Ethics · Advanced · Ethics

Fertility Consultation with Gender Preference

Practise this PLAB 2 ethics station on Unexplained Infertility. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in a fertility clinic. A 36-year-old woman, Julia Beaumont, attends with her husband for a consultation. They are about to proceed with IVF treatment and they have asked the clinic whether it is possible to select the sex of their embryos before transfer. Please discuss the ethical and legal position regarding sex selection in the UK.

Background notes: PMH: Healthy, no significant medical history, no genetic disease in family

What this station tests

  • Human Fertilisation and Embryology Act: sex selection is illegal in the UK for non-medical reasons
  • PGD exception: sex selection is permitted for sex-linked genetic conditions
  • Non-judgmental exploration of their reasoning before explaining the law
  • Not facilitating circumvention: do not suggest travelling abroad for sex selection
  • Maintaining the therapeutic relationship after declining the request

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself. Establish the ethical issue and your role.
  • 1-3 min — Explore Perspective: Listen to patient/relative perspective. Understand their reasoning and concerns.
  • 3-5 min — Ethical Framework: Apply ethical principles: autonomy, beneficence, non-maleficence, justice. Reference relevant guidelines (GMC, Mental Capacity Act).
  • 5-7 min — Negotiate and Plan: Find common ground. Explain your professional obligations. Involve MDT where appropriate. Document plan.
  • 7-8 min — Closing: Summarise agreed position. Outline next steps. Offer further discussion.

Consultation approach

The opening

A couple requesting sex selection during fertility treatment raises ethical issues: it is illegal in the UK for non-medical reasons. The candidate must explain this while maintaining the therapeutic relationship. Julia (36) and Rajesh (38) are attending the fertility clinic and ask about choosing the sex of their baby. Open with: 'I understand you are interested in sex selection. Can you tell me your reasons?'

Core approach

Explore their reasoning non-judgmentally. They have three sons and want a daughter. Their preference may be cultural, personal, or about family balance. Listen without judgment before explaining the legal position.

Explain the law clearly. 'In the UK, sex selection for non-medical reasons is not permitted by law. The Human Fertilisation and Embryology Act prohibits choosing the sex of a baby unless there is a medical reason, such as a sex-linked genetic condition.' This is not a clinical guideline: it is the law.

They may be disappointed or frustrated. Acknowledge: 'I understand this is disappointing. Many couples have preferences about the sex of their children.' Do not judge their wish, but be clear that you cannot facilitate it.

Closing and safety netting

Refocus on the fertility treatment itself. 'Let us focus on helping you have a healthy pregnancy. The most important thing is a healthy baby.' If there is a sex-linked genetic condition (ask): then sex selection may be legally permissible through PGD (pre-implantation genetic diagnosis). If not: the request cannot be accommodated.

Do not suggest they travel abroad for sex selection (this would be facilitating something prohibited domestically). Maintain the therapeutic relationship: 'I hope this does not affect our working relationship. I want to support you through your fertility journey.' Follow-up: standard fertility pathway.

How examiners mark this station

Examiners will assess your ethical reasoning and interpersonal skills. Domain 2 (Clinical Management) is primary: marks for applying an ethical framework, referencing relevant legislation and guidelines, and reaching a reasoned position. Domain 3 (Interpersonal Skills) is equally weighted: marks for non-judgmental exploration, empathic communication, and negotiation skills. Domain 1 (Data Gathering) assesses your ability to fully explore the situation before forming a view.

Domain 1 (Supporting)

Scores well: Reasoning explored. Sex-linked conditions checked. Cultural context understood.

Costs marks: Not exploring reasons. Not checking for medical indications.

Domain 2 (Primary focus)

Scores well: Law explained accurately. PGD exception known. Request declined appropriately. Fertility treatment continued.

Costs marks: Not knowing the law. Agreeing to the request. Suggesting overseas options.

Domain 3 (Primary focus)

Scores well: Non-judgmental. Empathic about disappointment. Maintaining relationship. Refocusing on healthy pregnancy.

Costs marks: Judgmental. Damaging the relationship. Not acknowledging disappointment.

Common examiner feedback (and how to fix it)

Did not demonstrate adequate ethical reasoning or application of relevant guidelines

Fix: Structure your response around the four ethical pillars (autonomy, beneficence, non-maleficence, justice). Reference specific guidelines (GMC, Mental Capacity Act) where relevant.

Did not sufficiently recognise or respond to the patient's feelings, concerns, or expectations

Fix: Acknowledge the emotional weight of the situation early. Show that you understand why this is difficult before applying ethical reasoning.

Common mistakes in this station

  1. Being judgmental about the request: wanting a specific sex is a common human preference
  2. Not knowing the law: candidates who are unsure about the legal position cannot counsel accurately
  3. Suggesting alternatives abroad: this facilitates circumvention of UK law

Resitting PLAB 2?

If you have found ethics stations difficult, focus on learning a clear ethical framework (the four pillars) and practising how to apply it conversationally rather than reciting principles. Examiners reward candidates who can explore the tension between competing ethical principles while remaining empathic and non-judgmental.

Example opening

Thank you for coming in to speak with me. My name is Dr [Name]. I understand there is something important we need to discuss. Could you tell me your understanding of the situation?

Frequently asked questions

How do I structure my approach to this unexplained infertility consultation?

A couple requesting sex selection during fertility treatment raises ethical issues: it is illegal in the UK for non-medical reasons. The candidate must explain this while maintaining the therapeutic relationship. Julia (36) and Rajesh (38) are attending the fertility clinic and ask about choosing the sex of their baby.

What does a strong performance look like to the examiner in this station?

Strong performances show: Reasoning explored. Sex-linked conditions checked. Cultural context understood. Weak performances: Not exploring reasons. Not checking for medical indications.

What is the biggest pitfall in this unexplained infertility station?

Being judgmental about the request: wanting a specific sex is a common human preference. Another frequent error: Not knowing the law: candidates who are unsure about the legal position cannot counsel accurately.

How should I prepare for unexplained infertility if I have never seen it in practice?

Structure beats experience here. Focus on pGD exception: sex selection is permitted for sex-linked genetic conditions. The written guidance on this page covers the full approach, and practising the consultation aloud builds the fluency the examiner is listening for.

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