IVF is now possible with nearly 100% accuracy. 

In this article, we’ll explore exactly what the process entails and how much it is likely to cost. 

Fast Facts About Gender and Sex Selection

Terminology

• Gender selection, often referred to as sex selection, is the practice of choosing the biological sex of a future child.
• The terms are used interchangeably, and the process is sometimes called family balancing when parents pursue it to have a child of one sex after having several children of the other.

Accepted Methods

• While many theories suggest that diet or lifestyle changes can influence a baby’s sex, these approaches lack scientific evidence.
• Today, the only one method of gender selection that is accepted and used within reproductive medicine is in vitro fertilization (IVF) combined with preimplantation genetic testing (PGT), sometimes called PGS or PGD.

Scientific Basis

• The science behind sex selection is based on chromosomal differences.
• Females carry two X chromosomes (XX), while males carry one X and one Y chromosome (XY).
• By testing embryos created during IVF, doctors can identify which carry XX or XY chromosomes and transfer an embryo of the desired sex.

The Procedure

• Gender selection is not a stand-alone service but an additional step within the IVF treatment process.

Cost of Gender Selection

• Costs vary significantly between clinics, depending on what is included.
• The national average cost of gender selection is about $4,500, in addition to the $22,000-$35,000 cost of an IVF cycle with frozen embryo transfer (FET). 
• At CNY Fertility, gender selection costs closer to $2,000, with IVF and FET starting around $8,000, including medications, making it one of the most affordable options available.
• Many individuals and couples travel across the country to CNY’s network of full-service clinics to take advantage of these cost savings in their pursuit of gender selection. 

How Does Gender Selection Work?

The sex or gender of the baby is determined by two chromosomes known collectively as the Sex Chromosomes. 

Egg cells from the female always carry an X chromosome while male sperm carries either an X or a Y chromosome.

If a sperm with an X chromosome meets the mother’s egg, then the resulting embryo and baby will be a girl with an XX chromosome.

If a sperm with a Y chromosome fertilizes the woman’s egg cell, then the resulting child will be a boy with an XY chromosome.

In natural conception, this creates an almost even 50/50 chance of having a boy or a girl. With IVF and PGT, however, doctors can accurately identify whether an embryo has XX or XY chromosomes, making it possible to reliably select the desired sex.

Sperm Sorting Method: Gender Selection with Artificial Insemination (Not reliable)

Sperm sorting is a technique that attempts to separate sperm based on the fact that X-bearing sperm contain slightly more DNA than Y-bearing sperm.

Some methods use a centrifuge to sort by density, while others rely on fluorescent dye to tag the DNA. In theory, X-bearing sperm will settle lower in a centrifuge and appear brighter under fluorescent tagging, making it possible to distinguish them from Y-bearing sperm.

This approach has been explored for use in both intrauterine insemination (IUI) and in vitro fertilization (IVF).

However, results have been inconsistent. While some studies show modest effectiveness, sperm sorting is not considered highly reliable.

Because of its limited accuracy, sperm sorting is not widely practiced in the United States and is not offered at most fertility clinics, including CNY Fertility.

Gender Selection with IVF and Embryonic Genetic Testing

Gender selection through IVF combined with preimplantation genetic testing (PGT) is the most advanced and reliable method of sex selection, offering virtually 100% accuracy.

In this process, embryos are created through IVF. A few cells are carefully removed from each embryo several days after fertilization and sent to a genetics laboratory for chromosomal analysis. The embryos are then immediately frozen while awaiting the test results.

Once the results are available, intended parents can choose which embryo to transfer based on chromosomal information, including sex. A frozen embryo transfer (FET) is then performed with the selected embryo.

Detailed Steps of IVF Gender Selection

Because accurate gender selection requires the complex and involved process of in vitro fertilization (IVF), it is important to understand the four main stages of IVF: 

• Ovarian Stimulation: The intended mother takes hormone-based medications to stimulate the ovaries, encouraging the development of multiple mature, high-quality eggs instead of the single egg typically produced each cycle.

• Egg Retrieval: A minor surgical procedure is performed to collect the eggs directly from the ovaries.

• Embryology Laboratory: The retrieved eggs are fertilized with sperm in the lab, and the resulting embryos are carefully monitored as they develop over the next 3–7 days.

• Embryo Transfer: One embryo is selected and transferred into the intended parent’s uterus, where it can hopefully implant and develop into a healthy pregnancy.

Because gender selection requires additional embryonic testing, which takes several days for results, the process involves steps beyond a standard IVF process. 

The process of gender selection is best understood as two distinct treatment cycles:

• The creation and testing of embryos
• A frozen embryo transfer (FET) cycle that involves preparing the uterus for transfer and implanting the selected embryo.

Phase 1: The Embryo Making & Testing Cycle

This part of the process is much like a standard embryo freezing cycle. Embryos are created through IVF and then frozen for future use.

The key difference is that before freezing, a small biopsy is taken from each embryo and sent to a genetics lab for testing.

Ovarian Stimulation:

As with a standard IVF cycle, the intended mother takes hormone-based medications to stimulate the ovaries and produce multiple mature, high-quality eggs.

These medications usually begin on days 2–4 of the menstrual cycle and continue for about 10 days.

The goal is simple: the more eggs retrieved, the more embryos created, and the greater the chance of having embryos of the desired sex, ultimately increasing the odds of a successful live birth.

