Thanks to advances in reproductive technology like IVF with embryo genetic testing, gender selection is now a real and safe option for many intended parents.

Whether you’re considering choosing the sex of your baby with surrogacy for family balancing or to avoid a genetic condition, this guide will walk you through the process, the costs and what to expect.

If you’re considering surrogacy sex selection, we can help you find a reputable clinic that provides these services. Connect with a surrogacy specialist by filling out our online form.

Can You Choose the Sex of Your Baby With Surrogacy?

Yes — in many cases, it’s possible to choose your baby’s sex during the surrogacy process. But it doesn’t involve creating an embryo of a specific sex.

Instead, embryos are tested to identify their chromosomal makeup, which is what determines biological sex.

This is done through Preimplantation Genetic Testing for Aneuploidy (PGT-A).

While choosing the sex of your baby with surrogacy is possible, PGT-A’s primary purpose is to identify the embryos with the best chances of implanting.

How Does Sex Selection Work for Surrogacy? The Role of PGT-A

Sex selection begins with IVF. After eggs and sperm are combined to create embryos, doctors use PGT-A to evaluate each embryo’s chromosomal makeup.

This testing can determine whether an embryo is genetically male (XY) or female (XX).

Once testing is complete, your embryologist will choose which embryo to transfer based on health and, if desired, your preferred sex.

From there, that embryo is transferred to your surrogate, who carries the pregnancy.

How Much Does Sex Selection Cost?

PGT-A for embryo sex selection costs around $1,000 to $5,000. Embryo genetic testing also comes with potential benefits that go beyond choosing the sex of your baby.

PGT-A may improve the chances of selecting healthy embryos for transfer, which means avoiding:

• The emotional toll of a failed IVF cycle
• The cost of additional transfers
• The trauma of a pregnancy loss

PGT-A does not guarantee pregnancy but it can help you make informed decisions on your IVF and surrogacy journey. We encourage all intended parents to speak with a fertility specialist about whether PGT is right for them.

Get a breakdown of the cost of PGT-A per embryo.

Does Insurance Cover Gender Selection?

In most cases, insurance plans do not cover the cost of IVF sex selection unless there’s a medical reason. Genetic testing is generally considered non-essential by insurance providers.

However, if you are choosing sex selection to avoid a serious sex-linked genetic condition, your insurance may cover PGT-A or related procedures.

Some providers, like Aetna, offer limited coverage under certain conditions. It’s best to check with your insurance provider directly.

Is Sex Selection Ethical?

The ethics of surrogacy sex selection can be a sensitive subject. Some people feel strongly against it, while others see it as a valuable option.

• Gender bias: May reinforce harmful stereotypes and suggest one sex is more desirable.
• Demographic risk: Can contribute to population imbalances in some regions.
• Genetic overreach: Treats children as customizable, raising concerns about “designer babies.”

While some parents pursue surrogacy gender selection for personal or family balancing reasons, others are driven by a far more urgent factor: the health of their future child.

How Choosing the Sex of Your Baby Can Reduce the Risk of Hereditary Conditions

While many genetic disorders affect people regardless of sex, some are significantly more common or severe in either males or females.

Examples include:

• Autism spectrum disorders (ASD) – more frequently diagnosed in males
• Hypertrophic cardiomyopathy – often more penetrant or severe in males
• Autoimmune disorders like lupus and multiple sclerosis – significantly more common in females
• BRCA1/BRCA2 mutations – associated with elevated risks of breast and ovarian cancer in females, and prostate cancer in males
• Certain infertility conditions – may affect only one biological sex based on reproductive anatomy

In these cases, knowing the sex of each embryo before transfer allows families to make informed decisions that align with their family history and medical priorities.

How PGT-A and PGT-M Work Together in Sex Selection for Medical Reasons

While PGT-A examines the chromosome of an embryo, preimplantation genetic testing for monogenic (single-gene) disorders (PGT-M) screens embryos for specific inherited conditions.

Using PGT-A and PGT-M together helps intended parents select an embryo that is of a specific sex if that sex is medically preferable based on a lower likelihood of passing on a genetic condition.

Choosing the sex of your baby with surrogacy is a deeply personal decision. There’s no right or wrong answer, but it’s important to weigh the medical, emotional and ethical aspects before moving forward.

Is Sex Selection for Surrogacy Right for Your Family?

Choosing the sex of your baby can be a deeply personal decision — and one that often brings up a range of emotional, medical, and ethical considerations.

For some families, it’s about health and prevention. For others, it’s about balance and connection. There’s no one-size-fits-all answer, but there is space for thoughtful reflection.

Questions to ask yourself:

• What is motivating our desire for a baby of a specific sex?
• Are there cultural or emotional expectations we’re navigating?
• Are there medical concerns or risks to consider?
• Have we discussed our options with a genetic counselor or fertility specialist?
• Do we feel aligned as partners in this decision?

How American Surrogacy Supports You

At American Surrogacy, we can connect you with IVF and fertility providers across the country that offer PGT-A and/or PGT-M services.

Once you’ve worked with your clinic to create and screen your embryos, we step in with speed and expertise.

Fast, Personalized Surrogate Matching

We understand that timing is essential — especially after embryos have already been created.

Our matching process is efficient, proactive and built around your preferences, values and goals. We help you move from embryo creation to surrogate match without unnecessary delays.

Learn more about how we offer short surrogacy wait times.

What to Keep in Mind Before PGT Testing for Surrogacy

The opportunity to choose the sex of your baby with surrogacy can be exciting, but it’s only one part of a much bigger picture.

Your fertility clinic will always recommend transferring the healthiest embryo, and that’s what matters most for a safe and successful journey.

If you’re curious about your options, we’re here to help. Every family is unique, and we’ll help you build yours. Our specialists are ready to walk you through your next steps.

Get in touch with a surrogacy specialist today.