A couple of days ago we looked at a new poll showing that a majority of Americans are okay with gene editing of human babies if it was only done to eliminate diseases which are inheritable. The public drew the line, however, at the idea of “designer babies” who would be modified to be taller, stronger, more beautiful, etc. That discussion got me to thinking about another increasingly common practice in the medical community where such custom-designed children are already being born.

It’s the subject of a report in the Washington Post from this weekend and it deals with in vitro fertilization (IVF). To be clear, this procedure doesn’t involve any form of gene editing or CRISPR technology. But it does offer prospective parents the option of picking from as many different embryos as they can afford to have produced in a lab. And the options on the menu include many factors having nothing to do with health or the prevention of disease. In fact, some of the selection criteria are currently illegal in other countries.

While many countries have moved in recent years to impose boundaries on assisted reproduction, the U.S. fertility industry remains largely unregulated and routinely offers services outlawed elsewhere. As a result, the United States has emerged as a popular destination for IVF patients from around the world seeking controversial services — not just sex selection, but commercial surrogacy, anonymous sperm donation and screening for physical characteristics such as eye color.

This freewheeling approach has been good for business; the U.S. fertility industry is estimated to be worth as much as $5.8 billion this year. But as technological advances outpace any social consensus on such forms of reproductive intervention, discomfort with the hands-off status quo is rising.

Last month, news that a U.S.-educated Chinese researcher had created the world’s first gene-edited infants reignited a debate over the morality of “designer babies.” Some scientific leaders blasted the effort, which purported to make the babies resistant to HIV infection, and urged the U.S. government to step in.

Perhaps it’s something of a uniquely American perspective (plus Cyprus and the United Arab Emirates), but I’ve always taken IVF for granted as just another medical miracle of the 20th century which was a good thing. Infertile couples can go to a doctor’s office, have eggs and sperm combined to create viable embryos, implant them in the mother and welcome a new baby into the world. What’s not to like, right?

But as the “screening” process for the embryos has become more and more intricate, the concerns mentioned above are growing as well. Just as we saw in the poll about genetic editing, nobody seems to have a problem with doctors doing testing on the embryos and selecting the ones with the least propensity for medical problems further down the line. But once you open the curtains and take a peek into the baby’s DNA, there’s all of that other tempting information waiting to be discovered. How can parents resist having a look?

The easiest one to single out is the sex of the baby. Allowing parents to preselect either a boy or a girl seems harmless enough at first. But other countries outlaw the practice. In Great Britain, it’s illegal for IVF clinics to screen for gender. (Of course, it’s assumed that most of the clinics quietly “mention” the gender in passing without telling anyone else, so it’s almost certainly going on.) Is that morally unacceptable?

Today’s technology allows the clinics to go much further than that. In America, you can screen for other factors, such as picking an embryo that will produce a baby with blue eyes or blond hair. You can even get an indication of which baby will likely grow up to be taller. There’s obviously a procedural difference between editing the genes of an embryo and selecting the “best” one out of a batch of eggs that were fertilized with the father’s sperm, but isn’t the end result the same? Aren’t we allowing IVF parents to engage in the creation of designer babies?

More to the point, IVF was originally intended as a procedure to help infertile couples conceive. But today there are fertile couples going this route just to gain these advantages. And IVF isn’t cheap. Many employee insurance policies don’t even cover it, or only pay a small portion of medical bills that can quickly swell into the tens of thousands of dollars. That certainly sounds like a system where the wealthiest are able to design their own “super babies” while the rest of the great unwashed masses can’t. And wasn’t that the basis of all the objections to human gene editing in the first place?

The big question is what to do about it. I’m uncomfortable with suggesting more government regulation by default. But should we be debating whether or not IVF should be restricted to only couples who are proven infertile? And should clinics be barred from sharing genetic information about the embryos beyond screening for disease or deformity? These are some of the questions we’re probably going to have to wrestle to the ground as the 21st century marches on.