PGD ?

MJoule

Tell me a bit more about it?  How do they do it?  What does it cost? Benefits?

cjsbdl

https://en.wikipedia.org/wiki/Preimplantation_genetic_diagnosis

 Take all this with a grain of salt because it IS Wikipedia, but there's a lot of good information here.

cjsbdl

At my clinic it is about $4500 on top of normal IVF costs.

ibl530

PGD stands for preimplantation genetic diagnosis.  It allows you to screen your embryo's to determine which ones might be carriers of a genetic disorder, or have chromosomal abnormalities.

You would go through an IVF cycle.  They would harvest your eggs.  They would then use ICSI (intracytoplasmic injection) to fertilize the eggs.  This is taking one single, healthy looking sperm and injecting it into the cytoplasm of the egg.  This is to ensure that only one sperm gets in, and to also allow for a "clean" embryo on the outside.  On day 3 they would biopsy the fertilized embryos.  This involves creating a "hole" in the embryo and removing one cell.  This cell is then sent to a lab and tested for what you are looking for.  Then on day 5, they will put back unaffected embryos. 

The benefit is putting back healthy embryos and giving you a greater chance of a healthy baby.  Our lab gives a 2% error rate and suggests doing some form of prenatal testing. 

As for cost, it all depends on the lab you use, and how much your RE's office charges for the biopsy.

HTH.  Any further questions just page me.

Ila

 

MyColonyNJ

NOTE: after I typed this I realized that I wrote a book, sorry so long

For us, this is our only option.  We have had at least one m/c due to chromosome abnormalities and one that was inconclusive.

Since I have had 3 m/c and they can not pinpoint something wrong, pgd is the answer.

All answers will be based on what my RE has said.

You go through the same IVF process (meds, er, et, etc)

the eggs are usually fertilized using ICSI (adds to the expense) because they have to make sure that only the actual embryo is tested.  ICSI takes one sperm and injects in directly into the egg.

From what my RE says, it is possible that if they did not use icsi, then a sperm could "stick" to the outside of the egg.  So, when they took a cell of the fert embryo, it could possibly get a cell of the outside sperm.  This of course would alter the pgd results.

The embryos are usually grown to day 3 days.  At that point, one cell is removed through biopsy.  the cell is sent to a genetics lab - sometimes out of state.  the embryo remains at your clinic to grow to day 5.

I am assuming that the genetics lab does the testing the day they receive the cells because they have to know for sure the results by day 5, which would be transfer day.

my genetic lab tests for up to 12 different chromosomes - the most common ones that are usually abnormal (X, Y, 8, 13, 13, 15, 17, 18, 20, 21, & 22)

But, also have lower "packages" that would test for less.  If we did it, we would do the above, it is not that much more than the other packages.

in addition to chromosomes, it may be able to test for specific genetic defects.  There are things are are inherited from parents so this way they would not transfer embryos that had that defect.  This is an added expense.  Not a service that we need so I do not know too much about what defects it tests for.  There are also somethings that only a boy or a girl will have.  Since the "basic" testing determines the sex, there may be some times where full genetic defect testing may not have to be done.  You would just not transfer whatever sex would carry the defect gene.

After the do the testing, the clinic is contacted with the report and then only the "good" embryos are transfered back or frozen for later use.

Of course since the cost of PGD is added to an IVF cycle, most people will want to freeze any embryos that are not transferred.

The are some risks.  Some say that since you remove a cell, the embryo becomes damaged, and therefore has a slightly higher chance of not implanting in the uterus.  I guess that would be a risk that I would take.

I know that there are other small risks, but my doc did not seem too concerned with them to make them a big deal.

There are several costs involved when doing PGD, you have to remember that these costs are in addition to the IVF fee.  And since you have to do ICSI, those are additional costs as well.

Here are some costs - note I am adding the freezing fee as well

$3000 - ICSI
$2000 - Clinic Biopsy
$500 - Transportation Fee to Lab (my lab in same state though)
$2810 - 12 Chromosome screening (listed above)
$1150 - Embryo Freezing for one year
______
$9460 in addition to any IVF Fees.  I have the break down of fees for IVF if you need them.

Here are the other fees listed by my genetics lab - (services i don't need so I am not 100% what they really are, just copied from a list)

$3325 - Reciprocal translocation
$1625 - Aneuploidy 5 chromosomes
$2810 - Robertsonian translocation
$3250 - Comparative Genomic Hybridzation (CGH)
$3500 - 1 gene mutation
$4500 - 1 gene mutations

We may or may not presue any additional medical treatments.  If you have any questions, let me know and I will try to answer.  However, I have not done it yet, so all of my answers will take that into consideration

hannah&ben

The wikipedia page does have good info - basically there are 2 kinds of PGD.  One kind where they look at chromosomes for issues (they can look at a few, several, or all of them - just depends on the situation). Women who have had previous failed IVF's, multiple losses, a long history of not being able to get pregnant despite everything looking "normal", etc migh benefit from this.  Basically any situation in which there is a liklihood that there might be chromosomal issues causing losses or lack of pregnancy could benefit from this testing.

The other kind they look at single genes (they know 1 specific issue/genetic defect they are looking for) - this is what I did b/c I have a genetic abnoramality that caused cardiac defects in my son.  I'm now pregnant with a baby that has less than 1% chance of having that genetic defect.

We paid about $5k on top of our IVF cycle and that seems pretty average.

Basically what happens is just like any other IVf cycle - you do stims - they retrieve eggs.  They're fertilized using ICSI (they can't do it the other way b/c lots of sperm bonds to the outside of an egg and could contaminate the PGD process). They let the embryos grow to day 3 - then things get a little different.  Instead of having a transfer on day 3 they remove 1 cell from each embryo - those cells are then tested (the PGD). The genetics lab that does the testing does their best to get the info to your RE by day 5 - and on that day if you have any embryos that are healthy then you have your transfer.

It is somewhat risky procedure b/c a lot of things need to go just the right way to make it to transfer - I would never recommend it unless there is a real reason to be doing it (not just choosing the sex of your embies, etc).

I'm happy to answer any other questions!

Hannah

MJoule

WOW, thanks ladies.  I don't really think I would be a candidate for PGD for IVF #3 but I'm looking into everything to make sure we have the best possibility for success.

Thanks again, you are all a wealth of knowledge.