Pregnant after 35

Amnio or CVS

I am 37, had a m/c in 2009, I am 10 weeks 4 days, had an appt with my Dr yesterday, he asked me what we would do with the information. Please don't flame but we would terminate the pregnancy if we know there is something wrong.  So he recommended to skip the NT Scan and just go with the Amnio or CVS and he referred me to a Genetic Counseler. This facility performs CVS week 11 to 13, and Amnio as early as week 15. I am very conflicted which test I want to do. What I have been reading is chance of m/c is higher with CVS, but you do Amnio later, so god forbid if things come back not looking good, I am too far along into pregnancy. But I also reallize Amnio gives you a lot more information.

A footnote: My Dr does not offer nor does he recommend MaterniT21 or similar because they are not approved by FDA yet. 

I know a lot of you have done extensive research in this area, so I am seeking some more information or insight. If you think I have overlooked something, please let me know.

TIA

Re: Amnio or CVS

  • I had an amnio at 16 weeks, and would not have one earlier than that.  The earlier the amnio, the higher the risk.  I had it performed by a very well known MFM practice at a major NYC hospital with m/c rates lower than 1:1000. 

    Part of my issue with CVS was that, in some cases, they recommend an amnio after a CVS anyway.  I saw no reason to put ourselves through 2 invasive procedures. 

    We knew there was a possiblity that we'd teminate the pregnancy, depending upon the results.  I was still far more comfortable having an amnio, as opposed to a CVS. 

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  • Did you do any NTScan blood work ahead? My Dr thought it wasn't necessary, if we were going to do either Amnio or CVS.

     

  • I can't help it, I'm not flaming, and I don't know exactly what you'd terminate FOR, but just want to make sure you've fully looked at options. I really think it's sad to terminate b/c of Down Syndrome. I can understand the difficult decision with other trisomies, but many families say that their Down Syndrome baby was one of the biggest blessings of their life. Kelle Hampton's blog is great, too--www.kellehampton.com. Her adorable second daughter has Down Syndrome and is deeply loved.

    I am just throwing this out there because if the baby did have Down Syndrome and you terminated, you might miss out on a wonderful life. 

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  • You could start with an NT scan and bloodwork (non-invasive), and if you don't like the "odds" you get, then you could do an amnio. I did the NT scan/bloodwork and the MT 21, was happy with my results, and will be skipping the amnio. If I had gotten a positive result on the MT21, I would have done an amnio to confirm before terminating the pregnancy.

    My focus was on avoiding invasive procedures if at all possible. 

    ETA: No flames from me for terminating if there is a problem. NicoleWI, Down's can range from very mild to very severe impairment, and there is no way to know before birth what you are going to end up with. Being older myself, a Down's child would almost certainly outlive me and my husband. I have no siblings, no one else who could look after such a child after I was gone. He/she would become a ward of the state. I think that is a horrible thing to do to a person who is unlikely to ever lead an independent life. That is the reasoning behind my decision. TX Bride has already stated her position. Please don't question it.

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  • image NicoleWI:

    I can't help it, I'm not flaming, and I don't know exactly what you'd terminate FOR, but just want to make sure you've fully looked at options. I really think it's sad to terminate b/c of Down Syndrome. I can understand the difficult decision with other trisomies, but many families say that their Down Syndrome baby was one of the biggest blessings of their life. Kelle Hampton's blog is great, too--www.kellehampton.com. Her adorable second daughter has Down Syndrome and is deeply loved.

    I am just throwing this out there because if the baby did have Down Syndrome and you terminated, you might miss out on a wonderful life. 

    There are many other trisomies other than Downs Syndrome, many of which are incompatible with life where the baby will only live for several hours or months after birth.  Please don't be preachy here.  It's a very difficult situation to be in and until you are put in that situation, it's very difficult to say what you would or wouldn't do.

    Me:40 AMA, DH:36 0% morph, TTC#1;
    BFP#1 4/2011, MMC 6/2011 11wks Trisomy 13;
    BFP#2 11/2011, CP
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  • I just scheduled my CVS (I will be 12w2d at that time).  My MFM who will be performing it is one of 2 doctors in the area who does them, he will also be seeing me through the rest of my pregnancy along with my OB.

    Because I have a twin pregnancy, I elected to do CVS vs amnio solely bc it is earlier, and in the unfortunate event that I may need to terminate one of the babies, it is safer to do it earlier and it will also allow more time for the other surviving baby to grow.  I'm praying it won't come to this, but this was my reasoning.  If I was pregnant with a singleton, I would do Materni21, unfortunately it doesn't work for twin pregnancies.

