Vita Altera IVF Center
Gender Selection
Gender selection, meaning the selection of an embryo based solely on personal preference for a girl or boy, is not a routine IVF service that can be practiced in the Turkish Republic of Northern Cyprus (TRNC). The use of preimplantation genetic testing for the purpose of gender selection is prohibited in the TRNC. It may only be considered as an exception if there is a risk of a serious sex-linked hereditary disease or another documented medical necessity, following the completion of specialist evaluations and upon the center obtaining permission from its Coordination Board.
Is Gender Selection Legal in the TRNC?
In the TRNC, selecting an embryo’s gender based on personal preference, family balancing, or social reasons is not a legally permitted IVF practice.
The TRNC Regulation on Assisted Reproductive Treatment Centers and Assisted Reproductive Treatment Methods prohibits the use of preimplantation genetic screening for the purpose of gender selection.The Regulation only foresees an exception if gender selection is mandatory due to a medical necessity. In such cases, the center performing the treatment must apply to the Coordination Board and obtain permission before the procedure.A patient or couple having consulted with only one doctor, or the doctor finding the procedure suitable, does not replace official permission. The medical justification must be documented, genetic evaluations must be completed, and the necessary board approval must be obtained.Important legal noticeVita Altera IVF Center does not offer gender selection services for personal preference, family balancing, or the sole desire to have a girl or boy. This page is prepared solely to explain the medical and legal framework of gender selection in the TRNC.
What is Gender Selection?
Gender selection refers to practices aimed at preferring an embryo or reproductive cell of a specific gender before pregnancy is established.
In IVF treatment, information about the sex chromosomes of embryos can emerge during the genetic analysis of a cell sample taken from the embryo.An egg cell normally carries an X chromosome. A sperm cell can carry either an X or a Y chromosome. The formation of an XX or XY chromosomal structure in the embryo is related to the sex chromosome originating from the sperm cell.The technical possibility of obtaining information about an embryo’s sex chromosomes does not mean that using this information for personal preference is legally permissible.Gender determination and gender selection are not the sameDetermining the sex chromosomes of an embryo during a genetic test is a laboratory result. Giving priority to an embryo of a specific sex solely due to personal preference constitutes gender selection and is prohibited in the TRNC except in cases of medical necessity.
For Which Purposes Cannot Gender Selection Be Performed?
Unless there is a serious medical risk linked to gender, personal, cultural, social, or familial preferences do not constitute a valid medical reason for gender selection.
- Desiring the first child to be a girl or a boy
- Desiring a boy because there are only girls in the family
- Desiring a girl because there are only boys in the family
- For the purpose of family balancing
- Cultural or traditional expectations
- Preference of grandparents or one of the spouses
- Reason of inheritance, surname, or continuation of the family line
- Belief that raising a child of a specific gender would be easier
- Unsubstantiated beliefs that an embryo of a certain gender would be more successful
- Purely for curiosity or preference without any risk of genetic disease
Family balancing is not a medical necessityThe fact that a family previously has only girls or only boys does not, by itself, constitute a medical or legal justification for selecting the gender of an embryo.
What Does Gender Selection Mean in Case of Medical Necessity?
Medical necessity may mean that there is a risk of a serious hereditary disease associated with sex chromosomes in the child to be born, and that embryos of a certain sex carry a higher risk for the disease.
In some X-linked diseases, there is a possibility of disease transmission from a female carrier to a male child. This is because males have only one X chromosome.However, the presence of a history of any genetic disease in the family does not automatically mean that gender selection can be performed. The genetic change causing the disease, its mode of inheritance, and the risk of transmission to the embryo must be evaluated by a genetic specialist.The decision on medical necessity is not based on the patient’s request but on genetic test results, family pedigree, disease reports, specialist physician opinions, and the applicable PGT method.Doctor’s approval alone is not sufficientA specialist doctor and geneticist can evaluate the medical necessity; however, for the procedure to be performed in the TRNC, the center performing the treatment must apply to the Coordination Board and obtain official permission.
