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A guide to the PGD process
Stages 1 &
2
Down-regulation and stimulation of the natural female
hormonal cycle.
The availability of multiple eggs is essential so that our embryologists
can fertilise a number of eggs with the partner's sperm prior to
gender selection and replace the chosen embryos into the female's
uterus.
1. We down-regulate the woman’s natural hormones, using a
nasal spray for 14 days. This switches off the release of hormones
which normally stimulate the ovaries. The nasal spray is started
on Day 21 of the menstrual cycle and is used for 14 days. This is
followed by an examination, blood test or scan at the end of the
woman’s period using the spray to ensure that full down-regulation
has occurred.
2. The stimulation phase in which daily injections containing the
human gonadotrophin hormones (egg maturing hormones), are administered
by sub-cutaneous injection for a period of 10 to 14 days to stimulate
the ovaries into producing a number of egg follicles. A series of
scans help determine the rate of follicular growth in each ovary
and further blood tests may be done to confirm follicular development.
3. After 10 or 11 days, a different type of hormone is administered
to complete the follicle ripening process and prepare the follicles
for egg collection. This is the last phase of treatment carried
out before the couple travel to our associate clinics abroad for
the remaining stages to be completed
Stage 3: Egg
Collection
This straight-forward procedure takes 30-40 minutes and is usually
carried out under a local anaesthetic, using transvaginal ultrasound
directed egg recovery to provide high definition images on a scanner
monitor to ensure pinpoint accuracy. The procedure involves drawing
the fluid from each follicle using a vaginal probe and needle. The
content of each follicle is passed directly to the embryologist
working in an adjacent laboratory. As each egg is found, the gynaecologist
will move on to the next ripe follicle - usually 6 follicles from
each ovary will be aspirated producing around 12 eggs.
Stage 4: Fertilisation
After the 'egg harvest', a semen sample from the male will be carefully
prepared prior to its use in Intra-Cytoplasmic Sperm Injection (ICSI)
or standard IVF insemination procedures, to give the highest fertilisation
rate possible. The fertilised eggs, which are now known as embryos
are allowed to develop to the 8 – 16 cell stage.
Stage 5:
Embryo Selection
Usually by day 3-4 (after fertilisation), the new embryos will have
reached a sufficient stage of development to enable the Clinic's
embryology team to differentiate the gender of individual embryos
using PGD. We aim to replace 2 or 3 embryos of the couples chosen
gender in the female’s womb.
Stage 6:
Embryo Transfer.
The moment that most couples look forward to is when their embryos
are transferred from the laboratory to the uterus, using a very
fine catheter. The procedure is quick and painless. The cervix (neck
of the womb) is visualised by passing a speculum into the vagina,
before the tip of the catheter is passed through the cervical canal
into the uterus. To ensure that the tip of the catheter is in the
best possible location within the uterus, an abdominal scan is often
used. Finally, when the gynaecologist has located the optimum position,
the embryos are gently transferred from the syringe, settling in
the lining of the womb.
After a rest following embryo transfer, our female patient is ready
to join her partner, hopefully looking forward to a successful and
happy pregnancy.
One of the most often repeated questions is: "What can I do
to maximise my chance of the embryos implanting?" The answer,
realistically, is very little - other than to avoid any heavy lifting,
strenuous activity or over-zealous housework for about a week after
embryo transfer. The female partner should also, of course, avoid
becoming over tired or stressed - but in all normal circumstances,
she can resume a full, active life, going back to work, if appropriate.
Stage 7:
Post treatment support and pregnancy
After egg collection, we start the female on a course of progesterone
– a hormone which nurtures the lining of the womb (endometrium)
and encourages embryo implantation. This usually continues for five
or six weeks after embryo transfer, but it is not uncommon for the
hormone to be maintained until much further into the pregnancy -
when, around the 12th week, the placenta takes over the hormonal
support function.
In most pregnancies arising from PGD, there will be no need for
anything more than the routine ante-natal monitoring which should
normally be provided through the couple's local health services.
However, our interest doesn’t stop when you leave the Rainsbury
Clinic after successful embryo transfer - and we ask all couples
keep in close contact with us and alert us to any concerns or difficulties
immediately. Pregnancy can produce a variety of side-effects and
no two pregnancies are the same. Concerns are always dealt with
quickly and effectively, but if at any time, a couple become worried
about any aspect of the pregnancy, we will arrange for the partners
to be seen almost immediately - as close to their home as possible
- and carry out any necessary tests and examinations. Private antenatal
care and delivery can be arranged if required.
Because this programme utilises assisted conception and embryology
techniques widely used throughout the world for many years, the
associated risks and complications are few, and small. However,
as with any surgical procedure, there are slight risks of infection,
together with a small risk of ectopic or multiple pregnancies, miscarriage,
and of ovarian hyperstimulation, when the ovaries over-respond to
the drug regime, requiring the treatment to be cancelled. Because
patients are carefully monitored throughout their treatment and
pregnancy, there is very little risk of these complications. We
would simply ask to be informed in the event of any concern, however
small.
Rest assured, our sole aim is to give you a healthy, normal baby
of your chosen gender.
For more detailed information please click
here for a copy of your full guide which you can download and
print for future reference.
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