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Preimplantation genetic diagnosis (PGD) is technology used to identify a genetic mutation in an embryo created through in vitro fertilization (IVF) before implanting the embryo into the uterus. The purpose of PGD is to identify an embryo for implantation that is unaffected by a specific genetic disorder, thereby reducing or virtually eliminating the risk of having a child with that disorder.
The first baby born using this technique was born in 1989. As of 2006, more than 15,000 babies have been born following PGD.
There are different techniques used for certain indications and varying by center. In general, PGD involves extracting genetic material from the embryo for analysis. Removing a cell from the embryo for genetic analysis does not hurt the embryo. The embryo compensates for the removed cell and continues to divide normally. This genetic material is then used to test and determine if the embryo has a mutation.
Families with a high risk of having children with a genetic disorder or chromosome abnormalities and who wish to avoid elective pregnancy termination or to prevent the birth of an affected child following prenatal diagnosis may consider PGD. Performing genetic diagnosis prior to implantation of the embryo may reduce the potential for termination of affected fetuses diagnosed by prenatal testing.
There is no difference in pregnancy rates for couples going through IVF and PGD and\ couples doing IVF alone. The rates are age dependent, but as a general rule it is 30-40% per IVF cycle.
At this time, prenatal diagnosis by chorionic villus sampling (CVS) or amniocentesis is still recommended for reassurance and confirmation of PGD since this technology is not guaranteed. However, prenatal testing is a personal decision that every couple must make for themselves.
PGD has been attempted for various single gene disorders including cystic fibrosis, Tay-Sachs disease, alpha-1-antitrypsin deficiency, retinitis pigmentosa, hemophilia A, Alport disease, sickle cell disease, thalassemia, X-linked hydrocephalus, and myotonic dystrophy among others. It is possible to do PGD for most genetic disorders with an identifiable mutation.
The cost for PGD is usually more than $15,000. Some insurance companies have been found to cover the PGD procedures but many do not. Some insurance companies will cover the IVF procedures (although usually this requires a diagnosis of infertility). Typically reproductive centers have genetic counselors who are happy to work with you to check your coverage and to help provide any necessary documentation to your insurance company.
There are some people who have voiced opinions against the use of PGD. Some of these reasons include worrying that PGD will be used to design the “perfect baby” as well as the fact that fertilized cells that have a mutation are not implanted and are allowed to die in the dish.
There are more than 50 centers worldwide that offer PGD. A good place to start if you are interested in PGD is to contact a local physician or fertility specialist. Many physicians and fertility specialists have working relationships with certain PGD centers that they can refer you to. Also, some parts of the process of PGD may be performed at a local IVF center. Additionally, many PGD centers have websites where you can access more information.
Reproductive Genetics Institute
Molina B. Dayal, MD. emedicine: Preimplantation genetic diagnosis. emedicine.medscape.com/article/273415
Written By Andrea Harbison, MS and Hope Northrup, MD
Updated by Laura Farach, MD and Hope Northrup, MD (updated August 2013)
**This information from the Tuberous Sclerosis Alliance is intended to provide basic information about tuberous sclerosis complex (TSC). It is not intended to, nor does it, constitute medical or other advice. Readers are warned not to take any action with regard to medical treatment without first consulting a health care provider. The TS Alliance does not promote or recommend any treatment, therapy, institution or health care plan