What is a Sex-Linked Hereditary Disease?
Sex-linked hereditary diseases are genetic conditions where the genetic change associated with the disease is located on the X or Y chromosome.
In X-linked recessive diseases, women can be carriers of the genetic change associated with the disease. A male child can be affected by the disease when he inherits the X chromosome carrying the disease-associated change from his mother.Because female children have two X chromosomes, the other healthy X chromosome can often reduce the effect of the disease. However, it is also possible for female children to be carriers or, in some cases, be affected by the disease.Therefore, simply determining whether an embryo is female or male is not always a sufficient genetic evaluation. If the change causing the disease is known, directly examining the embryo for the relevant genetic change may be more appropriate.Hemophilia A and B
Genetic disorders affecting blood clotting, mostly inherited in an X-linked manner.Duchenne Muscular Dystrophy
An X-linked disease that can cause progressive muscle weakness, primarily affecting male children.X-Linked Adrenoleukodystrophy
A group of X-linked hereditary diseases that can affect the nervous system and adrenal glands.Other X-Linked Diseases
If a different X-linked disease is identified in the family, a personalized evaluation is conducted by a genetic specialist.Knowing the disease name is not sufficientFor PGT-M to be applicable, the genetic change causing the disease in the family usually needs to be identified through molecular tests. The mere presence of similar symptoms in the family does not replace a definitive genetic diagnosis.
What Does It Mean to Be a Carrier of a Genetic Disease?
A carrier of a genetic disease is a person who carries a genetic change associated with a disease but does not show symptoms of the disease or shows limited symptoms.
Not every carrier status requires gender selection. In autosomal recessive diseases, the risk may be independent of the child’s gender, and both male and female children can be affected.In autosomal recessive diseases such as Beta Thalassemia, Cystic Fibrosis, or Spinal Muscular Atrophy, the embryo’s gender does not determine the disease risk. In these cases, the issue to be investigated is whether the embryo carries the genetic changes that cause the disease.Medical evaluation regarding gender selection can be considered primarily in cases where the disease is linked to the X or Y chromosome and poses a significant risk for a specific sex.Not every genetic carrier status allows gender selectionThe relationship of the carrier status with sex chromosomes, the severity of the disease, the risk of transmission, and whether it can be directly investigated with PGT-M are evaluated by the genetic specialist and the relevant board.
Differences Between PGT-A, PGT-M, and Sex Chromosome Analysis
Observing an embryo’s sex chromosomes and investigating a specific genetic disease in the embryo are not the same procedure or the same medical purpose.
PGT-A
Aims to evaluate chromosomal number variations in embryos. Information about X and Y chromosomes may be generated, but it does not directly indicate a specific single-gene disease.PGT-M
Investigates whether a specific single-gene disease or a disease-associated genetic change, previously identified in the family, is present in the embryo.Sex Chromosome Information
Information regarding the embryo’s XX or XY chromosomal structure. Using this information for personal preference is prohibited in the TRNC.PGT-A is not a test for sex-linked diseasesThe presence of information about sex chromosomes in a PGT-A result does not definitively show whether an embryo is affected by a specific X-linked disease. If the disease-associated genetic change is known, a personalized PGT-M may be necessary.
Why Is Looking Only at the Embryo’s Sex Not Sufficient?
In families at risk for sex-linked diseases, the primary medical goal is not to select a specific gender but to reduce the risk of transmitting a serious hereditary disease to the future child.
In an X-linked recessive disease, not all male embryos will be affected. A male embryo is affected only if it inherits the X chromosome carrying the disease-associated genetic change.Similarly, not all female embryos are genetically risk-free. Female embryos can be carriers of the disease-associated change or, depending on the nature of the disease, may show symptoms.If the disease-associated genetic change can be identified, performing PGT-M directly can provide more detailed information compared to making decisions based solely on sex chromosomes.The goal is not to select a specific gender, but to evaluate disease riskThe medical program should be prepared to reduce disease transmission. Information about gender can only be considered to the extent necessary for the disease’s inheritance and within the framework of official permission.
