Coronavirus update and advice: pre-implantation genetic diagnosis service
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What to expect
We appreciate that the decision to go ahead with PGD can take some time, and waiting for appointments can be emotionally challenging. We are committed to ensuring that your appointments with us happen in a timely and efficient manner with continuity of care wherever possible.
This page is designed to help explain the PGD process from referral to pregnancy. It contains general information, and may not apply to you. If you have any questions about your specific situation, you are more than welcome to contact us. You may also wish to look at our frequently asked questions page.
Before your PGD treatment
Most of our referrals come from genetics counsellors or clinical geneticists. Before attending an appointment to discuss PGD, it is essential that you and your partner have met with your local clinical genetics service to be eligible for NHS funding. This is to ensure that you have had the opportunity to discuss the inheritance of your condition, and to make sure that all the necessary preparatory laboratory work has taken place. It also provides you and your partner an opportunity to discuss all of the reproductive options available to you as you plan your family.
If you are not currently under the care of a genetics service, you can ask your specialist or GP to refer you to your local service. If your genetics service has questions about your case, they can contact us directly. There is also additional information for healthcare professionals.
After your local genetics team has referred you to us, we will make sure that it is possible for us to offer you PGD. We will review your eligibility for NHS funding, and whether the laboratory is able to perform an accurate test.
If we are able to offer you PGD, we will send you an information pack which has information on PGD, and contains forms for you and your partner (if applicable) to complete. It will also advise you on how to organise your first appointment.
Your first appointment
Your first appointment will be with one of our clinical genetics colleagues. Although you will likely have already met a genetic counsellor or geneticist in the past, this appointment will be very different.
The appointment usually lasts around an hour, and we will discuss:
- a general introduction to PGD treatment
- whether or not we will need to apply for a HFEA licence to offer PGD
- the likelihood of success and the limitations of the procedure
- your general health and reproductive history
- how you might manage emotionally, practically, and physically during your PGD cycle.
We will create a timeline for PGD for your unique situation at this appointment. Sometimes we will require blood or DNA samples from other members of your family, which we will discuss with you at your first appointment.
After your first appointment, you will be sent a letter summarising our discussion. You are not committed to proceeding with PGD at this point. However if you decide you would like to proceed with PGD, you will be asked to send us a 'reply form' which will commit you to the PGD process.
Depending on the genetic condition, we may then request DNA or blood samples from you and/or other people in your family. Once we have everything that we need, we will refer you to the Assisted Conception Unit.
Your second appointment
Your second appointment will be with the Assisted Conception Unit. At this appointment, the fertility specialists will talk to you about the treatment. This appointment may include:
- taking a detailed medical history (both partners)
- blood tests (both partners)
- semen analysis (for the male partner)
- taking consent for the PGD process (both partners).
If either of you have had previous fertility assessments, it would be very helpful if you brought the results to this appointment.
At this appointment, we will be discussing the treatment in detail, in addition to any risks involved. If you would still like to proceed at this stage, we will ask you to sign consent forms which give us permission to carry out PGD.
We have a legal obligation to consider the welfare of any children born as a result of treatment. We will ask you to complete forms which ask you questions about your background which are relevant to you having PGD. We will also ask for your written permission to contact your GP(s) and any other doctors involved in your care.
Once the doctors assess your natural fertility and have everything the lab requires from your family, the doctors at the Assisted Conception Unit will book you in for your active treatment. This process is the same as other types of in vitro fertilisation (IVF).
Medication will be given to stimulate the ovaries for nine-12 days. The female partner will have scans to carefully monitor the progress. The female partner will then have an outpatient procedure at Guy’s Hospital to collect the eggs from the ovaries. The male partner will need to attend on the same day to provide a sperm sample. The eggs are fertilised in the laboratory on the same day by a process called ICSI (intracytoplasmic sperm injection).
We have strict witnessing procedures to ensure that we are using the correct sperm and eggs. Your sperm and eggs will never be used to treat another couple without prior consent.
Once the fertilised eggs (now called embryos) are several days old, the lab will safely remove several cells for genetic testing. Genetic testing can take different amounts of time depending on the condition and the structure of your family. You will be told in advance how long your genetic testing will take.
If there are healthy embryos at this stage, we will arrange another outpatient procedure to place the embryos back into the womb. We also provide the female partner with medications to increase the chance of a successful pregnancy ahead of this transfer.
What happens next?
Around two weeks after the embryo transfer, couples are asked to take a pregnancy test. If you happen to fall pregnant, we will arrange an early pregnancy scan. If all is well, you can continue with routine antenatal care in your local hospital. There would be no need for you to be seen by a specialist unless you have any other health problems.
What happens if the PGD process does not work?
We appreciate it can be extremely disappointing if you do not fall pregnant. We will arrange another appointment for you to discuss your options.
If there is no underlying medical reason why another round ('cycle') of PGD is unlikely to be successful, we can discuss a further cycle of PGD. A cycle describes the process of egg stimulation and embryo creation. Couples can be funded for up to three cycles of PGD through the NHS. However, funding can stop if the female partner turns 40 years old, or if the couple have an unaffected child together.
Are there any other appointments I will need to attend?
Depending on your needs, we may ask for you to attend other appointments to monitor your response or to assess your fertility. This will be discussed with you in advance.
In general, most couples will come to Guy’s Hospital five to six times. If you are travelling from a long distance, we can try to arrange some investigations closer to your home. We can discuss this with you at your appointments.
We can also arrange for you to meet with our experienced fertility counsellors. Counselling provides support from a trained professional who understands what is involved in your treatment, and can provide you with the time and space to talk over your concerns. This is included free of charge with your treatment.
What if I am using a sperm or egg donor?
If you are using sperm or egg donors, we will arrange for you to meet with our fertility team to select a donor. The cost of the donor is not currently covered by NHS funding, so will need to be arranged on a self-funded basis (PDF 37Kb).