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Issues associated with PGD for translocation
1.
The Risk of Embryo Biopsy: While PGD is a
relatively new procedure in IVF, the micromanipulation
techniques required to perform it have been in use for many
years. The risk of accidental damage to an embryo during
removal of the cell(s) in the hands of an experienced
embryologist is very low, and it is currently calculated at
less than 0.6% Other Assisted Reproduction procedures such
as Intracytoplasmic Sperm Injection (ICSI), Fragment Removal
and Assisted Hatching are all performed by making
microsurgical openings in the covering of the egg or embryo
and none have been found to have other than mostly positive
effects on implantation and viable pregnancy rates.
2. Removal of Cells from the
Embryo: No part of the future fetus will be
affected because one or two cells are removed from an embryo
approximately two days after fertilization. At this
develeopmental stage all cells in an embryo remain
totipotent (until about the fourth day). These cells have
not differentiated yet, meaning that each cell by itself can
grow into a whole and perfect fetus. The biopsy procedure
merely delays continued cell division for a few hours, after
which the embryo reaches the same number of cells as before
and continues its normal development. It is possible that
embryo biopsy may lower embryo implantation rates slightly,
while selection of chromosomally normal embryos via PGD may
increase them. Therefore, the balance between potential
biopsy damage and beneficial effects of PGD seems to be
positive.
3. Misdiagnosis: The
accuracy of PGD for aneuploidy is approximately 90%. This
means that the error rate is 10%. Within this chance of
misdiagnosis, there is a false negative rate, a false
positive rate, the chance for no result and the chance for
mosaicism. A mosaicism is defined as the embryo having cells
with different chromosome make-up. Typically, all cells of
the embryo have the same chromosomal make-up as they
originate from the same fertilized egg. However, it is
possible for cells of the same embryo to have differing
numbers of chromosomes.
When the cell analyzed has a different chromosomal
complement than all the others in the embryo a misdiagnosis
occurs. Due to the chance of misdiagnosis as well as the
presence of aneuploidies, for which testing is not
available, we recommend prenatal testing as stated earlier.
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Our experience in PGD for translocations
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