Madam,would you like to know the sex of your baby?

            It was an interesting day in the ultrasound room today.One of our patients today was a pregnant woman ,about 26 weeks gestational age.She came for a routine ultrasound scan.After the initial pleasantries she was ushered to the couch by the nurse.The examination commenced as i applied the ultrasound gel and probe to her abdomen and started a conversation."Why are you doing this scan madam?,I began,and she responded,"my doctor asked me to do a scan",and i said ok. Next, I asked,"did you complain of anything in the hospital?",her referral form gave the indication as "routine".I like to ask these questions to cover the bases,and they have been helpful.In this case,however,the woman had no complain.So,the scan proceeded as normal,with me taking various measurements of the baby.
After that, I introduced her to her baby,showing her the baby"s head,the heart beating,the arms and legs,amniotic fluid,placenta,and telling her the estimated foetal weight and expected date of delivery.She was pleased that everything appeared OK, however she was not satisfied,i could tell from the look on her face.So I asked her,"Madam,would you like to know the sex of your baby?",and 
she said "That"s why I came for the scan."

Male genitalia as seen in 2D ultrasound

                                                                                                                                                                                                     "Madam,you are going to have a baby boy",I told her.This was one of those scans in which I had easily seen the foetal gender as soon as I started,sometimes due to the baby"s lie,truncal obesity,and a variety of other reasons,it may not be easily determined.Although ultrasound findings have a lot to do with the skill level of the operator,even the most experienced of operators may not be able to visualise the sex of the baby and the scan may be rescheduled.Sometimes,a sonologist who is very committed to determining the gender may have the woman turn to the sides or even take a walk around the block and come back.I have had to do all that and even ask the woman to talk to her baby!!,for the bible says that children should obey their parents(Ephesians 6:1).And they do.

Back to my patient.She was very excited at the news that she was going to have a boy. Very excited.She went on to tell me that she felt this would be a boy,because it was so different from the two other pregnancies in which she had girls.Her husband would be overjoyed ,she told me.He is the only son of his parents.In Africa preservation of family name and the issues surrounding the inheritance of lands and property make the having of male children a very delicate and important issue.

After the initial excitement,she goes on to ask me,"doctor,are you sure its a boy?",and I said "yes".She said "how sure are you?".This is a very frequently asked question .I replied her,"I am 100% sure,otherwise i would have told you that i did not see it".(I believe this is the standard all operators should adopt,because it is forgivable if a sonologist does not visualise the sex of the baby,not so much if he says its a boy and it turns out to be a girl when the child is born). My answer gladdened her,but she wanted more,so she said "how do you know its a boy?",I pointed her to the ultrasound monitor again and demonstrated the image of the foetal genitals and showed that it is definitely a boy.We concluded the examination and she left,a very happy woman.

Sometimes,it does not turn out this way.In some cases the reason for the determining the sex of the baby is medical,the patient is sent to us by her doctor to find out the sex of the baby because their is a hereditary disease in the woman"s family that affects particular sexes.For these scans,the earlier the diagnosis of the sex of the baby is made the better.The earliest time the gender of the baby can be determined by ultrasound is between 12-13 weeks gestational age,with a good  quality,high resolution  machine and an adequately skilled operator.At this gestational age,screening the baby for some foetal abnormalities;Down"s syndrome by measuring the thickness of the skin fold behind the baby's neck(nuchal translucency),and trisomy 21 by examining the foetal nasal bone ,is also done.It would be important to note that a woman should go for her ultrasound scans when the doctor asks her to do so,because some findings are time dependent and can be missed if the woman goes for the examination later than instructed.

Many times the reason for the scan is for the woman to know the colour of clothes to buy,as she would not want to buy pink for a boy,or to paint the baby"s room in colours that are not for the child"s gender.

In a totally different scenario,I  had the experience of scanning a woman who has three girls and desired to have a male child desperately.In her community,once a male child is born,he is given four plots of land.Each male child.However,if a couple do not have a male child,they do not partake in this community largesse. So,this woman came in her fourth on-going pregnancy to check what she was going to deliver.On examining her,it turns out that she was carrying twins.Two girls.Her reaction to this finding is better imagined.Suffice it to say that we had a difficult time getting her out of the scan centre.

Female genitalia as seen in 2D ultrasound

Why is it that some couples consistently have boys and others have girls?Studies have shown that there is an equal chance of having either a girl or a boy in each pregnancy,What tips the balance in favour of the desired foetal sex for the couples that have boys and girls in the proportion they want them.We will examine this another time.

These are a few of the experiences I have had in the ultrasound room with regards to gender determination by ultrasound scans.Can you relate to that?Have you had your expectations of the sex of your baby confirmed or otherwise?Was your ultrasound scan accurate in predicting the sex of your baby?Are you rather interested in what you can do to tip the odds in your favour to conceive a boy or a girl?Feel free to share your thoughts with us.