Health authorities in Western Australia have reportedly given the go-ahead to a fertility clinic to perform sex-selection of embryos for families at a “high risk” of having an autistic child. According to The West Australian:
There are no genetic tests for autism, so instead of looking for a gene mutation, the screening identifies the embryo’s sex because boys are at least four times more likely to develop autism.
The test, says the report, would be done in pre-implantation embryos, presumably from in vitro fertilization. In this case, “high risk” apparently means families who have two or more boys with “severe autism.”
No existing genetics testing can confirm or exclude most causes of autism. The rationale for this test is that because autism is diagnosed four times more often in boys than in girls, male embryos would not be selected for implantation. Some research has suggested that being female might be “protective” against autism. But other studies indicate that girls and women with autism present very differently from boys and might go undetected because existing criteria skew toward the manifestations in boys.
According to The West Austrialian, “chief medical officer Gary Geelhoed said it was a sensitive area.” That’s putting it mildly. Some autistic people are not happy and view the decision as eugenicist. At the least, given how multifactorial the causes of autism appear to be and the questions of how real the sex bias in autism is, the rationale being used appears flimsy. Certainly, selecting a female embryo does not guarantee against having an autistic child.
The Reproductive Technology Council of Western Australia held a forum last May in which this issue arose. During the forum, speaker Dr. Kathy Sanders, a chair at the council, said [PDF]:
What about conditions that may have a genetic basis but may also have a strong environmental impact and/or the genetic basis isn’t really understood at the moment, for example things like Autism, but we know that there is unequal sex incidence, for example males have about four times the incidence of Autism than females. Is it acceptable to screen on the basis of sex to avoid conditions like Autism? That has been accepted and has been done.
So, it’s unclear how frequent this practice is already. According to The West Australian, UK health authorities are also considering such allowances [ETA: this post from 2006 covers some of the history of this idea in the UK). The UK website of the Human Fertilisation and Embryology Authority lists autism as a “genetic condition awaiting consideration” for pre-implantation genetic diagnosis. Autism is not listed currently on their site as one of the conditions that would allow for sex selection if diagnosed pre-implantation.
Complicating matters even more is the fact that some research has found a small increased risk of autism and intellectual disability with some forms of in vitro fertilization.