The Israeli National Committee for sex selection by pre-implantation genetic diagnosis: a novel approach (2005-2011).
BACKGROUND
Pre-implantation genetic diagnosis (PGD) for fetal sex selection raises complex dilemmas. In Israel, PGD is regulated by the Ministry of Health. It is basically prohibited, but exceptions can be made upon approval by the National Committee for Sex Selection by PGD for Non-Medical Reasons (the "Committee"). This report describes the Committee's work since its inception in May, 2005 through December, 2011.


METHODS
Files were abstracted onto a structured form. Discrete variables were analyzed by chi-square analysis, and continuous variables by T-Test.


RESULTS
During the study period 411 applications were received. Two-thirds of the applicants (n = 276; 67.2%) were Jewish and 26.8% were Moslem Arab. Over two-thirds (n = 285; 69.3%) had no children of the requested sex and ≥4 children of the opposite sex. Three-quarters of the requests were for a male (n = 308; 74.9%): 100% of Arab and 63% of Jewish applicants. Many noted more than one reason for their request. The most frequent category (n = 201; 48.9%) was a strong emotional desire, followed by medically-related reasons (n = 83; 20.2%). For 216 applications a decision was arrived at, with 46 (21.3%) approved. Of the remaining 195 for 192 over a year had passed since last contact with the Committee. The likelihood of approval was higher if applicants met the criterion of ≥4 same-sex children than if they didn't (33.7% vs. 11.6%, P = 0.001). The largest number of approvals were those requested for 'emotional' reasons, while the highest approval rate was for religious reasons.


CONCLUSIONS
This study reviewed the first seven years of Committee activity. Most requested males, and the primary reason was the parents' intense emotional desire. Only one-fifth of the decisions were approvals, possibly reflecting reluctance to encourage non-medically-indicated PGD, a viewpoint not unique to Israel. Limitations include the relatively small number of cases and lack of access to Committee deliberation protocols. It is recommended that longitudinal studies be conducted to gain insight into the consequences to individuals, couples and families--both those whose requests were approved and those denied-- of this major step in reproductive technologies and in society's effort to respond to them.
The National Social Work Service, Ministry of Health, 15 Noah Mozes St, Tel-Aviv, 67442 Israel.
Nirit
N
Pessach
Gertner Institute for Epidemiology and Health Policy Research Ltd, Women and Children's Health Research Unit, Tel Hashomer, 52621 Israel.
Saralee
S
Glasser
The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat-Gan, 52900 Israel.
Varda
V
Soskolne
Department of Obstetrics & Gynecology, Kaplan Medical Center, Pasternak St, P.O.B 1, Rehovot, 76100 Israel.
Amihai
A
Barash
Gertner Institute for Epidemiology and Health Policy Research Ltd, Women and Children's Health Research Unit, Tel Hashomer, 52621 Israel.
Liat
L
Lerner-Geva
Assisted human reproduction; Assisted-reproductive technology; Israel; PGD; Policy; Pre-implantation genetic diagnosis; Sex-selection