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Social and practical implications of fetal sex determination using ultrasound

Following recent debate on prenatal sex selection, the Council of Europe has resolved to encourage national ethics bodies to develop and introduce guidelines for medical staff discouraging prenatal sex selection by whatever means unless justified for the prevention of serious sex-linked genetic diseases. Ultrasound is the most common method for determining sex prenatally and is used for medical and social reasons. In some countries where male offspring are more desirable, fetal sexing during ultrasound examinations has been outlawed due to growing concern that large numbers of female fetuses are being terminated. Although Council of Europe decisions are not binding on the UK, it is timely to examine the use of ultrasound for the determination of fetal sex in the UK and to discuss some of the reasons behind why ultrasound cannot always get it right. We describe sex-linked conditions where sex identification is especially important and conditions and circumstances which make sexing difficult, including ambiguous genitalia. The social aspects of determining the sex of the fetus during an ultrasound examination are also explored as there is no doubt that many women want to know either from curiosity or to help plan for the new arrival. We recommend that ultrasound practitioners remain aware of the accuracy and limitations of ultrasound for the determination of fetal sex and should therefore exercise due caution when imparting sex information to parents.