It's one of the first questions parents-to-be ask: Boy or girl? Increasingly, that answer is arriving earlier than ever.
A blood test that accurately determines a baby's gender less than two months after conception could be offered in U.S. doctors' offices in about a year. But the question on physicians' minds isn't whether mothers-to-be will ask for such gender testing — they know they will.
The question is: Why will they want to know?
Most merely will be curious, doctors expect. Others will want to see if their child is at higher risk of gender-linked genetic diseases such as hemophilia or certain forms of muscular dystrophy.
But some worry the boy or girl predictor will also make it easier for couples to terminate a pregnancy if the test results aren't what they hoped for, a practice known as gender selection. Couples have long been able to determine the sex of their child, but never so early in the pregnancy, when abortion is medically safer.
"That has everyone concerned," said Dr. Robert Yelverton, chief medical officer of Women's Care Florida, a network of more than 100 obstetricians and gynecologists in Central Florida. "This could be seen as a very simple, uncomplicated, relatively inexpensive test to allow couples to determine whether to continue a pregnancy based on the sex of the fetus."
The test works by identifying the presence of a Y chromosome in the fetal DNA. If it's there, it's a boy.
The test received a major boost recently when a Journal of the American Medical Association review found it to be 95 percent accurate at seven weeks. It is already being used in Europe, and the U.S. Food and Drug Administration is expected to approve it in about a year.
But in a way, it's already here. A similar product, called Pink or Blue, is available over the Internet. It wasn't included in the JAMA review, but sales of it have "quadrupled, if not more than that," since the article came out, says Terry Carmichael, executive vice president of Consumer Genetics, which sells the test.
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Until this test, couples have had to wait until at least the 10th week of pregnancy to learn their baby's gender. Tests such as chorionic villus sampling (at 10 to 13 weeks) or amniocentesis (15 to 20 weeks) are used primarily to detect a chromosomal abnormality, but also reveal gender. An ultrasound can indicate gender, but usually only after the 16th week.
The blood test offers a distinct advantage, said Dr. Jerry Yankowitz, chairman of the Department of Obstetrics and Gynecology at the University of South Florida College of Medicine.
It could be done earlier, and is less invasive, he said, noting the small risk of miscarriage from existing tests.
"Women would rather do a test that carries zero risk," Yankowitz said. "When it becomes available, we will probably use it on a regular basis."
Doctors say the test will not replace more invasive procedures, since results aren't 100 percent.
But Yankowitz said couples could benefit from knowing three to five weeks earlier that their child most likely has a certain disorder. It would give them more time to learn about the condition, and if they decide to continue the pregnancy, get their finances in order, and decide on appropriate medical care.
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Doctors expect most people will want the test simply to answer the age-old question, ''Am I having a boy or girl?''
They would be people like Chelsea Wallace of Okechobee.
The 23-year-old found out about the Pink or Blue test on the Internet. Customers pay between $199 and $329 for the kit and lab service, depending on how quickly they want the results.
Wallace bought the kit, pricked her finger for a blood sample, and sent it to the lab in a postage-paid envelope. In days, she had an e-mail on her Blackberry:
"The results are in. Congratulations, you're having a boy."
"I believe there are a lot of women like me who want to know just for their curiosity," Wallace said.
She delivered her son Layton by cesarean section on Tuesday.
Consumer Genetics has sold about 15,000 Pink or Blue tests since 2005.
Sales of another test, Intelligender, have topped 500,000 since 2006, according to company founder Rebecca Griffin. Unlike Pink or Blue, Intelligender tests hormones in a woman's urine to determine a baby's gender in minutes, without having to send it to a lab. Urine testing was not part of the JAMA review, though Griffin said two independent studies have shown it is about 90 percent accurate. It sells for about $35 at pharmacies including Walgreens and CVS.
Because both tests are marketed as having no medical use, FDA approval wasn't required.
"Our test is not 100 percent, and we don't market it as such," Griffin said. "We encourage our customers and moms to wait until the doctor confirms the gender before they make a financial or emotional commitment to the test result.
"We feel our customers understand that. It's a fun experience to bridge the curiosity gap."
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Yankowitz thinks most doctors will use the new blood test, once the FDA approves it, only for medical reasons, such as when there is a family history of a gender-linked disease.
"I have a feeling it would be a small group" who would seek it for gender selection, he said.
Yelverton points out there's very little to stop a couple from gender selection now.
The makers of Pink or Blue require customers to sign a pledge that the test will not be used for gender selection, but Yelverton likens that to promising not to copy music CDs.
Still, he thinks the medical uses of the test outweigh the drawbacks.
"Sure, I'm concerned about the way this test can potentially be used," he said. "But not to the point where I'd want it to be outlawed."
Richard Martin can be reached at firstname.lastname@example.org or (813) 226-3322.