    Good luck OP with whatever you decide.

    Me:40 AMA, DH:36 0% morph, TTC#1;
    BFP#1 4/2011, MMC 6/2011 11wks Trisomy 13;
    BFP#2 11/2011, CP
    FSH: 17.9, AMH: 2.2
    IVF#1 w/ICSI: ER 4/3: 5R,4M,4F
    ET 4/6 All 4 (1-8A+, 2-8A-, 1-3A) BFP#3
    Two weeks of beta hell = Blighted Ovum
    IVF#2 Aug/Sept: ER 8/27: 4R,3M,3F
    ET 8/30 (1-8A+, 1-6A+)
    Beta#1 9/10: 350; Beta#2 9/12: 796; Beta#3 9/20: 9155
    Expecting Boy/Girl Twins! My babies were born 4/23/13 at 36w1d!

     
     

  • image NicoleWI:

    I can't help it, I'm not flaming, and I don't know exactly what you'd terminate FOR, but just want to make sure you've fully looked at options. I really think it's sad to terminate b/c of Down Syndrome. I can understand the difficult decision with other trisomies, but many families say that their Down Syndrome baby was one of the biggest blessings of their life. Kelle Hampton's blog is great, too--www.kellehampton.com. Her adorable second daughter has Down Syndrome and is deeply loved.

    I am just throwing this out there because if the baby did have Down Syndrome and you terminated, you might miss out on a wonderful life. 

    Thank you for voicing your opinion, I am not offended by it, I do reallize everyone's situation is different so is everyone's convictions and religious beliefs. Believe me the position we have was not derived lightly. We certainly hope that the result will be in our favor and we would not have to make that decision.

  • image danuli8:

    You could start with an NT scan and bloodwork (non-invasive), and if you don't like the "odds" you get, then you could do an amnio. I did the NT scan/bloodwork and the MT 21, was happy with my results, and will be skipping the amnio. If I had gotten a positive result on the MT21, I would have done an amnio to confirm before terminating the pregnancy.

    My focus was on avoiding invasive procedures if at all possible. 

    The more and more we are researching, we are also coming to the conclusion to do other tests before we do Amnio. Did you have to convince your Dr to do MT21 or they offered it to you?

  • image TX-Bride:
    image danuli8:

    You could start with an NT scan and bloodwork (non-invasive), and if you don't like the "odds" you get, then you could do an amnio. I did the NT scan/bloodwork and the MT 21, was happy with my results, and will be skipping the amnio. If I had gotten a positive result on the MT21, I would have done an amnio to confirm before terminating the pregnancy.

    My focus was on avoiding invasive procedures if at all possible. 

    The more and more we are researching, we are also coming to the conclusion to do other tests before we do Amnio. Did you have to convince your Dr to do MT21 or they offered it to you?

    We did nuchal at 11w1d and had a harmony blood draw at 10w0d. That way, if either comes back sketchy, we will cvs ASAP and will still be in that window.  Harmony takes 8-10 days. So, cvs can still be as early as 12w0d.   Harmony/maternit21/verifi all look at baby's DNA and are 90+%.  My MFM offers all three because they are slightly different and they actually recommended it to us. Back in 2010, I was part of the sequenom study group (maternit21 + for t21, confirmed by cvs, blood draw and cvs on same day) through my MFM practice so we are all very comfortable with the technology.

     

    Good luck with what you decide. 

  • image MrsNukem:

    I just scheduled my CVS (I will be 12w2d at that time).  My MFM who will be performing it is one of 2 doctors in the area who does them, he will also be seeing me through the rest of my pregnancy along with my OB.

    Because I have a twin pregnancy, I elected to do CVS vs amnio solely bc it is earlier, and in the unfortunate event that I may need to terminate one of the babies, it is safer to do it earlier and it will also allow more time for the other surviving baby to grow.  I'm praying it won't come to this, but this was my reasoning.  If I was pregnant with a singleton, I would do Materni21, unfortunately it doesn't work for twin pregnancies.

    Good luck OP with whatever you decide.

     

    Fyi, maternit21 can be used in twin or even triplet pregnancies. Just in case anyone else stumbles upon this... 

  • image Momof2hopingfor3:
    image MrsNukem:

    I just scheduled my CVS (I will be 12w2d at that time).  My MFM who will be performing it is one of 2 doctors in the area who does them, he will also be seeing me through the rest of my pregnancy along with my OB.

