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PGT and IVF
Information about preimplantation genetic testing and IVF treatment
With PGT you do not become pregnant in the normal way, but via IVF (in vitro fertilization). With PGT (preimplantation genetic testing), the laboratory can examine the embryo or embryos for the hereditary disease that you don't want to pass on to your child. This brochure explains the workings of IVF and PGT.
Prepare yourself well for the intake interview about PGT and IVF
It's important that you and your partner read this brochure carefully and watch the video (www.pgtnederland.nl/pgt-intakegesprek) on the website. If you have any questions, please write them down and ask them during the intake interview.
During the intake interview with a clinical geneticist from Maastricht UMC+, you will discuss your history and why you are considering PGT. We talk briefly about your family: your father, your mother, any children you may have and any brothers and sisters. We will then explain the steps of PGT and IVF and how long they can take. You find more information about the intake interview on the website (www.pgtnederland.nl/pgt-intakegesprek).
You can also tell us in which hospital you wish to receive your IVF treatment. In addition to Maastricht UMC+, this is also possible at UMC Utrecht, UMC Groningen or Amsterdam UMC.
How much does PGT cost?
During an informative meeting or an intake interview, you pay your full policy excess and, if applicable also the voluntary policy excess.
The costs of the interview and the PGT treatment are always charged to the woman's health insurance. Even if the man has a hereditary disposition. Check in advance whether your health insurer reimburses PGT treatments from your basic insurance. Check the website (www.pgtnederland.nl/kosten) for more information about the costs.
When is PGT possible?
- A group of specialists from Maastricht UMC+ will decide whether we can do PGT for your condition. We call them the PGT working group.
- The PGT laboratory checks whether it has conducted such a test before. If not, the PGT working group will ask the 'landelijke indicatiecommissie' whether the laboratory may conduct a new test.
The landelijke indicatiecommissie is a group of (medical) specialists who do not work at Maastricht UMC+. These people advise the PGT working group in certain cases whether or not they may conduct PGT. - If the landelijke indicatiecommissie issues positive advice, the PGT laboratory examines whether it is technically possible to create a new test.
When is IVF possible?
- The woman must be physically able to handle IVF treatment and pregnancy. This is especially important if the woman has the hereditary condition.
- The woman may not be older than 40.
- The woman's BMI (Body Mass Index) should not exceed 35. This could otherwise cause problems with the IVF treatment and pregnancy. The BMI shows whether someone has a healthy weight in relation to their height.
- For the woman, an internal examination and an ultrasound of the ovaries are required.
- For the man, we need to examine his semen. The man must have ejaculated between 7 and 2 days before the examination. Otherwise the examination will not succeed.
- We test the blood of the woman and the man to see if they have an infectious disease.
After a few weeks, the gynecologist will discuss the results with you. You will then hear whether you can undergo IVF treatment.
DNA testing of yourself and your family
During the preparation, we take blood samples from the woman and the man. Often also from family members. This blood test is necessary, even if the hereditary predisposition of your condition has already been examined before. You can have blood taken in your own region.
If the preliminary DNA test is ready and IVF treatment is possible, we plan the IVF treatment and the PGT examination.
IVF treatment
With IVF, the fertilization of eggs with sperm cells takes place in the IVF laboratory. But first, eggs must mature. We call this stimulation.
Stimulation
The woman uses medication to ensure her eggs mature. The eggs are in the ovaries. During this period, we make several ultrasound scans of the ovaries to monitor the maturation of the eggs. The eggs are usually mature after 10 to 14 days. If enough eggs have matured, ovarian puncture will follow.
Ovarian puncture
The woman first receives pain relief through an IV. The doctor then punctures the ovaries and aspirates the fluid. This contains the eggs. An ovarian puncture takes 15 to 30 minutes.
Fertilization
In the IVF laboratory we introduce a sperm cell from the man into each egg removed from the woman. After fertilization, the cells begin to divide. We then have an embryo. After 3 to 5 days, the embryo consists of an average of 8 to 60 cells.
The biopsy and the PGT examination
In most cases, we perform a trophectoderm biopsy or TE biopsy on the 5th or 6th day after fertilization. We use a laser beam to make a small opening in the shell that surrounds the embryo. We aspirate a few cells via a thin needle. Following the TE biopsy, we freeze all embryos while waiting for the results from the PGT laboratory.
In the PGT laboratory we examine the cells, so we can then see whether the embryo has the disease or not. Only embryos not affected by the disease will be eligible for transfer to the uterus.
Freezing the embryos
The reason we freeze embryos is in case you do not get pregnant, have a miscarriage or if you want a second child after a while.
Pregnant and PGT diagnosis check
If you have fallen pregnant after the PGT treatment, we will discuss whether you want us to check whether the PGT diagnosis was correct. The method of checking depends on the condition for which PGT is done. The clinical geneticist will discuss with you which method is suitable for you.
- A chorionic villus sampling in the 11th or 12th week of pregnancy.
- An amniocentesis in the 16th week of pregnancy.
- A NIPT (Noninvasive Prenatal Testing). This is a blood test for women from the 10th week of pregnancy.
- An extensive ultrasound in the 13th and 18th to 20th week of pregnancy.
Risks for women
1 to 2 percent of women who receive IVF treatment suffer from overstimulation. This means too many egg sacs are maturing. The woman may experience abdominal pain and fluid retention. Sometimes, we have to stop the treatment. In some cases, admission to hospital is necessary. Other possible problems include bleeding or infection.
Risks for the child
As far as we know now, removing one or more cells from a 3 to 6-day-old embryo (the biopsy) is not harmful to its development. Internationally, no increased percentage of children with congenital abnormalities after PGT has been reported.
Reliability and chance of pregnancy
The reliability of a diagnosis after the PGT examination is 95 to 99 percent. In other words: out of 100 children, 1 to 5 children still have the condition for which the PGT study was done.
The chance that a woman will become pregnant with IVF with PGT examination is approximately 20 percent with each treatment. In the Netherlands, a woman may receive a maximum of 3 of these treatments. On average, more than 50 percent of women become pregnant after 3 treatments.
Contact
In case you have questions or if you are not able to come to the hospital, please let us know.
Maastricht UMC+
Klinische Genetica
Telephonenumber (+31)(0)43 387 58 55 (0031433875855)
E-mail polikliniek.klinischegenetica@mumc.nl
Website
- PGT Nederland (www.pgtnederland.nl/)
- Klinische Genetica MUMC+ (klinischegenetica.mumc.nl/)
- MUMC+ (www.mumc.nl/)
PGT Nederland is a partnership between the Maastricht UMC+ PGT-centre and UMC Utrecht, UMC Groningen and Amsterdam UMC.