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The Preimplantation Genetic Diagnosis (PGD) is performed in IVF procedure under the guidance of an IVF specialist who has experience in dealing with such medical procedures, which boost the success rates of IVF procedure. Here are steps, which are performed for PGD with IVF treatment:
PGD with IVF starts with ovarian stimulation step where the infertility specialist makes use of fertility injections and medications to bring desired changes in the body of the woman. Infertility specialist first asks the patient to undergo certain medical tests. This guides them in finding out the required treatment plan. Once, the requirements such as hormonal levels and other criteria are fulfilled, the doctor proceeds with the next step of IVF.
Eggs are removed from the woman with assistance of egg retrieval procedure. The quality eggs are used in the fertilization step of IVF treatment. The infertility specialist takes out some amount quality semen from male partner or donor. The good quality sperms are then extracted from it.
After the eggs and sperm are taken from the couple or donor and tested for the best quality, they are sent for successful fertilization in the IVF laboratory. The embryologist performs fertilization step, which leads to the formation of the required embryo. A proper examination of the eggs and sperms are performed in terms of quality before the step is performed.
Embryo Biopsy is performed under the guidance of embryologist when the embryo reaches the blastocyst stage. Couples need to know that embryologists who have received a license from the Human Fertilization and Embryology Authority (HFEA) perform biopsy procedure. The removal of some cells from the embryo does not cause evident damage to the embryo. This type of embryo biopsy is also known as trophectoderm biopsy.
Once the cells are removed from the embryo in the embryo biopsy procedure, they are tested properly in the laboratory as per the defined medical guidelines of the embryology lab in the best possible manner. The practicing embryologist performs embryo testing and gives the results of the presence or absence of a genetic disorder.
A good quality embryo is only selected for the embryo transfer step in IVF. The healthy and disorder-free embryo is finally chosen and transferred to the uterus of a woman or female partner in the couple. The couple is asked to wait for approximately 2 weeks by infertility specialist before going for a pregnancy test. This helps the couple to prevent having false positive results of pregnancy.
Pregnancy test is recommended after two weeks of completion of embryo transfer step in IVF procedure. (Source: Preimplantation Genetic Diagnosis: How does it work?, Genetic Alliance)
IVF PGD procedure is available for the benefit of international patients (outside India) as well. Patients travelling from other countries can receive the IVF PGD procedure facility at affordable prices to achieve success and start their families.
SURROGACY AND IVF DOCTOR
TECOM, Bandra West, Dubai
He is an IVF PGD specialist practicing at Dr. Amal Alias Fertility Gynecology Center, Dubai. Dr. Allahbadia specializes in IVF ICSI, IUI, TESA, MESA, along with IVF PGD procedures and possesses a practicing experience of two and half decades.
Phayathai Road, Bangkok
He is an infertility specialist practicing at First Fertility PGS Center, Bangkok, Thailand and holds a practicing experience of over three and half decades. He has also achieved Diploma from Thai Sub Board of Reproductive Medicine. He specializes in IVF, IUI, Frozen Embryo Transfer (FET), along with Embryo Quality Assessment facility.
Scotts Road, Singapore
He is an infertility specialist with nearly three decades of experience practicing at Pacific Fertility Institutes in Novena, Singapore. He specializes in IVF, ICSI, PCOD problems treatment, Laparoscopy Surgery, and IVF PGD procedure.
Khlong Toei, Bangkok
She is an infertility specialist practicing at Inspire IVF Clinic situated in Khlong Tei, Bangkok. She specializes in IUI, IVF, PGD and PGS, Semen Analysis test, and Testicular Sperm Aspiration (TESA), Intracytoplasmic Sperm Injection (ICSI) procedure.
IVF AND INFERTILITY CLINIC
It is located in Dubai is one of the top infertility clinics offering IVF PGD procedure facilities with excellent success rates. The infertility specialists offer expertise in infertility treatments of top quality.
IVF AND INFERTILITY CLINIC
Pathum Wan, Bangkok
It is an infertility clinic in Bangkok which offers success oriented IVF PGD procedure. The infertility treatments performed here are of appreciating success rates with prime patient recommendation.