    Because I have a twin pregnancy, I elected to do CVS vs amnio solely bc it is earlier, and in the unfortunate event that I may need to terminate one of the babies, it is safer to do it earlier and it will also allow more time for the other surviving baby to grow.  I'm praying it won't come to this, but this was my reasoning.  If I was pregnant with a singleton, I would do Materni21, unfortunately it doesn't work for twin pregnancies.

    Good luck OP with whatever you decide.

    Fyi, maternit21 can be used in twin or even triplet pregnancies. Just in case anyone else stumbles upon this... 

    My OB says it can't, and I'm pretty sure I read the same thing on one of the internet websites.  I did come across this on the Harmony test, which is similar to Materni21: 

    The Harmony Prenatal Test can be ordered by

    healthcare professionals for women with pregnancies

    of at least 10 weeks? gestational age. The test is not

    for use in multiple pregnancies (such as twins) or

    egg-donor pregnancies.

    Me:40 AMA, DH:36 0% morph, TTC#1;
    BFP#1 4/2011, MMC 6/2011 11wks Trisomy 13;
    BFP#2 11/2011, CP
    FSH: 17.9, AMH: 2.2
    IVF#1 w/ICSI: ER 4/3: 5R,4M,4F
    ET 4/6 All 4 (1-8A+, 2-8A-, 1-3A) BFP#3
    Two weeks of beta hell = Blighted Ovum
    IVF#2 Aug/Sept: ER 8/27: 4R,3M,3F
    ET 8/30 (1-8A+, 1-6A+)
    Beta#1 9/10: 350; Beta#2 9/12: 796; Beta#3 9/20: 9155
    Expecting Boy/Girl Twins! My babies were born 4/23/13 at 36w1d!

     
     

  • My husband and I always said we were never going to terminate and we were pretty adamant about that.  And then I got my 1st tri screening results that put us at a 1 in 8 risk for Down's Syndrome.  After that hit me, my whole perspective about possible termination changed.  I'm an occupational therapist and work with children with special needs.  I've seen many different children with different diagnoses and chromosomal abnormalities from the very mild to very severe.  And while all of them are a blessing to work with and I'm lucky to know some of them and their families personally, I often wonder what will happen to them as they get older and as their parents get older.  Like danuli8 said, my husband and I are older and I know that our child will most likely be an only child and if she had Down's, there would be very little support once we pass.  The thought of that was what killed me more than knowing I could be carrying a child with Down's.

     Anyway, after talking with my doctor, my husband, and some friends who had a CVS, and doing some research, we decided to go ahead with the CVS.  As my doctor told me, the risk of miscarriage was actually smaller than my risk of having a child with special needs.  Fortunately that same day, he had the results of my MaterniT21 and those were normal.  I went ahead and passed on the CVS but am leaving the option open for an amnio if needed.     

    Good luck with your decision!! 

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  • We have a poster here, I think, who lost a healthy baby after she contracted an infection from CVS.  She went to a top doctor in a major metro area.  Personally I would do the NT scan and see what my odds were before moving to either amino or cvs.  It would help me better weigh the risk of miscarriage.  
  • image TX-Bride:
    image danuli8:

    You could start with an NT scan and bloodwork (non-invasive), and if you don't like the "odds" you get, then you could do an amnio. I did the NT scan/bloodwork and the MT 21, was happy with my results, and will be skipping the amnio. If I had gotten a positive result on the MT21, I would have done an amnio to confirm before terminating the pregnancy.

    My focus was on avoiding invasive procedures if at all possible. 

    The more and more we are researching, we are also coming to the conclusion to do other tests before we do Amnio. Did you have to convince your Dr to do MT21 or they offered it to you?

    I told my OB that I wanted it (the MT21). She initially said that I really didn't need to do both the NT+bloodwork AND the MT21, but I have read so many horror stories about older moms getting awful "odds" back from the NT+bloodwork that I wanted TWO sources of information. And frankly, the MT21, although still a screen and not a diagnostic, is a much more accurate indicator of a possible trisomy with fewer false positives than the NT+bloodwork. Thankfully, I got good "odds" from the NT+bloodwork AND a negative result for all three trisomies on the MT21, so I feel like I got double confirmation that my baby is okay (at least,  he doesn't have anything those two tests can detect).

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  • We did the CVS and I'm having twins. I called all 3 of the companies maternity21, Harmony, etc. Materniti21 was the only one that said I could use for twins but they only had limited data on the validity. After losing our last baby to T18, we needed the most accurate info. I had both done abdominally. This is a tough decision and the answer depends on your circumstances. For us it was the right thing. GL in your decision.

