Family Balancing at the Genetics & IVF Institute (GIVF)
What is Family Balancing?
A "balanced family" is one with equal numbers of male and female children. Many parents feel a strong desire to complete their families with the addition of a son or a daughter. Technologies exist that can determine the gender of an embryo, prior to implantation/pregnancy. At GIVF we offer this technology to couples who already have at least one child, and who would like to have another child of the non-represented (or underrepresented) gender. This program is referred to as "Family Balancing."
GIVF does not offer Family Balancing to couples looking to have their first child or to those whose families are already "balanced" in that they have equal numbers of boys and girls.
How is Family Balancing Achieved?
The woman undergoes an IVF (in vitro fertilization) cycle in order to obtain eggs from her ovaries which are then fertilized with her husband's sperm. The resulting embryos are tested to determine if they are chromosomally normal, and this information also determines whether each embryo is male or female. Embryos are tested before being transferred into the woman's uterus, therefore the gender is known prior to the start of a pregnancy. Family balancing is performed using the technology called Preimplantation Genetic Diagnosis (PGD). PGD is a widely accepted method for determining genetic information on embryos, including gender. PGD must be done in the context of IVF.
What is IVF
IVF is a fertility treatment whereby a woman takes medications that cause her ovaries to develop multiple mature eggs (whereas in a normal menstrual cycle a woman's body produces one mature egg). The process of getting the eggs to develop and mature takes about two weeks. During this time the woman is taking medications to encourage the growth of the follicles (fluid-filled sacs in the ovaries that contain the eggs). She is also taking medication to prevent the follicles from releasing the eggs (ovulation). The process for IVF is usually undertaken by couples who are having trouble conceiving on their own; however, for couples pursuing family balancing, IVF is necessary even if there is no history of infertility. PGD is a test done prior to the embryo implanting in the uterus; therefore, the only way to test embryos to determine their gender is through IVF with PGD.
What is PGD?
PGD is a type of test that is performed on embryos in the laboratory 5 or 6 days after egg retrieval. A small sample from each appropriately-developing embryo is removed for the purposes of testing. PGD gives us information about each embryo tested. The chromosomal information obtained in the PGD results indicates whether the embryo is male or female, or if there are any chromosome abnormalities such as Down syndrome or types of chromosomal abnormalities that can often be the cause of miscarriage. Our test includes information about the 24 different chromosomes with 98% accuracy. PGD can never be 100% accurate at any laboratory due to the limitations of working with embryos.
What can PGD tell me about my embryos?
PGD results can describe the status of the embryo but the test does not change or alter the embryo. (PGD does not make an embryo more or less likely to be either sex, it simply determines which embryos are male and which are female.) We know that statistically, half of all embryos conceived are male and the other half are female. We also know that many embryos are chromosomally abnormal, regardless of the family history, the woman's age or previous healthy pregnancies. This means that it is possible that a family balancing patient could get all the way through her IVF cycle only to find out on the day of embryo transfer that none of the chromosomally normal embryos are of the desired gender, that there are no normal embryos at all, or that there are no embryos of the desired gender.
What happens after the embryos are tested?
If there are available embryos for use after the PGD testing is completed, one or two are transferred into the woman's uterus to attempt to start a pregnancy. You may choose to use only embryos of the desired sex to attempt a pregnancy. The number of embryos to transfer is a personal decision that is made together between you and your physician. The number of embryos transferred and several other factors will determine the risks for a twin or triplet pregnancy, which your physician will estimate for you.
The other normal embryos may be frozen for your own use, discarded, or donated for laboratory use. Embryos determined to be abnormal or unusable for any reason may be discarded or donated for laboratory use.
Who is performing the testing on my embryos?
Genetics & IVF Institute's PGD laboratory has been performing testing on embryos since 1993. Because we have our own PGD laboratory onsite, it is not necessary to ship cells from your embryos out for testing or to coordinate with a separate laboratory. All testing is done in our lab; nothing leaves the building! Having our own PGD lab also gives us the flexibility to test embryos on the 5th and/or 6th day after fertilization, whenever embryos have developed appropriately. Therefore, it is possible for testing to be completed in time for a fresh embryo transfer, when many other clinics only give the option of a frozen embryo transfer. GIVF's genetic counselors will discuss your PGD results directly with you.