Who Can Be Considered for Medical Evaluation?
Being considered for medical evaluation does not mean that the procedure will definitely be performed or that board approval will be obtained.
- Individuals with a history of a serious X-linked disease in their family
- Women whose carrier status for an X-linked disease has been confirmed by molecular testing
- Families who previously had a child affected by a sex-linked genetic disease
- Couples who received a diagnosis of a serious sex-linked genetic disease in a previous pregnancy
- Families where the same disease is observed in multiple male or female individuals in the family pedigree
- Individuals for whom a genetic specialist has determined a risk of transmission related to sex chromosomes
- Special cases where the direct genetic change cannot be identified but the risk of a serious X-linked disease is strongly documented
- Individuals deemed appropriate for evaluating medical necessity by the specialist physician, geneticist, and the center
Application evaluation does not mean approvalEach case is examined separately in terms of medical reports, inheritance pattern, disease severity, and applicable genetic tests. Final approval for the procedure requires permission from the Coordination Board.
Which Documents and Tests Might Be Required?
The required documents may vary depending on the disease in the family, existing genetic results, and the health status related to the IVF treatment.
Genetic Documents
- Genetic test report of the affected individual in the family
- Carrier results for the prospective mother and father
- Molecular report of the genetic variant causing the disease
- Karyotype (chromosome analysis)
- Prenatal diagnosis results from previous pregnancies
- Health and genetic reports of the affected child
- Detailed family pedigree and inheritance evaluation
- Genetic counseling report
IVF Evaluations
- Gynecological examination and ultrasound
- AMH and ovarian reserve tests
- Required hormone tests
- Semen analysis
- Infectious disease screenings
- General health and anesthesia evaluation
- Previous IVF and embryology reports
- Assessment of the uterus and endometrium
Genetic reports must be reviewed before treatmentPGT-M may require personalized test preparation for some families. Therefore, the genetic laboratory may need to review existing reports and confirm the technical feasibility of the test before starting ovarian stimulation medication.
How Does the Process for Medical Eligibility and Official Approval Proceed?
For patients at risk of sex-linked diseases, the process involves more than just IVF treatment. Genetic evaluation and official approval stages must also be completed.
1
Initial medical consultation
Detailed information is obtained about the disease in the family, previous pregnancies, affected children, and available genetic tests.2
Review of genetic reports
The relationship of the disease with the X or Y chromosome, the genetic change, and the transmission risk are evaluated by a genetic specialist.3
Genetic counseling
The inheritance pattern of the disease, the risk rate for the child, the PGT-M option, alternative methods, and the limitations of the test are explained.4
Documentation of medical necessity
Why sex chromosome information is necessary and the feasibility of direct disease testing are explained through specialist reports.5
Genetic laboratory preparation
If PGT-M is to be applied, a family-specific test system is prepared, and necessary DNA samples are evaluated.6
Application to the Coordination Board
The center performing the treatment applies to the Coordination Board with the necessary medical, genetic, and administrative documents.7
Official approval evaluation
The application is reviewed for medical necessity and compliance with current regulations. No procedure intended for gender selection can be performed without approval.8
Planning of IVF treatment
After approval and genetic laboratory preparation are completed, an IVF program suitable for the prospective mother’s ovarian reserve is established.9
Egg retrieval and microinjection
Mature eggs are collected and fertilized in the laboratory with suitable sperm cells.10
Monitoring embryo development
Embryos formed from fertilized eggs are followed until the blastocyst stage suitable for biopsy.11
Embryo biopsy and PGT
A limited number of cells are taken from suitable embryos to evaluate the disease-associated genetic change and necessary chromosomal information.12
Embryo vitrification
Embryos are stored using the vitrification method until genetic results are completed.13
Genetic interpretation of results
Embryos may be reported as affected, unaffected, carrier, uncertain, or no result.14
Embryo transfer
Official approval, genetic results, embryo development, and endometrial preparation are evaluated together to plan the transfer of a suitable embryo.15
Pregnancy and prenatal follow-up
If pregnancy occurs, routine check-ups are continued, and the prenatal screening or diagnostic tests recommended by the genetic specialist are separately evaluated.What Information Can PGT Results Provide?
