Family balancing or sex selection is an interesting topic for both fertility patients undergoing IVF treatment with PGD and for fertility specialists who deal with IVF on a daily basis. Some of the most common questions patients ask are:
- what is genetic testing in IVF?
- what are the sex selection techniques?
EggDonationFriends have invited Dr Murat Önal to talk about family balancing/gender selection during our IVF webinar on 26th April 2018. Dr Murat Önal is a Medical Director, also a Gynaecologist and Obstetrician, at Gynolife IVF Center in Nicosia, Cyprus. In his work he has met fertility patients who have concerns about genetic diseases connected with certain baby gender and are interested in Preimplantation Genetic Diagnostics (PGD) and sex selection/family balancing. Dr Önal, having great experience in the field of infertility and X/Y chromosome linked diseases, was able to talk about the process of family planning, medical indications and the methods and techniques used.
Genetic sex selection – Questions & Answers
Q1: Is the genetic testing done in your in-house lab, or do you send it elsewhere?
We are an IVF centre. If we are going to do a genetic testing we have to have a perfect genetic lab so we send this to a big genetic lab to have the most accurate results. You have to have a very good genetic specialist to give you the results you need and the best genetic conditions in the lab. So we prefer to send tests to a genetic lab, not to do this in-house.
Q2: If I do chromosome screening using NGS, can I see XY results or embryo?
With the NGS technology, we are able to see the X and Y results.
Q3: If I see the results, who is responsible for selecting embryos for the transfer?
We also see the results, which are, of course, an information sheet, so patients may not understand everything. We do not expect patients to understand everything, so we have a consultation and decide together how many embryos we should transfer and their gender.
Q4: What are the risks to the embryo with genetic testing for sex selection?
They may be a slight risk because of the biopsy procedure. There may be a negative impact on embryo development and also issues during the pregnancy; the risk of miscarriage or a biochemical pregnancy may be increased. But, with day-5 embryo biopsy, trophectoderm biopsy, these risks are very low.
Q5: My wife is 53 years old. Can we have a baby with an egg donor in Cyprus?
Yes. In Cyprus, you can do this, but according to our Ministry of Health, you need to show approval from a cardiologist and internal medicine specialist to proceed.
Q6: If I know which embryo is X or Y, I may select the preferred one. Is that correct?
Yes. If the IVF centre is able to tell you, and this is not possible in every country, and is able to give that opportunity, then you can select.
PGD for sex selection
Q7: Do I have to do IVF to do PGD or PGS?
Yes. We have to have embryos to do the biopsy procedures. Other techniques are just for sperm selection and with those techniques with lower probability have gender selection. You can then do intrauterine insemination, but to do PGD or PGS you have to do IVF.
Q8: Can I give the reason for gender selection IVF that I’m afraid of having a child with genetic abnormalities? What diseases can be detected through genetic testing?
First of all, PGD testing will give us information about chromosomal abnormalities. Of course, there are other genetic abnormalities, for example, some single gene disorders like Thalassemia or Sickle Cell Anemia, but with these kinds of genetic abnormalities, we cannot give guarantees using this technology. If you are a carrier of a mutation and if your husband also carries the same mutation, you can tell us and we will do the setup procedures to have a look at that specific gene problem. There are approximately 5,000 genetic abnormalities, and it is accepted that every person has one to ten genetic disorders. Even if the patient is healthy, there may still be a risk that she carries some genetic mutation. This will only be important if her husband is also a carrier. If we are talking about somatic mutations or X-linked mutations, this is another matter and she can do gender selection for this reason.
Q9: Why do genetic testing? Is the fear of giving birth to a sick child reason to do gender selection, even if I am not a carrier?
If you wanted to screen all of the chromosomes, for example, to avoid trisomy-21, a Down syndrome baby or such kinds of chromosomal abnormalities, of course, you can do PGS and during this process, you may learn the gender of your baby. However, being a carrier is one thing and having a chromosomal abnormality is quite another.
Q10: Extra embryos – what are the options at your clinic?
If we had good quality, chromosomally normal embryos, you have the right to freeze those embryos.
Q11: We are planning to travel to Cyprus for IVF. Can I start the process locally before we travel for the embryo transfer?
Yes. The process, from beginning to end, is approximately 17 to 20 days and not all patients are able to stay in Cyprus for so long. Generally, patients start their treatment in their own country or city and come here for the final days, for ovulation induction or for egg collection, and wait until the egg transfer.
Q12: What’s the maximum age for men? Can you use the sperm of a 45-year-old?
There is no maximum age for men for these treatments because we select the sperm and do genetic testing. We can use the sperm of a 45-year-old man because it is not like with women; usually, men have a comparatively longer fertility period.
Q13: Are there any indications to do chromosome screening (NGS within IVF with donor eggs) as eggs are from a healthy donor?
In my centre, we generally recommend NGS for egg donations to patients who have had lots of failed attempts with egg donation. For example, if I see four attempts failed attempts, I advise them to go to NGS to check for chromosomal abnormalities whether it is with egg donation or not. Importantly, being young and healthy doesn’t mean that all of the eggs are healthy. They may seem to be of good quality but the internal structure, the genetic part, may not be. Of course, the percentage of unhealthy eggs is very low in egg donors, which is why I don’t recommend it as a first step. However, if we have a lot of unsuccessful attempts, we may think about NGS for chromosomal screening. The woman may be healthy, but the chromosomes not. For women in their twenties, 90% of eggs are healthy, but according to some research, for women aged 43, this is only 8%. There is no such thing as 100% normal at any age, so to be sure, doing NGS is the right decision. However, if you are young, if your egg donor is young, as a first step, I would not recommend NGS.
Q14: What is the number of embryos you recommend for embryo transfer?
For the transfer of embryos with PGS, for example with NGS, the implantation rate is very high, so we may want to transfer one embryo. If patients want to have twins, and if they have healthy embryos, we can transfer two embryos, but with PGD we would not recommend three embryos or more.
Q15: Without normal embryos, could I consider transferring mosaic embryos?
This not very common topic in the science field, since, after moving from CGH technology to NGS, a more sensitive technology, we can easily detect mosaic embryos. We consult with our genetic experts and if the percentage is less than 20%, in our centres, we strongly recommend transfer. If it is more than 20%, we discuss this with the patient and act accordingly. We do not transfer all mosaic embryos because this is not our first aim. It depends on the percentage and the chromosomes: these are important.
Dear attendees, thank you for taking part in our webinar on sex selection and preimplantation genetic diagnosis and your questions to our expert. If you have more questions to dr Murat Önal or you wish to book a consultation with the clinic, contact the clinic’s coordinators via EggDonationFriends website. Check the complete clinic profile of Gynolife IVF Center in Cyprus.