It is a gynecology hospital located in Novena; Singapore.The centre also offers IVF, IUI, PCOD treatment, Hysteroscopy, and Laparoscopy Surgery. The medical specialists practicing at the centre are members of MRCOG and FAMS.
IVF AND INFERTILITY CLINIC
Khlong Toei, Bangkok
It is an IVF centre based in Khlong Toei, Bangkok. The centre offers IUI, IVF, ICSI, FET, Preimplantation Genetic Disorder (PGD), Frozen Embryo Transfer (FET), and Endometrial Receptivity Analysis (ERA) test. The infertility specialists practicing at the clinic have received training from some of the top institutes across the world.
I was trying to conceive a baby but failed twice with IVF procedure. Therefore, my infertility specialist recommended going for PGD before next IVF cycle. We are thankful to Ela for suggesting us with the best doctor for our complicated medical case.
My wife and I were planning to start a family and decided to take assistance of medical specialist. Fortunately, we came across Ela. It was a wonderful experience for us, as we did not face any troubles during our IVF procedure. The best part is that the pre-implantation genetic diagnosis helped us reach our goals over the time.
Ela and team guided us throughout each of the steps of IVF treatment and it was a peaceful experience for us. One of the best features of our treatment was that we received constant on call support of a dedicated Ela specialist who was allotted for our case. IVF with PGD procedure was a boon for us. We found it cost-effective and useful as well.
PGD and IVF proved to be of great help. I am grateful to the team of Elawoman for showing the right path by introducing us to one of the top IVF specialists who believes in using advanced medical solutions for reaching to the best possible solution to complex cases of patients visiting the centre. Also, we received proper counseling about our treatment from one Ela specialist which was very useful for us.
1. What is Preimplantation Genetic Diagnosis (PGD)?
Preimplantation Genetic Diagnosis (PGD) is an advanced medical test, which is advised and performed for determining the presence of genetic disorders in the embryo formed in the IVF laboratory before performing the implantation procedure in In Vitro Fertilization (IVF) procedure.
2. History of Preimplantation Genetic Diagnosis (PGD):
In the year 1989, PGD came into existence in the field of medicine. The practice of this medical test was efficiently started in the same year. Alan Handyside, an American embryologist and geneticist made the best efforts in introducing the medical test of Preimplantation Genetic Diagnosis (PGD). His main aim was to detect the presence of defects in the genes, which lead to the occurrence of cystic fibrosis. Cystic fibrosis is a X-linked disorder, which is caused because of X-chromosome's genetic chromosome. In the next year, Alan performed biopsy of embryos formed with IVF procedure. In this respective procedure, he removed up to two cells from each of the embryos formed with the fertilization step of IVF procedure, which proved to be helpful for carrying out the procedure. He performed the procedure after two to three days of the completion of IVF procedure. In this medical trial, Alan took assistance of three couples in this medical test. Each of the couples took part in this test on a voluntary basis to help him to find a conclusion, which can solve infertility issues of other couples in a more defined way. One woman among three couple participants had two normal embryos. These embryos were successfully formed with the help of fertilization step. The embryos lacked the presence of cystic fibrosis gene in them. The best part was that the baby who born with the pregnancy that resulted from the implantation of the embryo was a healthy one and free from genetic defects, even the carrier types. With the help of this trial performed by embryologist Alan, it was found that single-gene disorders can be successfully identified with the assistance of medical tests such PGD. The usage and implementation of Preimplantation Genetic Diagnosis (PGD) became a part of several IVF procedures performed across different parts of the world. PGD test is still in the developmental mode and infertility experts will keep upgrading the test for the welfare of the patients. (Source: Preimplantation Genetic Diagnosis, Britannica)
3. Benefits of Preimplantation Genetic Diagnosis (PGD):
Medical tests like Preimplantation Genetic Diagnosis (PGD) are performed to help couples in certain crucial ways. These most important benefits of PGD are mentioned below in details:
4. Accuracy of Preimplantation Genetic Diagnosis (PGD) test:
The accuracy of PGD test is one of the most discussed aspects of these advanced medical tests. According to the latest medical researches and IVF experts, PGD accuracy is up to 98%. One of the best solutions for confirming the results in PGD is to also opt for prenatal testing. Prenatal tests include Chorionic Villus Sampling (CVS) and amniocentesis offer good quality results that help patients to get support for their IVF procedure in an efficient manner. (Source: Pacific Fertility Center)
5. Ethical concerns revolving around Preimplantation Genetic Diagnosis (PGD):
