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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 Artificial insemination; intra-cervical
58322     intra-uterine
58974 Embryo transfer, intrauterine
58976 Gamete, zygote, or embryo intrafallopian transfer, any method
88182 Flow cytometry, cell cycle or DNA analysis
88184 Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker
+ 88185     each additional marker (List separately in addition to code for first marker)
88187 Flow cytometry, interpretation; 2 to 8 markers
88188     9 to 15 markers
88189     16 or more markers
89261 Sperm isolation; complex prep (e.g., Percoll gradient, albumin gradient) for insemination or diagnosis with semen analysis
89268 Insemination of oocytes
89300 Semen analysis; presence and/or motility of sperm including Huhner test (post coital)
89310     motility and count (not including Huhner test)
89320      volume, count, motility, and differential
89321 Sperm presence and motility of sperm, if performed
96040 Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family
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
CPT Codes / HCPCS Codes / ICD-10 Codes
Information in the [brackets] below has been added for clarification purposes.   Codes requiring a 7th character are represented by "+":
ICD-10 codes will become effective as of October 1, 2015 :
Preconceptional sex selection techniques:
No specific code
Other CPT codes related to this CPB:
58321 Artificial insemination; intra-cervical
58322     intra-uterine
58974 Embryo transfer, intrauterine
58976 Gamete, zygote, or embryo intrafallopian transfer, any method
88182 Flow cytometry, cell cycle or DNA analysis
88184 Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker
+ 88185     each additional marker (List separately in addition to code for first marker)
88187 Flow cytometry, interpretation; 2 to 8 markers
88188     9 to 15 markers
88189     16 or more markers
89261 Sperm isolation; complex prep (e.g., Percoll gradient, albumin gradient) for insemination or diagnosis with semen analysis
89268 Insemination of oocytes
89300 Semen analysis; presence and/or motility of sperm including Huhner test (post coital)
89310     motility and count (not including Huhner test)
89320      volume, count, motility, and differential
89321 Sperm presence and motility of sperm, if performed
96040 Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family
Other HCPCS codes related to this CPB:
S0265 Genetic counseling, under physician supervision, each 15 minutes
S4011 - S4042 In vitro fertilization and related services


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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