The scope of the PGT result varies depending on the type of test performed and the genetic disease investigated in the family.
Unaffected Embryo
Indicates that the genetic result associated with the investigated disease was not detected in the embryo.Affected Embryo
May indicate that the embryo carries the genetic change causing the investigated disease in a manner that will result in the disease.Carrier Embryo
May indicate that the embryo carries the relevant genetic change in a way that could potentially be passed to future generations, even if the embryo itself is not expected to be affected by the disease.No Result
Interpretable genetic results could not be obtained for the embryo due to DNA quantity or technical reasons.PGT does not guarantee 100% accuracyEmbryo biopsy involves examining a limited number of cells from the embryo. Due to technical and biological reasons, there is a possibility of erroneous, uncertain, or no-result reports, so genetic evaluations during pregnancy remain important.
Limitations of PGT and Embryo Biopsy
The presence of medical necessity and official approval does not mean that the treatment will necessarily result in a suitable embryo or pregnancy.
Lack of embryos reaching biopsy stage
Not all collected eggs may fertilize, and not all resulting embryos may reach the biopsy stage.No embryo with a suitable result
All tested embryos may show results that are affected by the investigated disease or unsuitable for transfer.No result
Interpretable results may not be obtained from some embryos due to DNA quantity, biopsy sample, or technical reasons.Impact of embryo procedures
Even when performed by an experienced team, the possibility of the embryo being affected by procedures like biopsy, freezing, and thawing cannot be completely eliminated.Uninvestigated diseases
PGT only provides information about the planned genetic disease and chromosomal conditions covered by the test.No guarantee of pregnancy
Transferring a genetically suitable embryo does not guarantee implantation, ongoing pregnancy, or live birth.Does PGT Replace Genetic Tests Performed During Pregnancy?
PGT involves examining a limited number of cells taken from an embryo before pregnancy and does not replace all screening or diagnostic tests during pregnancy.
If pregnancy occurs, routine ultrasounds and pregnancy screenings appropriate for the mother’s age are continued.After PGT-M, prenatal diagnostic methods such as chorionic villus sampling or amniocentesis can be discussed with the genetic specialist and obstetrician to confirm the investigated genetic results.NIPT is a screening test and is not the same as diagnostic tests like amniocentesis or chorionic villus sampling.Pregnancy monitoring must continueThe fact that PGT was performed on the embryo does not mean that there is no need for ultrasound, prenatal screening, or diagnostic tests if deemed necessary during pregnancy.
Vita Altera’s Approach
At Vita Altera, requests related to sex chromosomes are evaluated not as a personal preference service, but within the framework of serious genetic disease risk and current TRNC regulations.
- Not accepting requests for personal preference or family balancing
- Reviewing existing genetic reports before treatment
- Evaluating the risk of sex-linked hereditary diseases
- Coordination between the genetic specialist and IVF doctor
- Assessing the feasibility of PGT-M with the genetic laboratory
- Documenting medical necessity with reports
- Making an official application to the Coordination Board
- Not starting the procedure without official approval
- Coordination of embryo biopsy and genetic laboratory
- Explaining genetic results with counseling
- Clearly communicating the risks and limitations of PGT
- Providing recommendations for prenatal follow-up if pregnancy occurs
- Protection of patient privacy and genetic data
- Support from a personal patient coordinator
- Opportunity for online preliminary medical evaluation
This page is not an advertisement for gender selection servicesThe purpose of this page is to accurately explain the legal prohibition in the TRNC and the exceptional official process that can only be applied in cases of medical necessity.
Frequently Asked Questions About Gender Selection
Is gender selection legal in the TRNC?
