PGD/PGS Techiques and Process
Women and men interested in pregenetic screening (PGS) for gender selection first have a face-to-face or phone consultation with the fertility clinic. The doctor will review their complete medical history including any information regarding their past pregnancies, fertility issues, miscarriages or birth defects in previous pregnancies, and any family history of genetic or chromosomal disorders.
Patients using PGS for gender selection go through virtually the same protocol as couples seeking IVF alone, with some additional steps (and costs) involved for the genetic screening of embryos:
- Patients must first go through an initial history and physical exam with fertility-related exams, including an ultrasound, blood tests and/or a semen analysis.
- Clinic staff will then provide a daily schedule of medications needed for IVF and will teach the patient how to self-administer follicle-stimulating hormones in order to maximize ovarian stimulation and egg yield at the time of egg retrieval.
- On the first day of her cycle (day 1 of menses), the woman begins the cycle monitoring protocol with a clinic visit. She takes medications to stimulate her follicles (she or her partner or friend inject them) and reports back to the clinic on a regular basis for ultrasounds of her ovaries and blood tests to hormone level checks. This typically takes between 8 and 12 days of stimulation and usually requires 3 (or 4) ultrasounds and blood tests.
- As her egg follicles begin to grow and mature and her hormone levels reach the correct levels, she will undergo egg retrieval in an out-patient visit to the clinic, in which the doctor removes the oocytes (eggs) from the ovaries with a fine needle inserted through the vagina using ultrasound guidance.
- At the same time, the husband gives his semen sample or donor semen is used. If a fresh semen sample is not available, a frozen sample may be thawed for use.
- The sperm and egg are united in the laboratory (either the co-incubation or intracytoplasmic sperm injection (ICSI) techniques).
- The resulting fertilized eggs (now called embryos) start to divide in the petri dish. After they reach either the 6 to 8-cell stage or the blastocyst stage, they’re ready for PGS to determine their gender and to screen for basic chromosomal abnormalities. With PGD (pregenetic diagnosis) scientists can screen for specific inherited genetic diseases.
- After receiving the embryo report, the partners have to make a big decision regarding how many embryos to transfer to the uterus. With their doctor’s advice, in addition to guidelines from the ASRM (American Society of Reproductive Medicine), the partners decide, and the rest of the healthy embryos can be frozen for later use.
- In IVF cycles without pregenetic screening, more embryos are often transferred if a woman is of “advanced age” or has a prior history of unsuccessful IVF cycles. When transferring euploid embryos after PGS, physicians at HRC Fertility and other high quality fertility clinics often recommend a single embryo transfer because the pregnancy and delivery rates are virtually the same with a single or double embryo transfer. However, the rate of twins (and triplets) and their corresponding more complicated pregnancies are significantly higher with more embryos transferred.
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