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  • I completely understand what you are going through...that was me a week ago!

    I am 39, I had a m/c in 2011, I am 12 weeks 2 days pregnant.  I have 2 boys ages 5 & 6 and never did any tests with them...but we were younger then.  This time my husband really wanted to test.  I want the peace of mind and like my husband, wanted the test but the thought of possibly miscarrying a healthy child due to my need to know just crippled me. 

    My husband said he would want to terminate.  I told my husband that I didn't think I would want to terminate but I have no way of knowing how I would feel if the test came back abnormal...I am not sure anyone can say until faced with that; there is just too much to consider. 

    We went to the genetic counselor and we talked a great deal after.  After our doctor went over termination later in the pregnancy I told my husband that he just couldn't ask me to do that, he said he would never ask me to do that.  He said he would rather not know at that point.  That is why we agreed that an amino was just not for us and the other testing would just be too inconclusive and too late.  That is how we came to the decision that we would either do CVS or no testing. 

    We made the appointment for the CVS without knowing if we could actually go through with it.  On Tuesday (3 days ago), we were in the waiting room still not knowing if we could go through with it.  I was in the room and on the table before I fully realized we were going to do it.  I had tears running out of my eyes the whole time just because I wasn't sure if we were doing the right thing.  The test went absolutely fine and was over quickly.  I went home and basically went to bed for 2 days just because I didn?t want to take any chances.

    Yesterday morning we received a call from the office that the initial tests back from the CVS and I am happy to report the test came back completely clear, baby is healthy!

    I can tell you that one day later I am very happy that we did the CVS.  If I had to do it again I would do the CVS.

  • The thing that finally made my decision for me was that my odds of having a Downs child were much higher than my chance of miscarrying due to the CVS test.

  • Having had to make this decision recently, I wanted to share my perspective with you.  

     Based on NT and blood work, we were given a 10% chance of a normal baby which was absolutely devastating to me.  DH and I were not sure about whether we would terminate or not.  I don't think you really know how you feel or whether  you would actually consider it until you are faced with true chances for abnormalities.  I always thought I was someone who would never consider it, but as previous posters have already mentioned, being older was a huge factor. At the same time, having a child with special needs requires so much extra care and preparation, and I wanted to be able to provide the best for our child and make the best possible choices for him/her. The selfish part of me could not bear with  the stress of wondering and worrying until delivery.  I wanted answers fast, and that was the primary reason we went with the CVS.  Although there are no guarantees, I made sure my procedure would be done by the most experienced perinatologist.  I think my fear of a chromosomal or anatomical defect overshadowed my fear of a miscarriage from the CVS.  I ended up having the procedure transvaginally based on the location of my placenta.  We opted to have the FISH studies done so that we would have results for the trisomies in 48 hours although the rest of the chromosomal analysis took almost 10 days. I made sure to take it very easy for 72 hours - no lifting, almost complete bedrest, although this was not necessary.  We were also offered microarray and SNP testing which I declined and wanted to wait for the chromosomal studies and later US before deciding.  Very very fortunately, the chromosomal studies and recent US were all normal.  For me, this was worth the peace of mind, and I now feel I can enjoy my pregnancy with my whole heart.

    As an aside, my baby's NT measurement was 4.5.  Our perinatologist said he would not have waited for the blood work which would have been abnormal anyway, and would have had my OB refer me to him based on NT alone.  Good luck to you in your decision making.  I know how hard it is to know what the right thing to do is.

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  • I'm 38 and like you a Down's or Trisomy diagnosis would have made a difference for us so we wanted to do the earliest test possible. CVS will give you 100% accurate results at the earliest date. Mine was done through the abdomen. I had no pain and no complications. We can now relax and enjoy the rest of our pregnancy.
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  • Also, make sure the doc you are going with is very experienced. Our doc only does genetic testing. His miscarriage rate was less than .5%. An earlier post said "sometimes they reccommend an amnio after cvs", that would only be the case if some reason they were unable to perform the cvs.
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  • We chose to go with an Amnio.
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  • image JenBee74:
    Also, make sure the doc you are going with is very experienced. Our doc only does genetic testing. His miscarriage rate was less than .5%. An earlier post said "sometimes they reccommend an amnio after cvs", that would only be the case if some reason they were unable to perform the cvs.

     

    Not true.  Refer to  mosaicism for further explanation of the reason for the recommendation of amnio after certain CVS results.

