NEW TREATMENTS
July 10, 2019

Genetic Testing and IVF

More and more couples undergoing in vitro fertilization are opting for genetic testing before implantation.

For couples finding it hard to conceive, in vitro fertilization, IVF, has been a game-changer, making it possible for a woman's eggs to be fertilized in the lab and then implanted into her uterus.

Now, testing embryos for genetic abnormalities before implantation is becoming a common part of the IVF process. It gives parents pursuing this expensive route to pregnancy a chance to be sure the embryo that is implanted has the best possible chance of survival. But little is known about how parents going through IVF feel about embryo testing.

In many cases IVF patients have been trying to conceive for years. If a patient miscarries because an embryo was genetically abnormal, it can take three or four months until she can try again.

A new study from New York University and Northwestern University offers an answer. Women who had undergone preimplantation genetic testing were asked if they regretted having their embryos tested to make sure they carried a full set of 46 chromosomes — not more or fewer — before undergoing IVF. The women reported they felt little regret about having the information, even if the news was disappointing.

Nearly 400 patients at a fertility clinic who had their embryos tested took part in the study. They were asked to complete anonymous surveys; 69 of those patients met the criteria to be included in the study. The researchers wanted to look at patients’ reasons for pursuing pre-implantation genetic testing, and find out if they experienced regret or anxiety following testing and transfer of a genetically normal embryo.

No Major Regrets

“Even after a negative outcome, most women said they found the information gained form embryo testing valuable for reproductive planning,” Kara Goldman, lead author of the study, told TheDoctor.

Most of the patients were educated, white and over 35. The majority pursued pre-implantation testing of their embryos on their first IVF cycle, to maximize IVF efficiency and reduce the risk of miscarriage.

Ninety-four percent of all respondents said they were glad to have the information provided by genetic testing. That didn't mean they were without regrets, however; 39 percent said they had some degree of regret about preimplantation testing, particularly those whose embryos were found to have an abnormal number of chromosomes.

“The low level of regret suggests patients understand that while a negative outcome during the IVF process can be very disheartening, having that information only gets them closer to a successful outcome in the future,” said Goldman, an assistant professor of reproductive endocrinology and infertility at Northwestern University Feinberg School of Medicine.

Ninety-four percent of all respondents said they were glad to have the information provided by genetic testing.

Patients undergoing IVF are, typically, in their 30s and 40s. In many cases they have been trying to conceive for years, so time is an important element. If a patient miscarries because an embryo was genetically abnormal, it can take three or four months until she can try again. If doctors can make IVF more efficient via genetic testing, it can result in more meaningful outcomes for patients, Goldman said.

“We are seeing this in practice, where patients are opting to continue treatment until they achieve their desired outcome, because they are avoiding the psychological burdens that accompany failed IVF cycles and miscarriages.”

One of the reasons patients drop out of IVF has to do with the psychological stress couples experience as they go through the process . At some fertility centers, psychologists are available as needed to help patients who are struggling with IVF, and at others, psychologists are an integral part of every patient’s IVF treatment.

“At the center at Northwestern, we have mental heath professionals who shepherd couples through each stage of treatment. I think that approach is very important for making patients feel supported,” said Goldman.

The psychological burden of infertility can be significant and targeted support during treatment is often needed. “We understand how challenging this is, and if we can harness available technology to improve outcomes and reduce the psychological burden of IVF, we should be doing that,” added Goldman.

The study was published in Human Reproduction.

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