Opinions concerning pre-implantation genetic diagnosis and sex selection among gynecologist-obstetricians in Brazil George H. Caldas a,b, *, Erika Caldas a,c , Edilson D. Arau ´ jo c , Tatiana C.S. Bonetti a,d , Cla ´ udio B. Leal b , Aure ´ lio M. Costa b a Medicine Center of Sergipe – Fertility Clinic, CEMISE-CLIFERT, Aracaju, SE, Brazil b University of Pernambuco – UPE, Recife, PE, Brazil c Federal University of Sergipe/RENORBIO – UFS, Aracaju, SE, Brazil d Federal University of Sa˜o Paulo – UNIFESP, Sa˜o Paulo, SP, Brazil 1. Introduction Assisted reproductive technology (ART) and pre-implantation genetic diagnosis have engendered complex scientific, social, ethical and political dilemmas related to their application [1]. In vitro fertilization (IVF) offers unique access to the oocyte and embryo and presents the ability to diagnose genetic diseases before embryo implantation. Although pre-implantation genetic diagnosis (PGD) is most frequently used to test for specific genetic disorders, the potential applications of PGD for non-medical purposes are growing and include sex selection (SS) of embryos for social or cultural reasons [2,3]. Besides PGD, another technology, the cell sorting by flow cytometer that separates the 2.8% heavier X-bearing sperm from its Y-bearing counterparts to produce an X- or Y-enriched sperm sample for artificial insemination or IVF; such a procedure allows for preconception SS of embryos [4]. PGD is a treatment option that is relatively unregulated and lacks standardization compared with other forms of diagnostic testing. Professional organizations have developed some PGD specific guidelines; however, there are numerous ethical and moral issues surrounding the question of whether and under what circumstances the use of PGD is acceptable [2,3,5–7]. The United States is one of the few countries in the world that permits PGD and SS for both medical and non-medical reasons [8]. In Brazil, the Federal Medicine Counselor (Conselho Federal de Medicina – CFM) agreed that avoiding sex-linked genetic diseases is an ethical use of PGD and allows it under these conditions. However, the practice of PGD for non-medical reasons is currently prohibited [9]. Surveys assessing the opinions of infertile patients and general population on SS have been conducted [1,8,10–16]. However, some health care providers have argued that decisions about the appropriate use of reproductive technologies are best made between providers and their patients [17,18]. Although health care professionals working in, or linked to ART, are likely to encounter ethical controversies, there is a paucity of European Journal of Obstetrics & Gynecology and Reproductive Biology 148 (2010) 158–162 ARTICLE INFO Article history: Received 12 May 2009 Received in revised form 22 September 2009 Accepted 19 October 2009 Keywords: Pre-implantation genetic diagnosis Sex selection Opinion Gynecologist-obstetricians ABSTRACT Objective: The aim of this study was to assess a sample of obstetrician-gynecologists on their technical knowledge of PGD as well as their views of PGD and sex selection (SS). Study design: Cross-sectional observational study, carried out during a Congress on Gynecology and Obstetrics. A self-report questionnaire was offered to all professionals registered to attend the Congress and answers of 723 physicians were analyzed. Results: Of the participants, 436 (60.3%) were female and 287 (39.7%) were male; 517 (71.5%) had children. Regarding knowledge of PGD techniques, 63.2% had heard something about PGD and/or preconception SS. Concerning SS, physicians believed that SS is always the couple’s choice (36.4%), should be the couple’s choice only in specific situations (42.6%), or did not agree that SS should be a couple’s choice (17.4%). A majority of the respondents were in favor of PGD and believed that pre- embryos with 6–8 cells are human life in potency. Conclusions: In spite of a small percentage of gynecologists-obstetricians in Brazil had knowledge of PGD techniques, many of them recognized it to be a method to prevent genetic diseases and agreed with its use. The SS appears to be highly accepted for use in specific situations. ß 2009 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Medicine Center of Sergipe – Fertility Clinic, CEMISE- CLIFERT, Rua Construtor Joa ˜o Alves, n8 228, Sa ˜o Jose ´ , Aracaju 49025-340, SE, Brazil. Tel.: +55 79 3234 1000; fax: +55 79 3234 1000. E-mail addresses: cientifico@cemise.com.br, tatiana@cemise.com.br (G.H. Caldas). Contents lists available at ScienceDirect European Journal of Obstetrics & Gynecology and Reproductive Biology journal homepage: www.elsevier.com/locate/ejogrb 0301-2115/$ – see front matter ß 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejogrb.2009.10.023