Yes, you can choose the sex of your baby through IVF. It is the only medically proven method with a sex identification accuracy of over 99%.
In vitro gender selection uses preimplantation genetic testing (PGT) during an IVF cycle to identify whether each embryo carries XX (female) or XY (male) chromosomes. Only embryos of the desired sex are then selected for transfer.
California is one of the most accessible states in the country for elective sex selection. There are no state laws restricting it, and fertility clinics like American Reproductive Centers (ARC) offer gender selection as part of a comprehensive IVF and PGT treatment plan.
This guide explains exactly how the process works, who it is for, what it costs, and what you should know before getting started.
How Does In Vitro Gender Selection Work?
Gender selection is not a standalone procedure. It is an additional step within a standard IVF cycle that uses genetic testing to reveal the chromosomal sex of each embryo.
Here is the step-by-step process:
- Ovarian Stimulation. The intended mother (or egg donor) takes injectable fertility medications to stimulate the ovaries. The goal is to produce multiple mature eggs rather than the single egg released in a natural cycle. This phase typically lasts 10 to 14 days and includes regular blood work and ultrasound monitoring.
- Egg Retrieval. Once the eggs are mature, they are collected in a short outpatient procedure performed under light sedation. A thin needle guided by ultrasound is used to retrieve the eggs from the ovarian follicles. Most patients return to normal activity within a day or two.
- Fertilization. The retrieved eggs are fertilized with sperm in the laboratory. This is done through conventional IVF or intracytoplasmic sperm injection (ICSI), where a single sperm is injected directly into each egg.
- Embryo Culture. Fertilized embryos grow in a controlled lab environment for five to six days until they reach the blastocyst stage. At this point, the embryo has roughly 100 to 200 cells and has developed two distinct cell types: the inner cell mass (which becomes the baby) and the trophectoderm (which becomes the placenta).
- Trophectoderm Biopsy and PGT. An embryologist carefully removes a small number of cells (typically five to seven) from the trophectoderm layer. The inner cell mass is not touched. These cells are sent to a genetics lab for analysis using next-generation sequencing (NGS) technology. The testing reveals whether each embryo is XX (female) or XY (male) and also screens for chromosomal abnormalities.
- Embryo Freezing. After the biopsy, all embryos are cryopreserved (frozen) while waiting for the PGT results. Results typically take seven to fourteen days.
- Frozen Embryo Transfer (FET). Once results are available, the intended parents choose a chromosomally normal embryo of the desired sex. That embryo is thawed and transferred to the uterus in a subsequent cycle. The transfer itself is a quick, painless procedure that does not require anesthesia.
This process allows patients to select the sex of their baby with an accuracy rate exceeding 99%.
The Science Behind Gender Selection: PGT Explained
The ability to determine an embryo’s sex comes down to one fundamental biological fact: females carry two X chromosomes (XX), and males carry one X and one Y chromosome (XY).
During natural conception, sperm carrying either an X or a Y chromosome fertilize the egg (which always carries an X chromosome). This creates a roughly 50/50 chance of having a boy or a girl.
With PGT, that randomness is replaced by precision.
Types of PGT Used in Gender Selection
There are three types of preimplantation genetic testing, and each serves a different purpose:
PGT-A (Aneuploidy Screening). This is the most common form of PGT used during IVF today. It screens every embryo for the correct number of chromosomes, identifying those that are euploid (chromosomally normal) versus aneuploid (missing or carrying extra chromosomes). Aneuploidy is a leading cause of miscarriage and implantation failure. PGT-A simultaneously reveals the sex chromosome makeup of each embryo.
PGT-M (Monogenic Disease Testing). This tests for specific single-gene disorders such as cystic fibrosis, sickle cell anemia, Tay-Sachs disease, and others. PGT-M is particularly relevant to gender selection when parents are carriers of X-linked genetic conditions (more on this below).
PGT-SR (Structural Rearrangement Testing). This screens for chromosomal structural abnormalities such as translocations or inversions that can cause pregnancy loss or birth defects.
When patients undergo PGT-A as part of their IVF cycle, the sex of every embryo is identified as part of the standard results. From there, families can choose which embryo to transfer.
At ARC, PGT is performed at our in-house genetics laboratory. Your embryos never need to be shipped to an outside facility for testing.