Additional information on PGD is available here and here.
What is the likelihood that a pregnancy will result from a Family Balancing cycle?
The chances of achieving a pregnancy in a particular IVF/PGD cycle vary widely depending on your reproductive history, age and several medical variables. It is important to note that even though family balancing patients often have no history of infertility, the procedure is not guaranteed to result in a pregnancy. After your consultation and diagnostic testing, your physician will discuss your specific chances for success at your follow-up consultation. You will find some general IVF success rate information please click here.
How long does it take to do a Family Balancing cycle?
The timeframe to complete an IVF cycle with PGD is variable depending on your initial test results and the specific IVF protocol the physician recommends for you. On average, a couple may need approximately three (3) months from the initial consultation to complete the pre-cycle work-up and first full IVF/PGD cycle. During the stimulation phase of IVF, women living locally or within driving distance should expect early morning appointments at GIVF about 5-6 times over 10-14 days on average. Typically, the male partner is only required to be at GIVF on the day of the egg retrieval to collect his specimen, but is welcome any time the woman has appointments.
What if I don't live in the area?
Out-of-town patients undergoing IVF/PGD at GIVF have a few options in terms of logistics. Some patients complete all of their appointments at our clinic. In that case, the woman would need to be in the Northern Virginia/Washington, DC area for about 2 ½ to 3 weeks. Others choose to start their IVF cycle monitoring (blood work and sonograms while on the medications) at an IVF clinic near their home, then travel to our Fairfax office for the final days of monitoring and the procedures. If starting the cycle near their home first, the woman would have appointments every few days for about 7-8 days on average before traveling to our area. The final days of monitoring, the egg retrieval, and the embryo transfer all occur at GIVF in Fairfax, VA. Patients often choose to come to GIVF for the 3 or 4 days leading up to and including egg retrieval, go home the day after egg retrieval, and then return for embryo transfer a few days later. Typically, the male partner is only required to be at GIVF on the day of the egg retrieval to give his sperm specimen, though of course he is welcome any time the woman has appointments. This timing and your travel options can vary for each couple based on the personal medical circumstances. Please discuss any specific concerns with one of our nurses after your initial physician consultation.
Are there injections involved in IVF?
Yes. The medications required to do an IVF cycle are administered by injection, similar to an insulin shot. We teach you (or your spouse) how to give your own injections.
What is a "cycle"?
Each attempt at pregnancy using IVF is called a cycle, though it is short for IVF treatment cycle. A cycle begins on the first day the woman begins taking IVF medications and concludes with egg retrieval and embryo transfer. A patient doing IVF for Family Balancing is said to be undergoing a "Family Balancing Cycle."
Read more about IVF cycles by clicking here.
What is a Reproductive Endocrinologist?
A Reproductive Endocrinologist is a board certified obstetrician-gynecologist with years of additional training and subspecialty board certification in reproductive endocrinology and infertility. Reproductive Endocrinologists are referred to as an "RE" rather than an "OB." When you schedule your appointment at GIVF it is with an RE.
A note about insurance coverage:
Many people do have insurance coverage for IVF and /or fertility medications, and therefore assume that their only out-of-pocket cost would be for the PGD. Unfortunately, this is usually not the case. What is not always made clear to patients who call their insurance company to inquire about IVF benefits is that insurance coverage for IVF usually depends on a diagnosis of infertility. If you do not meet the criteria for infertility it is unlikely insurance will cover any portion of the cost of IVF treatment or IVF medications. In most cases, doing IVF for Family Balancing is an out-of-pocket expense.
How do I get started?
If you feel that Family Balancing is right for your family, the staff at GIVF looks forward to helping you. Please call our Scheduling Office at 703-698-7355 or 800-552-4363 to schedule your initial appointment with one of our physicians. Please be sure to mention you are interested in PGD for Family Balancing when making the appointment. Your consultation may be done in person or by phone according to your preference. If you prefer that we contact you to schedule your appointment please click here.