Wednesday, June 1, 2011

Gender Selection?


Due to the fact that we have lost four pregnancies, my husband and I have decided to do genetic testing on the embryos from this IVF. This is referred to as Preimplantation Genetic Determination (PGD). There are different types of PGD with the most common method referred to as FISH. FISH has the ability to look at 5-12 chromosomes within each embryo. This method is a good choice for someone that is looking for a specific disorder or an inherited disease. Since there are 23 unique chromosomes including one that determines gender, FISH is obviously not the choice for someone experiencing recurrent pregnancy loss as 11-18 chromosomes are left untested. Array-Comparative Genomic Hypridization (aCGH), an advanced form of PGD, has the ability to look at all 23 pairs of chromosomes in each cell obtained from an embryo. Currently, just over 100 cases have been performed as this is a relatively new technology, and quite expensive. Despite my husband and I being genetically normal individuals, an abnormal number of chromosomes can result spontaneously from the maturation of the egg or during the process of embryo division. A common example of this is an extra chromosome number 21 (Down Syndrome or trisomy 21). It has been estimated that embryos fertilized in vitro contain chromosomal abnormalities in 50% or more of cases which leads to miscarriages.

The entire procedure consists of five different steps. The first three and final steps are performed by CNY and the remaining by a laboratory in NJ called Reprogenetics.
  1. The first part is producing embryos by IVF (I will get further into this in another post)
  2. The second part is the embryo biopsy in order to remove and analyze a cell from the embryo. This cell is removed from each individual embryo while in the petri dish, in the incubator using a micropipette. 
  3. The third part involves washing and transfer of the cells into a small test tube. 
  4. The cell is sent to Reprogenetics via same day courier where it is analyzed. Results are available within 24 hours at which time we decide which embryos to put back. Obviously we only transfer ones that are 100% chromosomally normal.
  5. Embryos are then transferred back into my uterus by CNY.
The one thing that my husband and I were unaware of is that with aCGH, we are notified of the gender of each embryo. I actually am not sure how I feel about this. Between now and June 15th, we need to decide what we are going to transfer back. We have decided to put back three embryos this time so we can maximize our chances, however, this puts us at greater risk for multiples. I do know that I definitely want a little girl, but there is a part of me that doesn't want to be unfair and actually would feel a bit guilty if we didn't put back a boy too. The one thing that I need to consider is I don't think that I am going to have the opportunity to ever do this again so it isn't like we can go for one gender now, and another later. I don't think that I can go through this again, physically or psychologically. So this is what I am thinking; I will with put back three girls or two girls and one boy. As I read what I am writing it sounds so morally wrong but at this point I don't have a choice, I have to decide. Any suggestions would be appreciated.

1 comment:

  1. i can completely understand your feelings. no one ever thinks they are going to have to make these kinds of decisions in life. i am not in the exact situation but our dr has talked to us many times about pgd. we were faced with similar ?s (before he realized w/my husband's inversion, it most likely would be a crap shoot)you are right...you have the choice...i don't think it is selfish to make the best out of this and favor the gender you've always dreamed of...to get you to the family you so deserve. i wish you lots of luck and will keep you in my prayers! :)

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