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  • Thank you all for the responses, so we decided to meet with the genetic counselor next week. FIL is an OBG and he strongly recommends that we still do the NT Scan, if needed to the Amnio or CVS, but this is where my Dr and I disgree with him, we are still going to do the Amnio even if the NTScan looked ok. Our biggest question for our counselor is if there is a cut off date in State of Texas for abortion due to abnormalities.  

  • First of all I want to wish you the very best no matter which test you choose or what the outcomes are.   

    I'm 40 years old and 16 weeks along with my first child.  We knew from the beginning that I would be considered high risk due to my age.   I had the NT and though the measurement at the back of the neck was normal my initial blood test still showed that I had a 1 in 50 risk of having issues with a genetic disorder.  I guess I'm lucky in that my doctor both offers and recommends the Harmony test, which is similar to the MaterniT21 test in that it was a blood test from me.  It took over two weeks, but I finally got the results today and to my relief I'm now considered very low risk with only a chance of only 1 in 10,000 for those issues so I no longer have to consider the CVS or Amnio.  If you can find a doctor to do this test for you I would choose it over the invasive test.  It's a simple blood draw and they send it to a lab.  I can tell you though that if this test had still come back as high risk I probably would have gone for the Amnio so I could know for sure and base my decisions from there.   

    My friend had a CVS as she wasn't offered the other tests either.  She said it was uncomfortable - slightly painful, but not too terrible. She had it done on a Friday morning so she could go straight home and stayed in bed the rest of the day and the entire weekend just to be safe.  She didn't have any complications and her results came back fine. She's actually due this week. 

    All any of us can do is make decisions based on the information we have.  And only you and your partner can make the right decisions for you. Don't feel like you have to explain or justify your decisions to others and don't ever feel guilty about your decisions.  You have to go with your instincts and you have to do what will be the best for you.  Just know that others are going through the same thing and we're wishing you well. 

      

  • My NT scan was 1.3, but because of my age (38) I wanted to do further testing.  I opted for MaterniT21, which indicated a healthy baby boy.  Had there been no so pleasant results, I would have opted for an amnio, but coupled with the mid-pregnancy US showing absolutely no soft markers or any indication of problems, I am comfortable with no further testing.

    And OP, I understand how you feel about termination.  My husband and I discussed it in depth when I was pregnant with my first son (before we had any testing done), and in the end we really both felt we simply were not up to the challenge to raise a special needs child.  If we'd been told our child suffered from a chromosomal defect, we had made the decision to terminate.  Luckily for us, the amnio came back showing a perfect baby boy.  I know our decision is not the right choice for everyone, but it was the decision we came to, and I still stand by it today.

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  • There are waiting lists of families who want to adopt a baby with down syndrome. Please give these babies a chance. You have the right to give this baby up and they should have the right to live. CHOOSE ADOPTION!!!
  • I had a CVS, and it was a very good decision. Everyone keeps talking about "Downs Downs Downs Trisomies Downs" and assuming that Materni21 or Harmony are good substitutes for Amnio/CVS, but they are not. Downs & the other 2 common trisomies only make up 40-45% of issues, and that's all you get with free cell DNA tests like Materni21.  A CVS or an Amnio is going to give you a much broader range of answers.  Also, the CVS miscarriage rate is very low to begin with, and is even lower when you go to an experienced practitioner. In fact, they have a hard time even excluding for "background" miscarriages, because a certain percentage of pregnancies will end in the same early weeks a CVS test is performed, so not every miscarriage that occurs can be attributed to the test.

    I was over 35 and I had suffered a miscarriage a year earlier. We also learned through Counsyl testing that I'm a carrier for SMA.  I really wanted definitive answers so I wouldn't spend my pregnancy wondering "what if".  The CVS was great. The procedure itself wasn't that bad, really no worse than a pap smear. I had zero complications, and I had the microarray with detailed answers about everything in about a week.

    I just wanted to provide balance, because I see a lot of talk on the boards about how scary the CVS test is.


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  • image cruzsmommy19:
    There are waiting lists of families who want to adopt a baby with down syndrome. Please give these babies a chance. You have the right to give this baby up and they should have the right to live. CHOOSE ADOPTION!!!

    TOTAL. COMPLETE. BS.  There are over half a million kids in the U.S. in foster care, a majority are eligible for adoption, and a good percentage have a variety of special needs including Down Syndrome. People are not lining up to take babies with Down Syndrome, or else we wouldn't see so many kids in foster care. Pro-Lifers need to call themselves what they are: pro-fetus. Because if they were pro-"life" we wouldn't have so very many kids without permanent families and homes.

    Besides, the reason for diagnostic testing isn't simply to find out whether a child has one specific condition and make the decision to terminate.


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