After the debates and the new law regulation, PGD for sex selection caused heated debates among the German population and specialists. This is the first study focused on this topic and the ethical attitudes of German specialists of reproductive medicine. Even if this study was done 2006, there are no new studies published till now.
The majority (67%) of German specialists of reproductive medicine would not tell the gender within the legal time for abortion, according to the guidelines from the society and the new law regulation 
. In the United States obstetrician-gynaecologists are more in favour of sex selection. In a survey in the year 2008/2009 among 1,154 U.S. obstetrician-gynaecologists 64% would help the patient to obtain an abortion for sex selection 
. The majority of units in Finland made fetal sex determination during the second-trimester ultrasonographic screening without medical indication at patient`s request 
While in 1995 
less than a half of the interviewed German human geneticists (47%) had received obvious requests of sex selection, 90% indicate that they have had such requests in the current survey.
In 1995, 90% of German human geneticists were opposed to pre-birth sex selection for non-medical reasons (asked in case of abortion), while in 1985 it was still 98% 
. The majority of the population and the majority of specialists in reproductive medicine today are still opposed to preimplantation sex selection for non-medical cases.
The Human Fertilisation and Embryology Authority (HFEA, dedicated to licensing and monitoring UK fertility clinics and all UK research involving human embryos) stated, that centres should not select the sex of embryos for social reasons and centres should not use sorting techniques in sex selection 
. The European Society of Human Reproduction and Embryology (ESHRE) as the European body for professionals in reproductive medicine and biology did not strictly ban non-medical sex selection - which is not allowed in EU, but after an ethical debate they report these data 
As a representative sample of the German population in 2003 
, 1005 men and women 18 years and older were asked whether preimplantation sex selection should be made available or not. 32% held that sex selection should be strictly prohibited, be it for medical or non-medical reasons, compared to only 2% of specialists in reproductive medicine in 2006. The tendency to agree to a restrictive legalisation for PGD in Germany can be observed in the majority of respondents. 54% accepted the use of preimplantation sex selection for medical purposes (specialists in reproductive medicine 2006 were 61% and another 18% for summoning an ethics commission). Only a minority of 11% approved the use of sex selection for non-medical reasons (specialists in reproductive medicine 2006 - 4% approve it generally and further 14% approve it for couples with at least two children of the same gender and who wish a child of the different gender). Specialists in reproductive medicine use techniques of reproductive medicine for other medical indications; perhaps there is less inhibition in comparison to the general population to agree on the use of techniques of reproductive medicine even for X-linked diseases as a medical indication. It might be that specialists in reproductive medicine are more tolerant than the general population, precisely because they are confronted with the individual fates of patients on a daily basis.
A survey among the general population realized in 2004 
resulted in a stronger disaffirmation of preimplantation sex selection for 92% of the sample. Only a minority advocates the preimplantation sex selection (8%) and would personally make use of it (6%), while the majority is for a restricted permission of PGD in Germany. 76% plead for allowing PGD in case of a disease which may cause death within the first year of life. 63% consider using the method for themselves in such a case.
In a web poll in 2007 targeting infertile people with a wish for a child 
, the disaffirmation of preimplantation sex selection compared to the survey from 2004 was lower (83%, in 2004
92%), if the techniques used would require several treatment cycles and corresponding costs for the couple and only 13% considered using the technique if the costs were to be covered by a health insurance company and limited to one treatment cycle.
43% of specialists in reproductive medicine demand the exclusive treatment of couples as criterion and reject the treatment of singles. This is reflected in the case vignettes, in which the treatment of singles is more often refused than the treatment of couples.
Between July 2003 and July 2005, a cross-sectional study 
was carried out with a sample of health care professionals working in assisted reproductive medicine in Brazil, Germany, Greece and Italy. 224 persons participated in the study, of these 50 Germans (39 with medical profession). One of the cases described a case of non-medical sex selection: “A heterosexual couple, who has two children, goes to a Human Reproduction Centre because they whish to have another child, yet due to a tubal problem, she is unable to have her ovum fertilized naturally. Considering their request involves a technical procedure and they already have two boys, they would only like female embryos to be implanted.” 76% would perform the procedure and 24% would not (no separate results for German professionals provided). In opposite to the current study under German specialists in reproductive medicine, more professionals from the international study are in favour of performing a sex selection for non-medical reasons.
In the survey among human geneticists 
it was possible to write answers in a free text field for reasons for positive and negative answers towards the case vignettes using prenatal diagnosis and consecutive abortion in cases of unpreferred gender ( “worldwide” – no separated German data available), for to examine personal attitudes and moral values. In the present analysis however, there was the possibility to agree with one of the predefined answers regarding preimplantation sex selection (PGD/MicroSort) and optionally insert another answer in a free text field.
Reasons of Approval or Rejection in at least one of the Case Vignettes.
29% of the human geneticists recommend the autonomy of the patients (specialists in reproductive medicine 16%) and 8% agree that the patients have the right to obtain any service they can pay for (specialists in reproductive medicine 0%). For specialists in reproductive medicine today, other ethical values are in the foreground, e.g. the right of the expert to refuse a service got an approval of 34% (human geneticists 7%). Otherwise, a refusal of sex selection in order to avoid gender discrimination got an approval of 72% of the specialists in reproductive medicine (human geneticists: 7%).
