Obstetric outcome of pregnancies resulting from embryos biopsied for pre‐implantation diagnosis of inherited disease

Abstract

Objective Pre‐implantation diagnosis of inherited disease is now a viable option for some couples at risk of transmitting inherited disorders to their children. Since the pregnancy begins knowing that the embryo is not at risk, the need for repeated terminations is eliminated. Up to 25 % of the embryo is removed during the procedure, and so it is important to study the resulting pregnancies. Here we report on the obstetric outcome of our first 16 pregnancies resulting from embryo biopsy and preimplantation diagnosis of inherited disease. Setting Teaching hospital. Sample The first 16 pregnancies (12 singletons and 4 twins) following pre‐implantation diagnosis. Results Three singleton pregnancies were lost in the first trimester. Of the remaining pregnancies, two had no prenatal diagnosis, six cases of X‐linked disease had the sex confirmed by ultrasound and chorionic villus sampling was performed in the remaining five. All the singleton pregnancies had an uneventful antenatal course and the birthweights and Apgar scores of the babies were normal. The twin pregnancies presented obstetric complications but these were not unusual. Conclusions Fifteen healthy infants were born, but for the foreseeable future pre‐implantation diagnosis pregnancies should be closely followed up.

Gender “tailored” conceptions: should the option of embryo gender selection be available to infertile couples undergoing assisted reproductive technology?

“…The proposed benefits of PGD for the sole intention of gender selection in a patient undergoing ART must be thus balanced against the small yet real risks of embryo loss, and even failure to achieve an embryo transfer, as well as the incremental costs incurred (approximately $2500 per cycle above the costs of approximately $7500–$10 000 for the IVF cycle and related procedures) 25. To date, there are no reports of increased identifiable problems (fetal malformations or others) attributable to the embryo biopsy itself 26. On the contrary, data suggest that PGD for aneuploidy screening may significantly reduce the risk of spontaneous abortions and of aneuploidies in the offspring of women undergoing IVF, particularly so in the reproductively aging patient population 23…”

Preimplantation sex selection demand and preferences among infertility patients in Midwestern United States

“…The two methods currently commercially available are sperm separation and preimplantation genetic diagnosis (PGD) [1][2][3][4][5][6]. Even though the intended use of such technologies was to prevent the birth of children with sexlinked genetic disorders, these technologies are being increasingly used for preimplantation sex selection for nonmedical reasons (http://www.microsort.net/index.php, accessed March 1, 2007) [7,8].…”

Preimplantation genetic diagnosis

“…To date there are no reports of increased fetal malformation rates or other identifiable problems (8). The International Working Group is initiating such a report, but confidentiality issues and selective reporting will remain continuing problems.…”