GIVF eNews

September 2011 eNews

24 Chromosome Microarray: Fresh Cycle Now Available On-Site at GIVF

24 Chromosome Microarray (analysis) is a new, comprehensive chromosomal screening of embryos that examines all chromosomes for abnormalities. GIVF is pleased to now offer patients the state-of-the-art 24 Chromosome Microarray on-site with a fresh IVF cycle.

Due to our own on-site PGD laboratory, we offer 24 Chromosome Microarray with the ability to provide a fresh, day 6 embryo transfer after day 5 blastocyst biopsy. In fact, GIVF is the only fertility center in the Washington, DC area offering a day 5 blastocyst biopsy with results available in time for a fresh transfer the following day.

Recent studies have shown that blastocyst or  trophectoderm biopsy likely gives the most accurate PGD results and avoids unclear results associated with day 3 blastomere biopsy. Patients need not worry about their embryo biopsies being sent to an off-site lab to be tested, rather, everything takes place at our fertility center in Fairfax, VA.

What makes 24 Chromosome Microarray different from previous aneuploidy screening?

  • 24 Chromosome Analysis examines all 24 chromosomes (all 22 non-sex chromosomes and the X and Y chromosomes) for abnormalities prior to transfer.
  • This method of testing is more thorough than past methods and allows for the identification of high quality embryos for transfer.
  • Embryos tested with 24 Chromosome Microarray that are determined to be normal are felt to have a much higher chance to result in a successful pregnancy.

24 Chromosome Analysis PGD may be of particular use to patients who have:

  • a history of multiple pregnancy loss,
  • failed IVF attempts despite transfer of good quality embryos, or
  • severe male factor infertility.

For a more detailed description of 24 Chromosome Microarray and PGD, read Dr. Stern's article below. Click here for pricing. To get started, click here.

24 Chromosome Microarray Explained
by Harvey J. Stern, MD, PhD, FACMG, FAAP

A Brief History of PGD
Preimplantation genetic diagnosis (PGD) of embryos for chromosomal abnormalities was introduced clinically in 1995 to evaluate embryos created by IVF and identify those embryos with the highest potential to produce a pregnancy.  Previous studies have identified chromosomal abnormalities as the main reason for failure of implantation of a transferred embryo or loss
of an ongoing pregnancy by spontaneous miscarriage.  Chromosomal abnormalities are found in 50-60% of embryos from women younger than 35 years of age, increasing to 80-90% in women over age 41.

The process of PGD for chromosome defects initially involved removal of one or more cells from an early embryo at the third day after fertilization.  The analysis uses a technique called fluorescent in-situ hybridization (FISH) where small DNA “probes” were used to identify specific chromosomal regions by producing a colored dot on a fixed nucleus from the embryonic cell.  Using PGD/FISH did lead to some improvement in IVF pregnancy rates and a decrease in the rate of spontaneous abortions.  Multiple studies, however, have failed to show an increase in delivery rate after PGD/FISH.  This was felt to be due to several factors including the fact that the current FISH tests could only evaluate 8-12 chromosomes (of the 24 existing chromosomes).  In addition, the early embryo is known to contain abnormal cells that could potentially be eliminated early in development leaving a normal embryo.  However, if the abnormal cell is the one analyzed, the embryo would be designated as abnormal and not used in IVF.  This is called mosaicism and is known to be common in the early human embryo.  Finally, it is believed that removal of even a single cell from the day 3 embryo can affect embryo development.   In summary, the FISH technique was felt to give suboptimal results due to difficulties in interpretation of results, effect of biopsy on embryo development and the presence of confusing mosaicism.

24 Chromosome Microarray
A new method of analysis of the chromosomal status of embryos has been developed over the past three years.  This new test is called 24 Chromosome Microarray, or comprehensive chromosomal screening.  A microarray is a glass slide where hundreds of thousands of DNA sequences are placed and then mixed with labeled DNA obtained from the embryo.  The test analyzes the amount of DNA in the sample relative to a normal male and female control.  By this method one can determine if all of the 23 pairs of chromosomes (not just 8-12) are present in the correct amount.  Embryos tested in this way which are determined to be normal have a much higher chance to result in a successful pregnancy.  In addition, it appears that biopsy of the embryo on day 5 (Blastocyst stage) may give more accurate results which are not as affected by mosaicism as well as not being as detrimental to embryo growth.  This is known as trophectoderm biopsy (the trophectoderm is the part of the embryo that will develop into the placenta and fetal membranes).

GIVF is pleased to now offer 24 chromosome microarray analysis for patients undergoing IVF.  In particular, PGD may be valuable for patients with a history of multiple pregnancy loss, failed IVF despite transfer of good quality embryos, or severe male factor infertility.  Due to the fact that we offer this test in our own on-site laboratory, we are able to offer 24 chromosome analysis of trophectoderm samples with the ability to provide a fresh, day 6 embryo transfer.

Dr. Stern is the Director of Reproductive Genetics and the Fetal Diagnostic Center at GIVF. To learn more about Genetic Services at GIVF, click here.

What's New at GIVF

  • Harvey J. Stern, MD, PhD, Medical Director of Reproductive Genetics, attended the international Fetoscopy Group's Annual Meeting this September in Hong Kong.
  • Andy Dorfmann, MS, Director of the Embryology Laboratory, and Sarah Zornetzer, MS, CGC, Genetic Counselor, presented at the 38th Session of National Continuing Education Course on Female Reproductive Endocrinology, Infertility Diagnosis & Treatment, and Advances in Assisted Reproductive Technology in Shanghai this September.
  • Sunita Kulshrestha, MD will speak at Inova Health System's 2011 "Focus on Women's Health" event on September 24. The only reproductive endocrinologist speaking, she will discuss a broad range of infertility topics.
  • David Wise, CEO and Jiming Zhou, PhD, Director of Operations of GIVF's Diagnostic Laboratories, traveled to the Mayo Clinic earlier this month with two hospital presidents and one top government official from Chongqing. In attendance were Dr. Ren Guosheng, President of The First Affiliated Hospital of Chongqing Medical University; Dr. Qu Qian, Director General of Chongqing Municipal Health Bureau; and Dr. Ren Hong, President of The Second Affiliated Hospital of Chongqing Medical University.