Who Is Gender Selection For?
Gender selection through IVF is used for both medical and personal reasons. Both are legitimate paths, and both are fully legal in California.
Medical Sex Selection
Some genetic disorders are linked to the X chromosome and disproportionately affect one sex over the other. These are known as X-linked recessive conditions. Because males have only one X chromosome, a single copy of a mutated gene on that chromosome can cause disease. Females, with two X chromosomes, are more likely to be carriers without showing symptoms.
Common X-linked conditions include:
- Hemophilia A and B: Blood-clotting disorders that cause excessive bleeding. Hemophilia occurs in about 1 in 5,000 male births.
- Duchenne Muscular Dystrophy (DMD): A severe muscle-wasting condition affecting approximately 1 in 4,000 male births. Most boys with DMD need wheelchair support by their early teens.
- Fragile X Syndrome: The most common inherited cause of intellectual disability, affecting males more severely than females.
- X-linked Agammaglobulinemia: An immune system disorder that leaves affected individuals highly susceptible to infections.
For families carrying these conditions, selecting a female embryo can significantly reduce the chance of passing the disease to their child. PGT-M can also directly test for the specific gene mutation, providing even more precise information than sex selection alone.
Elective Sex Selection (Family Balancing)
Many patients pursue gender selection for personal or family-building reasons. This is often called “family balancing.” Common scenarios include:
- Couples with children of one sex who want their next child to be the opposite sex
- Individuals or couples undergoing IVF for any reason who want to know and choose the sex while going through the process
- LGBTQ+ families building their family through IVF with donor eggs, donor sperm, or surrogacy who have a preference for their child’s sex
- International patients traveling to California from countries where elective sex selection is not available
Family balancing is one of the most common reasons patients pursue gender selection, and it is fully supported at ARC.
Is Gender Selection Legal in California?
Yes. Elective gender selection is legal in California and throughout the United States.
Unlike many countries that restrict or ban sex selection for nonmedical reasons, the United States has no federal law prohibiting it. California has no state restrictions either.
Here is how the legal landscape compares:
| Region | Elective Sex Selection |
| California / United States | Legal. No federal or state ban. |
| United Kingdom | Prohibited for nonmedical reasons (HFEA regulated). |
| Canada | Prohibited for nonmedical reasons. |
| Australia | Prohibited for nonmedical reasons in most states. |
| China and India | Banned in all forms to prevent sex-ratio imbalances. |
| Saudi Arabia and Lebanon | Permitted. Sex selection is the most common reason for PGT in these regions. |
This legal openness is one reason California is a destination for patients from around the world seeking gender selection. ARC has worked with patients from Europe, Asia, the Middle East, South America, Africa, and other U.S. states where access may be limited.
What Medical Organizations Say
The American Society for Reproductive Medicine (ASRM) published an Ethics Committee opinion in 2022 addressing this topic directly. Key positions include:
- Sex selection to prevent serious X-linked genetic diseases is ethically acceptable
- Sex selection for nonmedical reasons is considered ethically controversial, but ASRM does not call for a ban
- Practitioners are under no ethical obligation to provide or refuse to provide nonmedically indicated sex selection
- Clinics are encouraged to develop and share their policies on sex selection
In practice, most fertility clinics in the United States offer elective sex selection. At ARC, we believe in supporting our patients’ reproductive choices with transparency, compassion, and evidence-based care.
How Accurate Is IVF Gender Selection?
When PGT is used to identify the sex chromosomes of an embryo, the accuracy of sex determination exceeds 99%.
This makes IVF with PGT the only reliable method for choosing the sex of a baby. No other approach comes close to this level of accuracy.
What About Other Methods?
You may have seen claims about alternative gender selection techniques. Here is how they compare:
| Method | How It Works | Accuracy |
| IVF + PGT | Embryo chromosomes are directly analyzed in a genetics lab | Over 99% |
| Sperm Sorting (MicroSort) | Sperm are separated based on DNA content differences between X and Y sperm | 70 to 75% at best |
| Shettles Method | Timing intercourse based on the idea that X and Y sperm behave differently | No scientific evidence of effectiveness |
| Diet and Supplements | Claims that maternal diet can influence a baby’s sex | No scientific evidence of effectiveness |
IVF with PGT is the only method of sex selection accepted and used within reproductive medicine today.