Every new medical procedure or test introduced in the field of medicine has to face questions related to ethics and needs to pass them all to get implemented successfully in the medical practice. Preimplantation Genetic Diagnosis (PGD) is also one of the most recently introduced medical tests for improving the success rates of IVF procedure for couples. PGD is still facing several objections in different parts of the world for being used in the In Vitro Fertilization (IVF) procedure. In different countries across the world, couples want their kids to have 'high IQ'. Genetic selection to promote intelligence in the baby has increased the utilization of the procedure as well. This has made PGD use in IVF increase in different parts of the world. But in certain countries such as the UK and surrounding nations, PGD is not yet practiced in an effective manner. PGD is useful in improving several features of the baby but then this test has become popular because of its efficiency in reducing or completely nullifying the chances of having a baby with genetic or chromosomal disorders. Some of the experts mention that the 'normal' embryos will prove to be the smartest of all. (Source: The Guardian)
Therefore, it is contradictory that whether it is ethical to prioritize to have a focus on high IQ feature while going for PGD in the IVF procedure. Some countries such as the United States do not have any ethical issues with the practice of PGD for finalizing with a healthy and quality embryo, which can result in a successful IVF procedure. But then, one needs to understand that ethics associated with PGD needs to be considered while undergoing the test. (Source: Designer Babies: a conflict between science and a lot of things, New age Youth)
6. What are the types of PGD in IVF procedure?
Preimplantation Genetic Diagnosis (PGD) test is classified into several different types based on the condition to be diagnosed with the chosen procedure.
Patients need to understand that ample of patience is required while undergoing PGD with IVF procedure. The ones who keep patience during their procedure will only receive the desired results at the end of the procedure.
7. Is it possible to go for Gender Selection with PGD in IVF procedure?
Yes. In fact, gender selection is one of the key features of PGD, which is practiced in countries, where a selection of gender in babies is not an illegal aspect. The gender selection procedure was performed since long, but then the accuracy of gender selection came to more than 99% with the utilization of Preimplantation Genetic Diagnosis (PGD) test. You will be surprised to know that the methods used for finding out the gender of the baby, which includes individual evaluation of chromosomes of the sperm, achieved around 75% to 80% of success rates at the end of IVF procedure.
A couple needs to make sure that usage of PGD test in IVF procedure for determining the gender of the baby must comply with the laws surrounding to PGD test. This will ensure that the couple does not fall in any kind of trap with respect to the involvement of PGD in the success of the IVF procedure. (Source: PGD for Gender Selection, IVF1)
Prenatal Genetic Testing was performed for the first time in 1970's. This was used along with amniocentesis guided by ultrasound. In the 1990's, Preimplantation Genetic Diagnosis also known as Embryo Screening was performed to make sure that only embryos of interest are utilized in the embryo transfer procedure in IVF procedure. In the year 2011, Noninvasive Prenatal Testing (NIPT) was introduced with the aim of extracting and testing fetal DNA. The DNA is extracted from the samples of maternal blood, which is taken during 8 weeks of pregnancy. The aim of these advanced medical tests is to make sure that embryos with a particular genetic sequence are identified. This can work in two ways. One is that the unhealthy embryos are prevented from being transferred into the uterus of the woman. Another major benefit is that high quality embryos will only be useful in the IVF procedure. Some of the major conditions, which are identified, include Down's syndrome, Tay-Sachs Disease, Sickle Cell Disease, Cystic Fibrosis, and Thalassemia. These days, even disability rights advocates have opinionated about gender selection techniques and specified that women must have the right to choose to give birth to a baby. (Source: Genetic Solution, Center for Genetics and Society) Family balancing is one of the major advantages of opting PGD with the aim of gender selection. There are various couples across different parts of the world who want to have a small family and therefore want to utilize PGD with IVF procedure to prevent birth of multiple children over the years. When one X chromosome from sperm and one X chromosome are present in the embryo, then it leads to the birth of a baby girl. In case, one Y chromosome from sperm and one X chromosome are present in the embryo, then the woman gets pregnant with a baby boy. The chances of birth of a baby girl or boy vary from one case to another. (Source: You can choose your baby's sex before birth, Punch)
8. Issues associated with PGD in IVF procedure:
PGD has also got certain issues, which affect the success of IVF procedure. Some of the possible issues, which can occur with the use of PGD, include:
9. How does Preimplantation Genetic Diagnosis impacts IVF procedure success?
The first point, which comes in the minds of the couples consulting infertility specialist, is about the impact of use of PGD while using IVF procedure to conceive a baby. You will be surprised to know that several clinics across the world have achieved increased success rates when chromosomal PGD was performed and only 2 to 3 tested and normal found embryos were used in the implantation step of In Vitro Fertilization (IVF) procedure. Performing Preimplantation Genetic Diagnosis (PGD) will prevent implantation of the abnormal embryos, which are actually considered as unfit for usage in the IVF procedure.
PGD will prove to be a successful solution for cases where recurrent IVF failures occur without occurrence of a pregnancy in the woman. Recurrent IVF failures can occur in the form different cases. This includes earlier unexplained IVF failure, recurrent miscarriages; age of the woman is above 38, aim of family balancing, and premature ovarian failure.
10. Legal aspects of Preimplantation Genetic Diagnosis (PGD):
PGD includes certain legal issues around it, which are still in talks under the expertise of infertility specialists who are constantly working to improve the success rates of IVF procedures performed across different parts of the world.
In the United States, some of the states such as Florida, Pennsylvania, Louisiana, Maine, and Minnesota have completely banned the practice of PGD completely. In certain states of the US such as Michigan, North Dakota, and Rhode Island, PGD is legally performed only in some specific medical conditions. However, needs to understand that as per the latest information available in the rulebooks of US, most of the other states do not have any specific laws revolving around performing of Preimplantation Genetic Diagnosis (PGD) in IVF procedure. In Germany, only a small number of centres are permitted to perform PGD procedure for patients with legal approval. From last few years, the regulation came into effective practice, thus helping patients to a great extent. In the Netherlands, from the year 2008, embryos can be sorted out to find out any presence of major hereditary disorders. In France, an effective law came out in the year 2011, which is linked with the conditions where PGD can be used in the infertility procedures. In Great Britain, Human Fertilisation and Embryology Authority (HFEA) has strictly regulated the law relating to usage of PGD. It mentions that PGD can be used for gender selection only if the sex-related hereditary disease has got a prominent and clear medical indication. In Switzerland, according to the reports released in the year 2014, PGD will only be used to prevent the passing of hereditary disorders. (Source: Preimplantation Genetic Diagnosis, AACC)
The Council of Europe's has got its own international regulations pertaining to Preimplantation Genetic Diagnosis (PGD). When the legal aspects finalized in each of the countries in Europe where compared, it was concluded that each of these countries offers legal protection to the embryo in different ways. In the year 2006, processing, preserving, and proper storage of the embryo cells received proper legal guidance in the form of a directive, which came into the act in different states from the year 2006. So, if the couple is planning to opt for PGD while opting for infertility procedure, then they need to keep a check on the respective country's legal aspects, which are decided for Preimplantation Genetic Diagnosis (PGD). The laws surrounding the practice of PGD will determine whether PGD is prohibited or allowed in the chosen country for the medical test. (Source: PGD Legal Aspects, DRZE)
11. Cost of Preimplantation Genetic Diagnosis (PGD):
Preimplantation Genetic Diagnosis (PGD) cost varies from one country to another. You need to understand that PGD is a costly affair and couples need to realize this and plan accordingly. The cost of testing of 4 embryos costs up to $2,500 on an average, where the cost of the IVF procedure falls between - $20,000 to $25,000. In some countries, a specific probe is required where some kind of genetic abnormalities need to be diagnosed. This significantly prevents passing of life-threatening disorders to the baby conceived with the procedure. (Source: How much does it cost to get PGD testing?, IVF1)
12. Risks of Preimplantation Genetic Diagnosis (PGD):
