In God’s Hands?

Boy or Girl? Through in-vitro fertilization Jeffrey Steinberg, 52, has been helping infertile couples to conceive for about 20 years. Then he began to offer sex selection to couples. Today he’s the most sought after sex selection doctor in the world.

Interview: Peter Hossli

jeffrey_steinberg_peter_hossliDoctor Steinberg, do you have Children?
Jeffrey Steinberg: Three, two girls and one boy.

Who selected their sex?
Steinberg: My wife and I did it the old-fashioned way and let it happen by chance. We’d also be very happy to have three girls.

Your clients are different. They come to you because they absolutely want to have a boy or a girl. What’s your success rate?
Steinberg: It stands at 100 percent. I’ve never made a mistake.

How do you do that?
Steinberg: Before I implant an embryo into the uterus I test its genetic material. I can see whether it has two X or a Y and an X chromosome. With absolute certainty I can say whether an embryo will be a boy or a girl.

This pre-implementation diagnosis is very controversial. Many European countries outlaw it. How long have you been practicing it?
Steinberg: The technology has been available for about eight years. Originally I only used it to test for genetic abnormalities. For the last four years I’ve been offering sex selection.

How has your business changed?
Steinberg: 75 percent of my clients were infertile couples who wanted to test their embryos for genetic diseases. Now 75 percent want to test them for their sex.

How many couples do see?
Steinberg: I have about three or four couples per day or roughly a 1000 children per year. My waiting list is rather long. Couples wait up to four months to see me. The demand for my services is surpassing all the expectations. Nobody is selecting the sex of more embryos than I.

This makes you a very rich man. For each selection cycle you charge 18480 dollars, which translates into annual revenue of about 18 million dollars. What does money mean to you?
Steinberg: The prospect of money did not make want to become a fertility doctor. Later in my career money became somewhat important because I had to pay salaries. Now it has hardly any meaning, I have enough to live.

You became a multimillionaire by playing God.
Steinberg: I don’t play God. I study how God works. I learn from God. But I don’t alter God’s work more than a surgeon who removes an inflamed appendix. The patient survives only because the surgeon interferes. I don’t even interfere. I only make a choice.

An inflamed appendix is life threatening. Whether somebody has a boy or a girl is not a question of life and death.
Steinberg: Exactly. Neither is the question whether somebody wants to enlarge her breasts of fix his nose. These are things that can make somebody’s life better. I live in Los Angeles. People want to better their lives all the time. They always want to look better and feel better.

Then you don’t offer a medical service, you offer a lifestyle?
Steinberg: Yes, in a sense. Many of my patients consider a sex-balanced family an important part of their lifestyle. Women see me who have five sons and long to finally have a daughter whom they can dress girlish. Shall we deny these women that wish even tough the technology can help them? «No», says the ethics commission of the American Society for Reproductive Medicine. They don’t support this method. But they leave to decision about families to the patients. I understand critics who say we should test embryos only for genetic disorders, not for the sex. But then we should not enlarge breasts, whiten teeth or operate on eyes.

Do you ask couples on why they come to you?
Steinberg: Never. But all of them volunteer it to me during the first meeting. They want to get rid of their guilty feelings.

Historically, sex selection goes as far back as the Old Egyptians. What are the reasons your patients give you?
Steinberg: A woman who has five sons wants a daughter so she can have the same mother-daughter relationship she had with her mother. I can understand this really well. For many cultures it is very important to pass on the family name. If a family has only girls, they might want a boy to pass on the name.

These are rather trivial reasons.
Steinberg: This is possible. It is not up to me to judge.

Are you religious?
Steinberg: I’m Jewish, my children take religious classes.

What does your Rabbi say about sex selection?
Steinberg: He accepts it. Jewish faith has no problem with it. The Rabbi says: «be fruitful and multiply», he does not say how we should do that.

There are couples that need the genetic material of a boy or a girl to help an already living child. Do you help them?
Steinberg: Of course I do.

Then you fabricate designer babies?
Steinberg: I don’t fabricate babies. I observe a process and then I select. I drop a sperm on an egg and see what nature does. I don’t change the genetic material.

