There was a vacancy in Betsy Gilman's life, an emptiness her husband, two sons and a full-time job couldn't fill.
She wanted a baby girl.
"I didn't feel like my family was complete or that I was complete," she says.
So she sought ways to better the 50-50 odds in selecting the sex of her offspring.
As more parents seek the same course, it has touched off an ethical debate that reverberates from church to clinic to laboratory.
It hinges mostly on a sperm-separation technique developed a decade ago by a Montana doctor that is leased to about 65 clinics worldwide, including one in Albuquerque.
Patients go to clinics in the United States, Canada, England, India, Malaysia, Pakistan and Singapore to balance their families or to fulfill cultural pressure to produce boys.
In the United States, the couples are primarily middle-aged, middle-class professionals. Gilman is 42.
The technology involves separating sperm that carry a Y chromosome, which will produce a boy, from sperm that carry an X chromosome, which will produce a girl. Then women are artificially inseminated with whichever kind of sperm would lead to the gender they want.
It is based on evidence that Y chromosome-bearing sperm swim faster than X-bearing sperm, says Dr. Ronald Ericsson of Alzada, Mont., who patented the process.
Washed and spun sperm is layered on increasingly thick albumin protein, through which the strongest sperm swim the fastest.
Producing X-weighted sperm is more difficult, Ericsson says, so fertility drugs are used as a backup.
The process, which costs $300 to $800 per insemination, improves the chance of having a boy by 30% and a girl by 20%, he says.
Ericsson claims that more than 1,500 gender-correct babies have been born using his method.
Others say there is no evidence that the system is effective.
Dr. Francis Byrn, chief of reproductive endocrinology at the University of New Mexico, says he philosophically opposes gender selection and doubts that it works.
"If you look very carefully at well-done studies, it isn't clear to me that you can guarantee an increased chance of males or females," Byrn says.
But he refers patients who raise the issue to clinics such as Gender Selection of New Mexico, the only facility in the state offering Ericsson's procedure.
"I think that getting pregnant is a random process and people should enjoy either sex," Byrn says. "I don't feel like I ethically can aid or abet a couple in trying to create a pregnancy with a preferential sex."
Some ethicists and researchers say that although legislating against gender selection would impinge on women's reproductive rights, the process raises some concerns.
"In the most fundamental sense, selecting the sex of one's child is a matter of reproductive choice and if we were to limit this . . . then it might invite the floodgates to open up and we might see other aspects of reproductive choice limited," says Neil Bennett, associate professor of sociology at Yale University and editor of "Sex Selection of Children."
"However, I would really be very concerned about (parental) motivations if they were to go so far as to use some sex-selection technique," Bennett says. "Is it that the father has this great desire to play ball with a son? Well, I would argue, why not play ball with your daughters?"
There are also worries that widespread use of gender selection could create an unbalanced society, says Jim Nelson, associate editor for ethical studies at the Hastings Center, a private nonpartisan ethics think tank in Briarcliff Manor, N.Y.
"There is a natural regulator of gender balance and it doesn't take a lot of imagination to see that a rough 50-50 balance is conducive to social harmony generally, and that sex pre-selection, if it became widespread, might have some untoward aspects in terms of upsetting that balance," Nelson said.