Important Caveat: Accuracy vs. Pregnancy Success
While sex identification through PGT is over 99% accurate, the overall IVF pregnancy success rate per embryo transfer varies based on multiple factors, including age, egg quality, and underlying fertility diagnosis.
IVF success rates are not 100%. Transferring a euploid embryo of the desired sex gives you the best possible chance at both the pregnancy and the sex you want, but no fertility treatment can guarantee a pregnancy on the first transfer.
Additionally, sex selection may reduce the total number of transferable embryos. On average, roughly half of your embryos will be of each sex. If you produce four euploid embryos, you may have only two of your desired sex available for transfer.
What Does Gender Selection Cost?
Gender selection is not a standalone fee. It is part of a full IVF cycle that includes PGT. Here is a general breakdown of what to expect:
| Component | Estimated Cost Range |
| IVF Cycle (stimulation, monitoring, egg retrieval, fertilization) | $10,000 to $15,000 |
| Fertility Medications | $3,000 to $6,000 |
| PGT (embryo biopsy and genetic analysis) | $3,000 to $6,000 |
| Frozen Embryo Transfer (FET) | $3,000 to $5,000 |
| Total Estimated Range | $19,000 to $32,000 |
Costs vary by clinic, region, and individual treatment needs. Some patients may need additional procedures, multiple cycles, or donor gametes, which can affect the total investment.
Does Insurance Cover Gender Selection?
In most cases, insurance does not cover the sex selection component because it is considered elective. However, if you are undergoing IVF for medical infertility, your insurance may cover parts of the IVF cycle itself.
A major update for California patients: Senate Bill 729 (SB 729) takes effect January 1, 2026, and requires fully insured large group health plans (employers with 101 or more employees) to cover infertility diagnosis and treatment, including IVF. This includes up to three completed egg retrievals and unlimited embryo transfers.
The new law also expands the definition of infertility to include LGBTQ+ individuals, single people, and others unable to conceive without medical intervention. However, PGT performed purely for elective sex selection may not be covered under all plans. Check with your insurance provider for specific coverage details.
ARC offers interest-free financing to help make treatment accessible for all patients. Contact our team to discuss your options.
Gender Selection at American Reproductive Centers (ARC)
ARC has offered gender selection services for over 18 years across our California locations, including Palm Springs, Redlands, and our affiliate in El Cajon.
Here is what sets ARC apart:
- In-house genetic testing. Unlike many clinics that ship embryo biopsy samples to labs in other states, ARC performs PGT at our own facilities. Your embryos stay local throughout the entire process. This reduces turnaround time and adds an extra layer of security.
- Same pricing for all patients. Whether you are a local California resident, traveling from another state, or coming from overseas, the cost of gender selection at ARC is the same. There is no premium for out-of-state or international patients.
- Comprehensive care under one roof. ARC offers the full range of fertility services, from initial consultation through genetic testing, IVF, and embryo transfer. If you need donor eggs, donor sperm, or surrogacy, ARC provides in-house programs that reduce costs and simplify coordination.
- LGBTQ+ inclusive. Same-sex couples and LGBTQ+ individuals are at the core of our practice. ARC provides fertility solutions, donor matching, surrogacy coordination, and legal support tailored to every family structure.
- Experience with international patients. ARC regularly works with patients from Europe, Asia, the Middle East, South America, and beyond. We coordinate with your local physicians to prepare you for treatment before you arrive.
Schedule your consultation with ARC today to discuss gender selection.
What to Expect: Your Gender Selection Timeline at ARC
Here is a general timeline of what to expect when pursuing gender selection through IVF at ARC:
- Week 1 to 2: Initial Consultation and Testing. Meet with a reproductive endocrinologist at ARC to discuss your goals, review your medical history, and complete baseline fertility testing. This includes bloodwork, an ultrasound, and a semen analysis if applicable.
- Week 3 to 4: Treatment Planning. Based on your results, your doctor creates a personalized IVF protocol. You will receive instructions on medications and monitoring schedules.
- Week 5 to 6: Ovarian Stimulation. Begin daily injectable medications to stimulate egg production. You will visit the clinic for monitoring appointments every two to three days during this phase.
- Week 7: Egg Retrieval and Fertilization. Eggs are retrieved in a brief outpatient procedure and fertilized with sperm in the lab that same day.