You describe an in-vitro fertilization like a visit to the dentist. If you offered your services in Europe, you would go to jail.
Steinberg: Many things American fertility doctors are offering is punishable by law not only in Europe, but also in many parts of the world. In the United States, reproduction is considered a private matter. The government cannot interfere. All I do is legal. America is a country that was founded by people who wanted to decide for themselves. This is especially true in very private matters like reproduction.

So it is a right to have either a boy or a girl?
Steinberg: I don’t tell anybody to do this. The government doesn’t tell anybody to either have a boy or a girl. It’s up to the parents to decide. I’m obliged to properly use the technology.

There are historic reasons for Europe’s reservation. Selection reminds many people of Eugenics, a dismal chapter of the Nazi area.
Steinberg: You’re talking about a fascist state that decided whether life was worthy or not. We leave every decision to the couple that is about to conceive. Nobody is forcing anybody. This is an essential difference.

You profit from laws that ban sex selection in other countries. How many of your clients are foreigners?
Steinberg: More than 60 percent come from abroad. We work with fertility clinics from all over the world. Normally, foreign women get tested and hormonally stimulated at home. They only see me for the in-vitro fertilization because it is outlawed in their home country. I fertilize the eggs, test and implant them. After five days, they fly home pregnant. Many of them are outraged that they have to leave their countries to do this.

Where are your clients come from?
Steinberg: Most of them fly in from Asia, from Japan, Korea, Singapore, many from China. Then we have many European patients, mostly from Britain, Germany and France, but also from Australia and Canada.

You have Chinese clients?
Steinberg: We have a lot of Chinese couples seeing me.

What sex do they select?
Steinberg: They always want boys.

China has a gender imbalance because of its one-child policy. There are 140 boys to 100 girls in certain parts of the country.
Steinberg: I’ve been to China many times. People told me these horrible stories about girls being dropped on the side of the road. If I can choose between helping a family to have a boy or a girl being dropped off at the side of a road, I choose to help the family have a boy.

By doing that you strengthen sexism in China.
Steinberg: That’s right. But this is a problem that the Chinese need to solve internally.

Therefore sex selection is just a business for you?
Steinberg: Of course not, it is happy medicine. I could be treating cancer patients, but that is sad medicine. There is nothing more satisfying than helping an infertile couple to have a child.

Nevertheless, sex selection is strengthening sexism towards boys.
Steinberg: You’re wrong. The statistics tell another story. There are cultural differences. Asians prefer boys while Canadians choose girls in 75 percent of all cases. South Americans also prefer girls. Overall I select as many girls as boys.

There is another method of sex selection. In the US it is legal to determine the sex of an embryo that is already in the uterus and then have an abortion, depending on the sex of the child. Do you offer this?
Steinberg: I’d never do this. I consider this as a form of Genocide. I offer a much safer and ethically less problematic method.

When does life begin?
Steinberg: With the viability to live, which starts in week 23 of a pregnancy.

Originally fertility doctors said they would never use pre-implementation for sex selection. Why did your guild change that?
Steinberg: Normally society follows technological progress. About twenty years ago I was one of the first doctors who offered in-vitro fertilization. Our critics said that «test tube babies have no soul». Today, you can walk in a cocktail party and have the guests have test tube babies. Nobody even talks about it anymore.

With pre-implementation diagnosis you can test not only the sex of an embryo.
Steinberg: We can test about 200 often really bad genetic diseases.

What do your clients want?
Steinberg: Many ask me whether I can test for hair or eye color, but also whether their children will be gay or straight. Right now, I cannot test that. Will it be available some day? Sure. Will I offer it? Only if the ethics commission approves it.

Parents spend 18000 dollar to have a desired child. They must have very high expectations. What happens, if the selected child does not meet those expectations?
Steinberg: All parents have high expectations and hopes for their children, including those that conceive naturally. Expectations always vary by sex, no matter whether the sex was selected in advance.

You conceived the old-fashioned way. Why did you not opt for sex selection?
Steinberg: If we had a third girl instead of a boy, I’d still be very happy. But I would choose a boy if we had a fourth child.