A few days ago, a woman arrived for an appointment at Dr Pankaj Shrivastav’s fertility clinic in Sharjah. She had four sons, but now she wanted a daughter.
Her reasoning, Dr Shrivastav says, was that when her sons were grown up and married with children of their own, they might not have enough time for their elderly mother.
“I want a girl who will take care of me in my old age,” she told him.
Such cases are unusual but not unheard of. Dr Shrivastav estimates that fewer than 5 per cent of clients at Conceive Gynaecology and Fertility want to select the sex of their child.
Sometimes this is for medical reasons, he says. Genetic diseases such as haemophilia or Duchenne muscular dystrophy could be fatal in boys.
But others, such as the lady with four sons, gender selection is for social reasons. Couples with a predominance of one sex want to even things out, a process known as “family balancing”.
Overall the split in his clinic is 60 per cent of couples asking for boys and 40 for girls, but Dr Shrivastav says: “Even though gender selection is available in our clinic, we don’t promote it.”
The procedure for gender selection can cost up to Dh40,000 and, while other clinics make more of a feature of it because it is more profitable, he warns: “If sex selection is promoted, there will be a population imbalance.”
Dr Shrivastav recommends sex selection for women who are experiencing recurrent miscarriages and also for genetic abnormalities and diseases.
While UAE law allows pre-implantation genetic diagnosis (PGD), where the child’s sex is known in cases of in-vitro fertilisation, it does not specifically deal with the issue of gender selection.
India has banned gender testing of foetuses because of concerns that families were aborting females.
China’s “one baby” policy has led to a similar ban, with couples preferring male offspring. In other countries, such as the UK, gender selection is only permitted for medical reasons.
“PGD should be allowed,” insists Dr Shrivastav. “There are many benefits. We have to look at cases on individual merits.” He believes it is sensible that the UAE has not legislated against the practice.
“Sometimes the marriage is dependent on the sex of the baby. We can’t say ‘no’ to the couples.”
Al Fakih Fertility Clinic in Abu Dhabi reports three or four Emirati couples seeking gender selection every month, numbers that have dramatically risen in the past two years.
Abu Zayed is one of their Emirati clients. He says he does not favour one gender, but that it has been one of his goals to have more boys in his family.
After several marriages he now has three boys and seven girls. His own family has only a few men, as the result of accidents and a low birth rate.
In the Arab world huge responsibility rests on the men, Abu Zayed says. “Having men in the family give it additional value as they are the protectors, providers and leaders.”
When deciding if he was going to proceed with gender selection, he set out to educate himself about the process.
He travelled to Jordan for a consultation with Dr Zaid Kilani, an expert on IVF in the region, and later approached a UAE fertility clinic, but was disappointed with the service offered.
“I already have seven girls, now I want more boys for a balanced family,” Abu Zayed says. “Also, ultimately boys will carry my name and legacy.
“I want to raise righteous children so that I could be proud of them in this world and hereafter.”
After working with Al Fakih, Abu Zayed’s wife is now pregnant with a son. The father says he is very happy.
Dr Michael Fakih is the founder of the clinic, which also has branches in Dubai and Al Ain.
“Family balancing, that’s what we do here in the clinic,” Dr Fakih says.
As with other fertility clinics in the UAE, the surplus embryos created in IVF treatment are destroyed.
Islam offers no objection to gender selection within reason, and also determines that the soul is the source of life, and only enters the foetus after several weeks of gestation.
In a Hadith, the Prophet Mohammed is quoted as saying: “Verily the creation of each one of you is brought together in his mother’s belly for forty days in the form of seed, then he is a clot of blood for a like period, then a morsel of flesh for a like period, then there is sent to him the angel who blows the breath of life into him and who is commanded about four matters: to write down his means of livelihood, his life span, his actions, and whether happy or unhappy.”
Under UAE law, all unused embryos must be destroyed once the treatment cycle is completed, unlike some countries that allow them to be frozen for future implants.
“In this country, any extra embryo you have to discard, whether it’s a boy or girl,” says Dr Fakih.
Having worked for more than 25 years in assisted reproduction, he says the UAE takes a tough approach when applying the rules.
Breaking the law results in severe punishment, Dr Fakih says. “You can’t play games in clinics here, the penalty is straight.”
Dr Fakih says it is a condition in his clinic that parents should have first tried to build a family with natural methods.
But sometimes this is not always possible. One example is women trying to have children at an older age.
Umm Khadija was one. She was married at the age of 26 and had her first baby, Khadija, a year after.
“If I had a boy first, I said to myself, then we would choose the gender of the second child,” she says.
Umm Khadija, 30, has a blocked fallopian tube that makes achieving pregnancy difficult.
She was also told by doctors that women over the age of 30 are less fertile.
As a result, she feared she might not be able to have any more children.
“I wanted children of both genders before it’s too late for me to bear,” Umm Khadija says.
After treatment, she is now seven months pregnant with a boy.
To make clients more aware about the process of IVF and how it relates to gender selection and issues such as hereditary diseases, the clinic has introduced an educational programme.
Every week Dr Monikaa Chawla, an IVF specialist, gives a talk on a particular topic. She says she is impressed by the growing number of Emirati men who accompany their wives to the clinic.
“A few years ago, it was rare to see Emirati men with their wives in a fertility clinic. Today the mentality has changed, which is great,” Dr Chawla says.
“There are no precise guidelines on gender selection in the UAE. We have to make an assessment of the patient, such as the age of mother, family history, any issues with conception for which she may need IVF.”
Of the Emiratis using the clinic, about three in 10 are doing so for gender selection, says Dr Chawla.
That amounts to about 50 couples a month. Of these, an overwhelming majority, 95 per cent, want a boy.
Dr Fakih disagrees with Dr Shrivastav’s concerns that gender selection will led to a population imbalance by the middle of the century.
“It’s always 50-50. There will be a balance in population, not imbalance,” he says.