- Week 7 to 8: Embryo Culture and Biopsy. Embryos develop for five to six days in the lab. Once they reach the blastocyst stage, the trophectoderm biopsy is performed, and embryos are frozen.
- Week 8 to 10: PGT Results. Genetic results are returned. You and your doctor review the results together, including which embryos are chromosomally normal and their sex.
- Weeks 10 to 12: Frozen Embryo Transfer. Your uterus is prepared with hormone support, and the selected embryo is transferred. A pregnancy test is performed approximately 10 to 12 days later.
Total timeline from first appointment to embryo transfer: approximately 8 to 12 weeks.
Frequently Asked Questions About In Vitro Gender Selection
Can you guarantee the sex of my baby with IVF?
PGT identifies the chromosomal sex of each embryo with over 99% accuracy. When a confirmed XX or XY embryo is transferred, the sex determination is essentially certain. However, IVF itself is not 100% successful. Not every transfer results in pregnancy, and not every pregnancy results in a live birth.
Is the embryo biopsy safe for my baby?
Yes. The trophectoderm biopsy removes a small number of cells from the outer layer of the embryo that will become the placenta, not the baby. The inner cell mass, which develops into the fetus, is not touched during the procedure. Research has shown that neonatal outcomes from biopsied embryos are comparable to those from unbiopsied embryos.
Do I need to have a fertility problem to use gender selection?
No. Some patients undergo IVF specifically for the purpose of gender selection, even without an underlying fertility diagnosis. This is called “elective IVF” and is legal in California. However, because IVF is an involved medical process, your physician will review your health and discuss whether it is the right approach for your situation.
How many embryos will be of my desired sex?
Statistically, about half of your embryos will be of each sex. However, this is not guaranteed. If you produce a small number of embryos, it is possible that most or all could be one sex. Patients pursuing gender selection should be prepared for the possibility that a second IVF cycle may be needed if the first cycle does not produce enough embryos of the desired sex.
Can I choose the sex if I am already doing IVF for infertility?
Absolutely. If you are already planning an IVF cycle, adding PGT to your treatment plan is straightforward. PGT-A screens your embryos for chromosomal health and simultaneously reveals the sex. You can then choose which embryo to transfer based on both genetic health and sex.
What happens to the embryos of the sex I did not choose?
You have several options for remaining embryos. They can be cryopreserved for future use, donated to another individual or couple, donated for research, or compassionately discarded. Your doctor and care team will walk you through these options so you can make the decision that feels right for you.
Is gender selection ethical?
The ASRM Ethics Committee recognizes that sex selection for medical reasons (such as avoiding X-linked genetic diseases) is ethically acceptable. For nonmedical reasons, the committee considers the practice ethically controversial but does not recommend a ban. The decision to pursue gender selection is deeply personal, and ARC supports patients in making informed choices that align with their values and family-building goals.
Does ARC offer gender selection for LGBTQ+ families?
Yes. ARC is proud to serve LGBTQ+ individuals and couples. Whether you are using donor eggs, donor sperm, a gestational carrier, or any combination of these, gender selection through IVF with PGT is available to you. ARC provides in-house egg donation, surrogacy coordination, and legal support to help every family-building journey go smoothly.
How is sex selection different from gender selection?
These terms are used interchangeably in fertility medicine, though there has been a shift toward using “sex selection” to be more precise. In the context of IVF, what is being identified are the biological sex chromosomes of the embryo (XX or XY), not gender identity. Many clinics and medical organizations use the term “sex selection” for accuracy, while “gender selection” remains widely used by patients searching for information.
Can international patients come to ARC for gender selection?
Yes. ARC works with patients from around the world, including those from countries where elective sex selection is not permitted. We coordinate with your local physicians to complete preliminary testing before you travel to California. Contact ARC to learn how we support international patients.
Take the Next Step Toward Your Family
Choosing the sex of your baby is a real option, backed by proven science, and fully legal in California. Whether you are pursuing gender selection for medical reasons, family balancing, or personal preference, ARC is here to guide you through the entire process.
With in-house genetic testing, experienced physicians, and a care team that treats every patient like family, ARC provides a supportive, transparent path to the family you are building.
Contact American Reproductive Centers today to schedule your gender selection consultation.
