What is infertility?
Infertility is define as the inability to conceive after regular unprotected intercourse (Without using contraception) for over 12 months. One Third of infertility can be attributed to male factor and about one in third (30%) can be attributed to female factors (World Health Organization). In about 20% cases of infertility is unexplained and the remaining 10% of infertility is caused by a combination of problems in both partners (WHO)
Do I need to see a specialist?
It is recommended that you seek the help of a fertility specialist if you are unable to achieve a pregnancy after 12 months of unprotected intercourse.
What is In-vitrio Fertilization?
IVF is an acronym for in-vitro Fertilization. It is a process by which an egg is fertilize by sperm outside the body. In-vitro fertilization is a major treatment for infertility when other options have failed. The process involves monitoring a woman’s ovulation process with ultrasound and blood tests. Removing eggs from the woman’s ovaries through a mild sedation and fertilizing with husband‘s sperm in the laboratory with the appropriate conditions that mimics inside the womb. The fertilized oocyte(egg) is monitored for development then transferred to the patient’s uterus after 2-5 days and if this implants then a pregnancy occurs
How does it work?
This fertility treatment involves a very mild stimulation of the ovaries with medication over a number of days to increase egg production in order to improve the chance of achieving a pregnancy. An ultrasound will be used to monitor the size of the follicles and when it reaches optimum sizes, HCG is administered to stimulate the release of eggs from the follicles. Your husband’s semen sample will be prepared (washed) in the laboratory to separate the best sperm from the seminal fluid. This procedure encourages the harvest of only good quality sperm. A catheter is used to inject the processed sperm directly into the uterus. Therefore, maximizing the number of sperms cells that are placed in the uterus.
What is pre-implantation genetics diagnosis (PGD)?
By definition, pre-implantation genetic diagnosis (PGD) is the diagnosis of a genetic condition prior to achievement of a pregnancy by checking the embryos to select the unaffected ones. PGD enables a couple to achieve a genetically healthy embryo and have an unaffected offspring.
How is the testing performed?
There are two basics typed of pre-implantation diagnosis. For example, there is the polar body analysis and embryo analysis. Both types of testing have advantages and limitation. Poor body testing focuses on the maternal contribution and is an early method of testing, while the embryo testing accounts occur at later development.
What is embryo biopsy?
When an embryo becomes a 6-10 cell mass (approximately 3 days after egg retrieval), it becomes possible to directly test the embryo through the removal of a single cell. Removal of this cell s usually not detrimental to other embryos, so all the cells are equivalent and no cell differentiation has occurred. The cell that is removed may then be analyzed to determine directly the genetic status of that embryo following embryo biopsy. The chromosomes are screened to detect any abnormality and the affected embryo(s) are separated from the normal ones.
How is PGD done?
Generally, due to the limited amount of DNA that is available for study (one single cell) and due to the limited time to obtain results, a special system for testing will be set for each couple. This testing will rely on a technology known as PCR which will enables the laboratory to use a small amount of DNA and get a rapid result. A system is a set up for each couple which will depend upon the condition being treated. Usually, in addition to testing for this gene change, the laboratory will also determine linked markers which are used in a fashion similar to DNA fingerprinting. Linkage allows the laboratory to have several ways to determine which gene (s) has/have been inherited. Therefore, different types of DNA samples to prepare the case and develop a system for the couple. Once this system has been created for the couple, the laboratory tests it on the various samples to assume that the testing works consistently in a single cell setting.
What is the accuracy of the testing?
This depend on the genetic condition being studied .The method by which is being studies and the number of linked marker for the couple. On average for a case performed blastomere 95-98%.
What are the limitation of PGD?
As with prenatal, PGD is aimed at reducing your chances of having a child with genetic error. However, it does not test for all birth defects. Every couple regardless of their ethnic background and family history has a 3-5% risk for birth defects with each pregnancy.
Does PGD replace prenatal testing?
No, PGD does not replace prenatal testing. PGD is a non-research based test allowing for a similar diagnosis to those available by prenatal testing. However, prenatal testing such as chronic villus sampling or amniocentesis is recommended to confirm the PGD test as prenatal diagnosis is the standard of care.
How can PGD and IVF help my family and me?
PGD can allow the laboratory to select those embryos that are known to be either “balanced or normal”, thus avoiding achieving a pregnancy with an unbalance set of chromosome. PGD can reduce the likelihood of couples having to deal with these particular circumstances by knowing prior to conception that the embryo(s) being transferred are not affected.