Egg Retrieval:

Egg retrieval is a minor procedure to collect eggs from the ovaries, usually about 12 days after starting stimulation medications. The exact timing depends on follicle development, which is tracked through ultrasounds and bloodwork.

The procedure requires no incisions, stitches, or general anesthesia. Instead, patients receive light sedation while an ultrasound-guided needle gently retrieves the eggs from the ovarian follicles.

The collected eggs are immediately sent to the embryology lab for fertilization and embryo development.

The Embryology Laboratory

During gender selection, the work inside the embryology lab can be summarized in five key steps:

• Isolation: An embryologist searches the follicular fluid for eggs and immediately places them in nutrient-rich media that mimics the fallopian tube environment.

• Fertilization: Within about 4 hours of retrieval, eggs are fertilized using either ICSI or conventional methods.

• Embryo Development: The resulting embryos grow in the lab for 5–7 days. Unlike standard IVF, where embryos may be transferred on day 3, genetic testing can only be done once embryos reach the blastocyst stage (usually day 5).

• Embryo Biopsy: At the blastocyst stage, a laser removes a small group of cells (3–6) from the trophectoderm, which develops into the placenta. These cells are labeled and sent to a genetics lab for chromosomal analysis.

• Embryo Freezing: After biopsy, embryos are vitrified (flash frozen) to preserve their quality until test results are available. Freezing does not harm success rates and may even improve outcomes for some patients.

The Genetic Testing:

The genetic testing itself is carried out by a third-party laboratory using Preimplantation Genetic Testing for Aneuploidy (PGT-A).

This technique analyzes the number and type of chromosomes in each sampled cell. The results identify whether an embryo is XX (female) or XY (male), along with other important information about chromosomal health.

With these results in hand, the intended parents and fertility clinic can move forward by selecting and thawing an embryo of the desired sex for a frozen embryo transfer (FET),.

Phase 2: The Frozen Embryo Transfer Using an Embryo with the Desired Sex

A frozen embryo transfer (FET) is simpler than the first phase of IVF and involves two main steps:

• Uterine Lining Development: The uterus must be optimally prepared for implantation. While a natural FET (without medication) is possible, most patients are advised to take estrogen and progesterone before and after transfer to ensure the lining is receptive.

• Frozen Embryo Transfer: An embryo identified through genetic testing as the desired sex is thawed from liquid nitrogen storage, loaded into a transfer catheter, and gently placed into the uterus through the cervix. At this point, the patient is considered pregnant until proven otherwise, carrying an embryo that can grow into a healthy child of the chosen sex.

How much does Gender Selection cost?

The cost of Gender Selection is highly variable and usually composed of multiple services and fees. 

That said, the average cost of gender selection in the USA is around $4,000-$5,000.  But it can be as low as $2,000 at CNY. Though pricing will vary at every clinic based on the number of embryos being tested.

The sex/gender selection fees are generally split into two different components:

• Fertility Clinic Biopsy Fees: This is the fee for taking the embryonic tissue biopsy and preparing it to be sent to a genetics lab for analysis.
• Genetic Lab Fees: This is the fee that the genetics lab charges for the actual testing of the embryonic cells, which will determine the sex of each embryo.

Together, these fees will usually come in around $4-5,000, but here at CNY Fertility, these fees most often range from $2,000-3,000.

Additional Fees

When clinics provide quotes for gender selection itself, they are generally only referring to the biopsy and genetic testing fees.

Sex or gender selection is always part of an IVF cycle, and it’s cost will be added on to the cost of an IVF cycel with frozen embryo transfer (FET).

The cost of IVF ranges widely and includes the following components: 

• Base IVF: This covers most of the procedure-related expenses in a standard IVF package.
• Monitoring: Ongoing ultrasounds and bloodwork are performed during ovarian stimulation to track hormone levels and follicle growth, supporting a safe and properly timed process.
• Medications: Fertility medications stimulate the ovaries to produce multiple eggs. More eggs typically lead to more embryos, which increases the chances of having embryos of the desired sex.
• Frozen Embryo Transfer (FET): Because genetic testing to determine embryo sex takes several days, embryos must be frozen while results are processed. Once the desired embryo is identified, it is thawed and transferred into the uterus during an FET cycle.

Some clinics may also charge extra for things like ICSI, which may be required for many.

The Total Cost of Gender Selection

The average total cost of gender selection (including the IVF process) is around $27,000.

At CNY Fertility, the total fee often comes in around $11,000-12,000, making far more affordable than other clinics. 

The calculator below makes it easy to see the full cost of gender selection. As outlined above, the total includes genetic testing, a frozen embryo transfer, and an estimate for medications.

You will also need to choose between in-house monitoring (if you live near one of our clinics) or remote cycle management (as more than half of our clients do when traveling from outside the area). Depending on your situation, you may also decide to add optional services.

The Bottom Line

Gender selection is best understood as an add-on service to IVF. When performed with PGT, it allows embryos of the desired sex to be transferred with more than 99.9% accuracy.

It’s important to remember that IVF itself has an average success rate of around 50% per transfer depending on your age.

In addition, sex selection often reduces the number of usable embryos by about half, since parents may choose not to transfer embryos of the opposite sex.

Another factor to consider is cost. Only about 25% of Americans have IVF coverage, which means IVF with gender selection can be expensive and often leads patients to explore financing options.

To learn more about gender selection and family balancing at CNY Fertility, we invite you to schedule a consultation by calling 844-315-2229 or requesting a consultation.