“House of Commons defeats bill to ban sex-selective abortion, but two thirds of Conservatives vote in favour,” was the headline in the 2 June 2021 edition of the National Post. Bill C-233 would have made it a crime “for a medical practitioner to perform an abortion knowing that the abortion is sought solely on the ground of the child’s genetic sex.”
The headline brought back memories of a day in 1990 when I was confronted with a situation I was totally unprepared for.
A young couple, recent patients in our fertility clinic, came to see me. She pushed his wheelchair gently through the door. Two years earlier he had suffered a high-level complete lesion to his spinal cord in a diving accident. I saw them several times during the preceding few months as we were assisting him to become a father. Just a couple of weeks before this visit I happily confirmed to them that she was now in the early stages of her pregnancy. I remembered how thrilled they were. I was a bit surprised, even concerned, to see them; I hoped that it was not some threat to her pregnancy.
Little did I know.
They took a few moments to settle in. Then, with hesitation in his voice, and both of them with tears in their eyes, he told me that they are about to decide to have an ultrasound test to determine the gender of their long-awaited baby. If the test said the expected offspring was a female, they would consider an abortion. They asked if I would be willing to repeat the insemination procedure with hopes for a male baby.
For a moment I was taken aback and didn’t know what to say. My mind was spinning. An abortion for gender selection? After all the work, all the people involved, and all the good luck to actually have a healthy pregnancy, and hopefully a healthy offspring of whichever gender? I felt a moment of disappointment, or perhaps I felt that our efforts were being taken for granted.
Like in a sped-up movie, my mind went back to 1975. I was involved in studying the damage to the sexual functioning potential of men and women with spinal cord injury. Most of my work was done in the Acute Spinal Injury Unit. At the time we understood that women with a spinal cord lesion could become pregnant but men with spinal cord lesions could not become biological fathers. The cited reasons: inability to enter into the act of intercourse, damaged spermatogenesis, and ejaculatory failure. Not surprisingly, most of my initial studies focused more on couples’ interpersonal problems rather than on their reproductive issues. However, after taking numerous histories from men with various levels and completeness of their recent or old injuries, I learned that, in spite of their injury, a few men became fathers without medical intervention.
Then I met Professor Guy Brindley, an extraordinary British physiologist. He casually mentioned to me that in an experiment with a few volunteer men with spinal cord injuries he applied a vibrating instrument to the genital structures and obtained seminal fluid with varied quality of spermatozoa. My research budget could not afford his expensive vibrating machinery, but as soon as I got home, my associates gifted me with a $25 Walmart vibrator. Then the message went out for volunteers. It was with considerable trepidation that I started working with the vibrator. Within a couple of months it became obvious that men with complete low lesions did not respond at all to a vibrator, but most men with a higher level lesion did respond with emission of seminal fluid containing a varied quality of sperms. Nothing was simple. A few men with high lesions suffered acute, severe headaches at the time of the start of the seminal flow.
We needed help from the departments of Medicine and Pharmacology to manage these hypertensive headache responses by premedication, and laboratory scientists helped to improve sperm quality. Dr Ron Stevenson, then a resident with our unit, worked with the Biomedical Department to put together a testicular cooling device—opinion then suggested that testicular cooling might improve sperm motility. To focus on men with low levels of injury, Dr Mark Nigro of the Urology Department joined our team and we visited Stanford University to learn about their experiments with electrical stimulation of the prostate to stimulate seminal flow. The Hershey Primate Lab gave us electrical engineering plans for the construction of an electrical prostate stimulator, which was constructed by the biomedical specialists at Shaughnessy Hospital. At the beginning we used either fresh specimen or thawed spun specimen, which we introduced into the vagina, but later we deposited the semen directly into the uterus. In the meantime, Dr Stacy Elliott, also a resident with our unit, became our expert at using hormonal support to coordinate the time of sperm retrieval and insemination with the partner’s fertile period. The elation when our team learned about “our” first pregnancy is hard to describe. A bit like landing on the Moon.
As I sat facing the young couple in my office, tears now pouring down their faces, it dawned on me that a so-called able-bodied couple could do whatever they wanted to do. If they wanted an abortion because of a genetic gender issue, or due to cultural norms that value male children over female children for a variety of social and economic reasons, they could go ahead with it and then have another try at another pregnancy on their own, in the privacy of their relationship, no medical involvement needed. A couple with a spinal cord injury in the male could not do that. Suddenly it was clear to me: my associates and I were basically technicians in a complex procedure to serve those in need of assistance. Our objective was to open up possibilities in life, not to question or block intentions. And that is what I told the young couple.
A week later I heard from them: they decided to abandon their plan for abortion. Seven months later I was invited to have a hug from them and to hold their baby boy for a precious minute.
The political debate about banning sex-selective abortion is over for now, and my memories are back in their hiding place. Canada is the only country where women have unrestricted full access to reproductive choices, including abortions.
—George Szasz, CM, MD
Wikipedia. Abortion in Canada. Accessed 17 June 2021. https://en.wikipedia.org/wiki/Abortion_in_Canada.
Wikipedia. Sex-selective abortion. Accessed 17 June 2021. https://en.wikipedia.org/wiki/Sex-selective_abortion.
This post has not been peer reviewed by the BCMJ Editorial Board.