This is more of a follow up to my last post. Wanted to elaborate on the Preimplantation Genetic Screening (PGS), especially because I left out all the background info & presentation info from my meeting and just put my Q & A.
Comparative Genomic Hybridisation (CGH) is new as far as PGS goes and this new use was discovered by Dr. Geoffrey Sher in Las Vegas (see http://www.newscientist.com/channel/sex/mg19325893.900-egg-screening-doubles-ivf-success.html). It sounds like FISH may be on its way out. CGH can test either the polar bodies (and thus check for maternal chromosomal damage only) or the embryos (and thus check mom + dad). Testing of the polar bodies should theoretically not affect the eggs because the polar bodies would otherwise be shed by the eggs. Testing of the embies is more risky because one or two cells are removed, thus possibly (a) compromising the embryo, (b) causing damage due to human intervention, or (c) giving an inaccurate reading due to mosaicism. Per Dr. Lincardi at NYU (http://infertilityblog.blogspot.com/), mosaicism means “that some cells have one type of DNA and other cells have different DNA. For example, in an 8 cell embryo, it’s possible to have some cells that cause Down’s Syndrome (this is an extra chromosome 21) and some cells can be normal. Just to back up, almost all of us have 23 pairs of chromosomes, for a total of 46. If an embryo is missing at least one, or had an extra 1, we generally call this aneuploidy. Aueuploidy is the genetic problem related to aging. Down’s is an extra chromosome 21, but any of the chromosomes affected in the same way, either an extra or missing. Getting back to PGD, if the embryo has 2 normal cells, and 6 abnormal cells, and the biopsy plucks off a normal cell, this mostly abnormal embryo will be transferred, probably producing no pregnancy. If the embryo is mostly normal and an abnormal cell is tested, that embryo will not get transferred, yet it may have produced a normal child."
Dr. Licardi's blog also says, "CGH may someday be the answer, but it’s way too early to tell. There is one doctor in particular who pushes CGH, but he has pushed a lot of other things in the past, none of which were any good. I am not saying he is wrong about this, I just need to see data reputable data from him or others."
Obviously CCRM is on a mission to get reputable data.
I can understand why a person would want to do PGS if they expect a lot of embies. For me, mine had morphology issues, and so it would be unlikely that selection would be needed. I'd just put back in what I have and hope for the best.
IVF is seeming to me more a game of statistics, since it takes a lot of women 3-4 IVFs to get pregnant and since most eggs are bad, even for young women. In the New.Scientist link above, it says that CGH on donor eggs (from mostly twenty-somethings) shows that 65% of them are poor quality.
In talking with the genetic counselor, I was most surprised to learn that morphology issues (fragmentation) is unrelated to genetic quality (chromosomes). However, this would explain cycles where the embies are fragment-free but don't implant or otherwise survive long. So that perfect blast could have a DNA issue, yet the struggling 5-cell at day 3 could have kick-ass DNA. And you would never otherwise know.
The other thing that struck me as undesirable is that CGH can determine chromosomal damage with 90% accuracy, yet chorionic villius sampling and amnio can test with 99.9% accuracy. And they highly stress that you should still have CVS or amnio -- that CGH is not a replacement for it. So in my opinion, CGH is best for those with (a) lots of embies who want to avoid risk of multiples, or (b) a motivation to isolate any imperfect DNA ASAP, thus avoiding a BFN, a blighted ovum, a miscarriage, or an abortion.
------------------------------------------------------------------------------------------------------------------------------------------
As far as I'm doing, I'm not doing great. GS and I had a big fight in the car while I was driving him to the airport. I was trying to explain egg quality and he said I was explaining it poorly and wasn't making any sense, and I got pissed because that's just rude, and he got pissed because I got pissed, and we had a shitty goodbye. I won't see him again until Sunday night, he's going to his niece's graduation in FL (deep breath...interestingly enough, his niece is headed for Yale for a pre-med degree and wants to specialize in genetics).
Anyway, back to me, I'm mad at him because he didn't apologize and doesn't even seem to get that he should. I don't even want to have his stupid baby at the moment. Shit.