Patient Success Story: How PGD at GIVF Worked a Miracle for Diana & Steve

When Diana and Steve came to GIVF, they had already lived through a rollercoaster of miscarriages.  While they both felt eternally grateful for their young daughter, they also strongly desired another baby to complete their family.  Following the birth of her daughter and several miscarriages, Diana was referred to GIVF by her OB/GYN.  Her OB/GYN recommended GIVF because she knew it would take an experienced PGD program to help Diana avoid further miscarriages. 

GIVF is one of the few infertility centers in the area with an in-house PGD lab, which allows patients to take advantage of both infertility treatment and PGD under one roof.  GIVF’s Reproductive Genetics department also plays a major role as genetic counselors work closely with patients to explain test results and help patients understand their options.

The GIVF Experience
Diana says of her experience at GIVF, “Even if people don’t need PGD, I would suggest GIVF for infertility treatment.  Everyone there is so warm, friendly, knowledgeable, and helpful.  I never met a single person there that wasn’t phenomenal, and the office is nice and always well-maintained.”  Both Diana and Steve found the staff at GIVF very comforting and professional, as well as helpful in keeping their hopes up while going through treatment. 

Diana continues, “I have nothing but positive things to say about GIVF.   Despite the difficulties of infertility treatment, it was a wonderful process.  The staff is awesome and the medical equipment is top notch.  I especially liked that morning monitoring appointments were different than other patients…for example; I didn’t have to be in the waiting room with women who were already pregnant.  That was very difficult to handle in other offices and it was a relief that I didn’t have to deal with that at GIVF.  Thank you GIVF for giving me the family I always wanted.  Thank you for giving me the most beautiful son in the world.  Words cannot say thank you loud enough, but they will have to do.  THANK YOU!!!”

The Doctors & Nurses of GIVF
About the doctors and nurses, Diana says, “I always felt comfortable and trusted the doctors and nurses at GIVF, and I always felt like I received the best care.  Dr. Stephen Lincoln was awesome—very informative and helpful.  Always had a great outlook and always stayed positive.  My favorite nurse of all time is Maureen Hanton.  She is the most awesome nurse ever. ”

Emotional and Personal Support at GIVF
While Diana sings the praises of all the staff members who helped her throughout her treatment, she can’t say enough about GIVF’s Director of Nursing, Maureen Hanton.  “Maureen was so incredibly patient with me… even when I called many times to get reassurance that I was giving myself the right meds in the right way. She was always available to me for questions and gave great support.  She cried when she found out I was pregnant—from sheer happiness for me and my family.  She has an awesome disposition and is extremely knowledgeable about all things IVF."

Light at the End of the Tunnel…
When asked how she felt when her son was born, Diana says, “both of my children are the best things ever, but my son (born through GIVF) is a true and honest miracle.  There were many times during this process that I was very ready to give up, but it was all worth it because my son is everything to me.  He makes me believe that all things are possible.  He also brought me and my husband closer together by going through this process together.  The best part of my day is hearing Jonah giggle…and he giggles a lot.”

Advice for Others Living with Infertility
“There are three pieces of advice I would impart to individuals or couples going through infertility treatment.   One, never give up.  Two, have someone to talk to about what you are feeling physically, emotionally, etc.  It is very important to have someone outside your family to talk to about these things, because going through infertility is emotionally draining, not to mention physically demanding.  It is easy to want to throw in the towel when you have gotten to this point, but having the doctors and nurses at GIVF help you through it is crucial.  Three, lean on your significant other/husband/partner for support as much as possible.  Help them understand what you are going through—it is important they understand what is happening to your body on a physical level.”

What do Diana and Steve have planned next?  They have frozen embryos stored, so they may return to GIVF in the near future for a chance at another miracle.

In addition to comprehensive infertility treatment, GIVF has one of the largest in-house PGD programs in the US. To schedule an appointment, click here.

Flexible Spending Account Match!

Have you considered using a Flexible Spending Account (FSA) to pay for infertility treatment? For patients who sign new contracts after September 14, 2011, GIVF will match up to $5,000 of the amount you are reimbursed from your 2011 FSA (per couple). For patients who sign a Multicycle IVF or Multicycle Donor Egg IVF contract, GIVF will match the reimbursed amount dollar for dollar, and for patients who choose a single cycle IVF or single cycle Donor Egg IVF contract, GIVF will match 25% for each dollar reimbursed. This special offer is not applicable to frozen donor egg cycles from Fairfax Egg Bank℠ or The Delivery Promise℠.

FSA is a common employee benefit that allows you to set aside pre-tax income for healthcare expenses not covered by insurance. Any balance left in your 2011 FSA account at the end of this year will be forfeited, so if you are considering using 2011 FSA funds for infertility treatment, now is the time to schedule a consultation at GIVF. Infertility treatment is often covered by FSA, but please speak to your employee benefits coordinator to verify your FSA benefits.

Interested in learning more? Contact a financial counselor by calling 800.552.4363 or 703.698.7355.

The Genetics & IVF Institute (GIVF) regularly publishes an informative newsletter featuring the latest infertility news and developments. The newsletter is sent electronically via email. To subscribe, click here.