For specialists in reproductive medicine, the responsibility of the physician is more focused, i.e. a physician is acting concerning his ethical values, while human geneticists in the survey from 1995 understood themselves more as service providers and were thereby more focused on the patient’s rights and the patient’s self-determination.
China and India reveal a significant son preference 
. Girls were abandoned, neglected or even killed after birth 
and due to the discrimination of female descendants, there is a risk of strengthening sexual stereotypes 
In Europe and the USA, a preference for the male gender was found in two-thirds of the cycles of non-medical preimplantation sex selection 
. In India and China, there is a preference for boys. Therefore, female descendants are discriminated, and there is the danger of a boost of gender stereotypes 
. With the use of sex-selective abortion, which became available in the mid-1980s, there are now an estimated 80 million missing females in India and China alone 
. A worldwide allowance of preimplantation sex selection would increase this imbalance.
In 2007 
in Germany, the preference for girls (19%) was higher than the preference for boys (11%). In an older survey from 2005 
, 14% wanted to have a boy while 10% wanted a girl as their first-born child. In Germany, a shift in the sex ratio caused by allowing preimplantation sex selection is not likely, because among the population there is little interest in the use of preimplantation sex selection on the one hand, and there is no significant gender preference on the other hand.
The use of reproductive techniques to fulfil the desire to have children is minimal. Only 1.65% of children are born with the help of IVF in Germany 
. In Germany 2010 from 50,583 oocyte retrievals led to an IVF or ICSI treatment, 1,074 children were born after IVF, 3,856 after ICSI and 108 after IVF/ICSI 
. Preimplantation sex selection offers an opportunity for patients with X-linked disease to get a healthy child, which is free of this disease. Fragile X syndrome was the most common indication followed by Duchenne muscular dystrophy and haemophilia 
The risk of birth defects associated with ICSI, but not IVF, remained increased 
. Robert G. Edwards did win 2010 the Nobel Prize for the development of IVF 
. This year`s Nobel Prize winners John Gurdon 
established the fundamental principles for Shinya Yamanka sensational discovery to induct pluripotent stem cells from mouse embryonic and adult fibroblast cultures 
. The reconstruction of female germ-cell development in vitro is a key challenge in reproductive biology and medicine. A team from Kyoto University used stem-cell technology to create viable egg cells in laboratory mice that were fertilised by IVF to produce normal, healthy offspring 
. But with more techniques available, more ethical controversy debates will raise. Today, the prenatal detection of Down syndrome or also Edwards syndrome is with a simple blood test available, used cell-free DNA in the blood of the pregnant woman 
In the case of a general allowance of preimplantation sex selection, there is a fear of a trend towards designer-babies and even towards eugenics 
. Parents could be willing to choose other characteristics 
, e.g. intelligence or the colour of the eyes. Should the autonomy of the patient be possible without restriction and is a selection of medically irrelevant characteristics permissible 
? Regarding PGD, it is necessary to scrutinize from which point in time human life is defined and whether an embryo is to be seen as a living being with the status of a person 
. Furthermore, the application of PGD is showing new ethical problems, e.g. there are surplus cryoconserved embryos which then partly have to be rejected 
The paper was sent out to the members to the German Society of Reproductive medicine and to German IVF centres. It is possible that the members of the Society did give an individual answer and that the answer of the same person is given by the IVF centre under the name of the centre. It is not completely excluded that double answers were given. In fact it cannot be ruled out that differences in answers are possible for nonrespondents with a response rate of 40.6%. These are the limitations of the study.
This German survey from 2006 showed the willingness of German doctors of reproductive medicine to perform a preimplantation sex selection only for medical reasons. Because of the German history and because PGD for non-medical reasons remains still forbidden today, this attitude will not have mainly changed. There is a high moral principle in Germany regarding the need for protection and selection of human life and the wrong gender itself is not a sufficient reason. This is the first study focused on this topic preimplantation sex selection and the ethical attitudes of German specialists of reproductive medicine. Even if this study was done 2006, there are no new studies published till now. Limitation of this study is that the new law regulation and the upcoming debates may have an effect on attitudes and further studies are necessary to evaluate this.
The majority of German specialists in reproductive medicine is against preimplantation sex selection for non-medical reasons, while they recommend the permission of preimplantation sex selection for medical reasons, for example X-linked diseases like haemophilia.
Obviously, sociodemographic variables did not play an essential role regarding the attitude of German specialists in reproductive medicine. Instead, personal attitudes and moral values have an effect.
This German survey from 2006 showed the willingness of German doctors of reproductive medicine to perform a preimplantation sex selection only for medical reasons. This attitude will not have mainly changed. Since the judgement of the Federal Administrative Court (BGH) as of July 2010 and the new law regulation in July 2011, the PGD is allowed in case of serious genetic defects. PGD for non-medical reasons remains still forbidden. Previously, PGD was not officially practiced in Germany, and the future application remains to be seen. If it were allowed without restrictions, preimplantation sex selection would still only be used in individual cases in Germany. To find law regulation for every individual case would seem justified, but is not realistic. In this context, every case should be discussed in an ethics commission.