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Clinical Policy Bulletin:
Preconceptional Sex Selection Techniques
Number: 0323


Policy

Aetna considers preconceptional sex selection techniques for enriching sperm samples for X spermatozoa medically necessary only when used to prevent the conception and birth of a male child to a woman who is known to be heterozygous for a seriously handicapping X-linked condition (e.g., Lesch-Nyhan disease).

Assisted reproductive techniques, including in-vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI) are not considered treatment of disease when the sole indication for the procedure is sex selection and not to prevent birth of child with a seriously handicapping genetic defect.

Note: The option of various post-sperm sorting infertility services (e.g., intra-uterine insemination, IVF, gamete intra-fallopian transfer [GIFT]) may be restricted depending upon the member's specific plan benefits.  Aetna provides coverage for IVF and other assisted reproductive technologies (ART) to treat infertility, where required by state mandate and when the member's plan provides for such coverage.  Please check benefit plan descriptions for details.

See also CPB 0327 - Infertility and CPB 0358 - Invasive Prenatal Diagnosis of Genetic Diseases.



Background

Primary sex selection (i.e., prior to fertilization using sperm sorting) has been suggested as an alternative to secondary sex selection (i.e., conception followed by prenatal diagnosis and abortion of affected fetuses) in couples known to be at increased risk for specific, detectable, heritable disorders.  Preconceptional sex selection techniques have been proposed as a mechanism to minimize the risk of transmission of sex-linked diseases to potential offspring and are accomplished by differential sorting of X- and Y-bearing sperm using filtration and/or flow cytometry.

Sperm sorting techniques have been reported to result in samples enriched for X- or Y-bearing spermatozoa to levels as great as 75 %.  Although preconceptional sex selection through sperm sorting increases the likelihood of male or female offspring, it does not guarantee the sex of the fetus.  Therefore, when medically indicated, invasive prenatal diagnostic procedures to confirm the sex of the fetus should be offered to the patient utilizing preconceptional sex selection techniques.

The American College of Obstetricians and Gynecologists Committee on Ethics (ACOG, 2007) presented various ethical considerations and arguments relevant to both pre-fertilization and post-fertilization techniques for sex selection.  The principal medical reason for sex selection is known or suspected risk of sex-linked genetic disorders.  Other reasons sex selection is requested are personal, social, or cultural in nature.  The Committee on Ethics supports the practice of offering patients procedures for the purpose of preventing serious sex-linked genetic diseases.  However, the committee opposes meeting requests for sex selection for personal and family reasons, including family balancing, because of the concern that such requests may ultimately support sexist practices.  Because a patient is entitled to obtain personal medical information, including information about the sex of her fetus, it will sometimes be impossible for health care professionals to avoid unwitting participation in sex selection.

 
CPT Codes / HCPCS Codes / ICD-9 Codes
There are no specific CPT codes for preconceptional sex selection techniques:
Other CPT codes related to this CPB:
58321
58322
58974
58976
88182
88184
+ 88185
88187
88188
88189
89261
89268
89300
89310
89320
89321
96040
Other HCPCS codes related to this CPB:
S0265 Genetic counseling, under physician supervision, each 15 minutes
S4011 - S4042 In vitro fertilization and related services
Other ICD-9 codes related to this CPB:
V26.1 Artificial insemination
V26.31 - V26.39 Genetic counseling and testing


The above policy is based on the following references:
  1. Carson SA. Sex selection: The ultimate in family planning. Fertil Steril. 1988;50:16-19.
  2. Johnson LA, Welch GR, Keyvanfar K, et al. Gender preselection in humans? Flow cytometric separation of X and Y spermatozoa for the prevention of X-linked disease. Hum Reprod. 1993;8:1733-1739.
  3. Reubinoff BE, Schenker JG. New advances in sex preselection. Fertil Steril. 1996;66:343-350.
  4. Berkowitz, JM. Sexism and racism in preconceptive trait selection. Fertil Steril. 1999;71:415-417.
  5. Sills ES, Kirman I, Thatcher SS 3rd, et al. Sex-selection of human spermatozoa: Evolution of current techniques and applications. Arch Gynecol Obstet. 1998;261(3):109-115.
  6. American College of Obstetricians and Gynecologists (ACOG), Committee on Ethics. Sex selection. ACOG Committee Opinion No. 177. Washington, DC: ACOG; November 1996.
  7. Ethics Committee of the American Society of Reproductive Medicine. Sex selection and preimplantation genetic diagnosis.  Fertil Steril. 1999;72(4):595-598.
  8. Robertson JA. Preconception gender selection. Am J Bioeth. 2001;1(1):2-9.
  9. Malpani A. Preconceptional sex selection. CMAJ. 2002;166(3):301.
  10. Sauer MV. Gender selection: Pressure from patients and industry should not alter our adherence to ethical guidelines. Am J Obstet Gynecol. 2004;191(5):1543-1545.
  11. Ethics Committee of the American Society for Reproductive Medicine. Preconception gender selection for nonmedical reasons. Fertil Steril. 2004;82 Suppl 1:S232-S235.
  12. Schulman JD, Karabinus DS. Scientific aspects of preconception gender selection. Reprod Biomed Online. 2005;10 Suppl 1:111-115.
  13. American College of Obstetricians and Gynecologists (ACOG), Committee on Ethics. Sex selection. ACOG Committee Opinion No. 360. Obstet Gynecol. 2007;109(2 Pt 1):475-478.
  14. Kluge EH. Sex selection: Some ethical and policy considerations. Health Care Anal. 2007;15(2):73-89. 


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Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
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