Genetic Screening

Creating a Family posted an excellent program today on the latest developments in the diagnosis and prevention of miscarriages. You can listen on iTunes or right on the linked page.

They'll apparently be doing an entire program on genetic screening of embryos next month. Meanwhile, the discussion around minutes 42-44 and 59-61 of this program really caught my ear.

Here's Dr. Richard Scott from the Reproductive Medicine Associates of New Jersey:

I think at the current time there are now a number of randomized trials which show benefit. In fact, a study which is not out yet ... actually shows that it reduces costs of treatment to screen embryos genetically, because you do so many fewer cycles. I think that patients look at these charges, and … it's a great deal of money, and that has to be respected, but the reality is your pregnancy rates per cycle go up dramatically, the number of embryos you put back goes down dramatically, your multiple pregnancy risk can be virtually negated … It makes a 42-year-old's risk of an ongoing Down Syndrome pregnancy less than when they were 21 … If you screen the embryo genetically, you can do as well with one as you do with two. And so now, all of the sudden, you can have pregnancy rates which, even in women in their 40s, can be in the 50-60% range or higher from a single embryo.

Later, he addresses what concerns me most:

When a patient goes through a clinical loss, by the time they go through a cycle, transfer those embryos without knowing if they're normal or not, go through a pregnancy, have the miscarriage occur, have their recovery interval (letting their hormones come down and their body reset), the time before they recycle on average in our clinic … is almost six months. It takes about five months, because there's an emotional healing. For a patient who's 39 or 40 ... those six months are not free. So now, instead of treating a 39-year-old, you're treating someone who's 40, and if they have two or three of those, they're 41 or 42 ... you are actually intervening to lower her cumulative long-term probability of delivery.

Yes, I'm leaning toward stimulated IVF with PGS (if we end up with enough embryos to make testing worthwhile), for exactly the reasons above: mainly a preference for single-embryo transfer and fear of another miscarriage with no time to waste. Next week, I have an appointment with my previous RE (the one who managed the IUI cycles before the natural-cycle IVF). It's time to start writing some questions down.