Preimplantation Genetic Diagnosis (PGD) has certain risks as well, which need to be understood while opting for the infertility treatment. It is important to know that the risks and side effects revolving around PGD are almost the same as that of the conventional type of IVF procedure. Here are certain risks, which revolve PGD:
13. Future of Preimplantation Genetic Diagnosis (PGD):
Preimplantation Genetic Diagnosis (PGD) will have a promising future if the cons of the procedure are dealt in a positive manner and the pros of this advanced test are strengthened further. Some of the infertility experts have mentioned that status of the embryo, aspects revolving reproduction along with child's welfare do not dictate the objection of use of PGD test in different infertility procedures. PGD actually proves to be beneficial in assisting embryologists and infertility specialists to find out imbalanced embryos which are of poor quality. Microarray type of Comparative Genomic Hybridisation popularly known as CGH is a promising method which is used in DOP-PCR or Multiple Displacement Amplification (MDA). The technique will be made simpler for the use in IVF laboratory in the near future which will offer more efficiency to the results of the tests performed with respect to Preimplantation Genetic Diagnosis (PGD).
Usage of new medical tests and procedures need to be encouraged for the welfare of the patients, thus improving the success rates of the chosen medical procedure. As per several medical researches in the field of infertility medicine, it is successfully concluded that Preimplantation Genetic Diagnosis (PGD) will prove to be helpful for couples who are already diagnosed with certain genetic disorders and lead to the birth of a healthy baby. Several techniques are under research and introduction of these procedures will lead to improved success rates of the performed infertility treatments. (Source: Preimplantation Genetic Diagnosis: Present and Future, NCBI)
14. How is Preimplantation Genetic Screening (PGS) different from Preimplantation Genetic Disorder (PGD)?
When a patient decides to go for an advanced infertility test while choosing for infertility treatment, it becomes important for the couple to know about different aspects of the same. So, you need to know about the pros and cons of PGS and PGD before going for the respective medical test.
Preimplantation Genetic Screening (PGS) is the medical test which is performed to find out the best embryo which has the right number of chromosomes for successful implantation of the embryo in the uterus of the woman. PGS is more popularly known as Comprehensive Chromosome Screening (CCS). You must know that the usual number of chromosomes in the embryo is 46 and if there is an extra or missing chromosome in the embryo, then it means that the embryo is not suitable for successful implantation. In such cases, one needs to understand that such embryos will not implant effectively in the uterus. Even if it implants to the uterine lining, there are high chances of occurrence of miscarriage in such pregnancy cases. In some of the recent researches, it is found that women of more than 35 years of age need to go for PGS test, if they want to conceive with success. On the other hand, one must know that the doctor can recommend Preimplantation Genetic Diagnosis (PGD) to women who at risk of having babies with genetic disorders or life-threatening chromosomal diseases irrespective of their race or age. Single-gene PGD and Chromosomal PGD are the two prime types of Preimplantation Genetic Diagnosis. In single-gene PGD, both the members in a couple are diagnosed only as carriers of a particular genetic disorder. In the case of chromosomal PGD, only the embryos which are proven to be healthy will be transferred to the uterus of the female partner of the couple.
One needs to know that PGD is made available for couples who are aware of their gene mutation. At times, it can happen that the couple is aware only about the presence of the disease. But they do not know about the genetic link associated with the detected disease. The test will help in finding this aspect of the disorder as well. One of the major benefits of PGD is that women who have opted for PGD can also go for PGS to understand whether the respective embryo can be successfully implanted in the woman's uterus. One must keep in mind that patients who undergo PGD also need to opt for PGS. But you need to know that not all patients undergoing PGS will go for PGD test. (Source: PGD vs PGS: Which one is right for you?, ORM Genomics)