Gender selection for personal preference or family balancing is prohibited. It may only be considered exceptionally in cases of medical necessity and upon the center obtaining permission from the Coordination Board.
Can a girl or boy be selected for family balancing purposes?
No. Having only girls or only boys previously does not constitute a medical necessity.
Can the gender of the first child be selected?
No. The gender of the first or subsequent children cannot be selected based on personal preference unless there is a documented medical necessity related to a genetic disease.
Is a doctor’s approval sufficient?
No. The specialist doctor’s opinion is part of the medical file. The center must apply to the Coordination Board and obtain official permission.
For which diseases can a medical evaluation be performed?
Serious X-linked hereditary diseases such as Hemophilia or Duchenne Muscular Dystrophy can be considered as examples. Definitive suitability is determined by examining the genetic cause of the disease and the transmission risk in the family.
Is gender selection required for every genetic disease?
No. The risk for many genetic diseases is the same for male and female children. In such cases, the embryo’s gender should be investigated via PGT-M for the genetic change causing the disease, rather than selecting based on sex.
Is being a carrier of a genetic disease sufficient to get approval?
No. Which disease the carrier status is related to, whether the disease is sex chromosome-linked, the transmission risk, and alternative genetic tests are evaluated.
Can the embryo’s gender be seen with PGT-A?
Information about X and Y chromosomes may appear during PGT-A. However, using this information for personal preference is prohibited in the TRNC.
Does PGT-A show sex-linked genetic diseases?
PGT-A primarily evaluates chromosomal number variations. PGT-M may be required to investigate disease-associated changes in a specific gene.
What is PGT-M?
PGT-M is a preimplantation genetic testing method that investigates whether a specific single-gene disease or genetic change, previously identified in the family, is present in the embryo.
Does selecting only female embryos completely eliminate the disease risk?
Not always. Female embryos can be carriers of the disease-associated change and, in some X-linked diseases, may show symptoms. Directly investigating the genetic change may be more appropriate.
Are all male embryos affected by an X-linked disease?
No. Whether a male embryo is affected by the disease depends on whether it inherits the X chromosome carrying the disease-associated genetic change from the mother.
Does the patient make the official approval application?
According to the Regulation, the required application is made to the Coordination Board by the assisted reproductive treatment center that will perform the treatment.
Is board approval guaranteed?
No. The application is evaluated based on the medical justification, genetic risk, and submitted documents. Making an application does not guarantee approval.
Can PGT be performed without board approval?
In cases where PGT is intended for gender selection, the procedure cannot be performed without medical necessity and Coordination Board approval.
Does PGT guarantee pregnancy?
No. The presence of a genetically suitable embryo does not guarantee implantation, continuation of pregnancy, or live birth.
Is the PGT result definitive?
No genetic test provides a 100% guarantee of accuracy. Due to limited cell samples and technical reasons, false, uncertain, or no-result reports may occur.
Are genetic tests needed during pregnancy after PGT?
Standard pregnancy follow-ups continue. Depending on the investigated disease, prenatal diagnostic options such as chorionic villus sampling or amniocentesis can be discussed with the genetic specialist.
Is the embryo’s gender information shared with the patient?
Reporting and sharing of information are evaluated based on the purpose of the test performed, medical necessity, patient consent, and current regulations. The information cannot be used to select embryos for personal preference.
Is a price provided for gender selection?
As gender selection for personal preference is not a legal service, packages or prices are not offered for this purpose. For patients with medical genetic risks, the PGT program, genetic evaluation, and official approval process are planned separately.
Can the initial evaluation be done online?
Yes. Existing genetic reports and documents of affected individuals in the family can be shared for preliminary review. An online consultation does not constitute official board approval or a definitive treatment decision.
Which documents should be sent for the initial evaluation?
Carrier tests, genetic reports of affected family members, previous pregnancy results, family pedigree, AMH, sperm analysis, and previous PGT or IVF reports can be sent.
