Every once in a while I see a question asked on Instagram asking what our reasons were for either doing or not doing PGD on our embryos during the IVF process, and I wanted to write my answer out because I have a few reasons and a lot to say about it!
To start, PGD stands for preimplantation genetic diagnosis. It is a reproductive technology used with an IVF cycle. PGD can be used for diagnosing an abnormal genetic condition in early embryos prior to implantation and pregnancy. Most of the genetic conditions that this testing detects are chromosomally related (such as Down's syndrome or cystic fibrosis, for example) and there are many others it detects as well, most of which I've never even heard of before.
Choosing to do PGD is a personal decision, so there is no right or wrong reason to do this testing. But the main reason why people ask whether they should do it or not, is because it comes with a steep price tag (around another $5,000 on top of all other IVF costs). So in order to get a nice group of embryos to work with (since the cost of doing PGD is usually the same regardless of how many embryos you have) some people might choose to "bank" their embryos (meaning doing numerous IVF cycles back to back in order to obtain a group of embryos to PGD test in one batch). Reproductive Endocrinologists (aka fertility doctors) say usually about half (give or take) of any batch or your embryos should come out normal, so it's better to work with more in this case. With us, that was perfectly correct.
We only had 2 embryos and one was normal (and is now our son) and one was abnormal with a chromosomal abnormality that would've either resulted in a miscarriage or negative pregnancy test. We didn't choose to bank our embryos, since we had already gone through a failed IVF cycle at another clinic, so I wasn't in the mood to do yet ANOTHER cycle in order to bank, plus our insurance doesn't cover any treatments so money was a big reason too. Yet we still went along and decided to pay for the testing on our only 2 embryos. It was mainly for some sort of peace of mind as well as obtaining more information. From this testing, we knew that the the abnormal embryo had Trisomy 15, was due to the sperm cell they chose (so was it from mother or father's side?), and the gender (which I did not want to know, though I have a strong feeling it was also a boy).
How it works is one or two cells are removed, or biopsied, from the part of the embryo that will end up being the placenta on day 5 of the embryo's development. You can also do a day 3 biopsy, but day 5 embryos have proven to be the strongest, therefore weeding out some of the unhealthy ones naturally. This is not damaging to the future baby in anyway. It's essentially like a super early amniocentesis if you think about it. Aside from diseases, it also can tell you the gender. So if we wanted to know what we were having, we could've known the day the lab called us with the results. How's that for a gender reveal party?
Sidenote: There is also something called PGS, or preimplantation genetic screening, which will still tell you whether something is abnormal in an embryo, but it doesn't give a specific diagnosis. It only tells you the number of chromosomes in each one.
Please note, when I say normal from here on out, that means the embryo was PGD tested and showed no chromosomal abnormalities. Because who am I to judge what's considered normal or not ;)
Please keep in mind these are my reasons and you may not agree with them and that's fine. Like I said, there's no right or wrong reason to do this testing.
Reason 1: Transferring a normal embryo gives you a greater chance at getting pregnant and delivering a healthy baby
One reason why we chose to do PGD testing on our two embryos in 2014 was because we wanted the best possible chance at getting pregnant with whichever embryo was transferred back to me. IVF is expensive and is not guaranteed to work, so we were trying to increase our chances at success as much as we could that last time. It gave us some sort of control in an otherwise completely uncontrollable shit-uation (see what I did there?) Sure, you could have a normal embryo not result in pregnancy too, I've seen this happen to multiple women in the infertility community on Instagram. It's all a part of the gamble that is IVF!
However, a PGD tested embryo that is proven to be normal, will give you a much greater chance at having a successful pregnancy and healthy baby. A PGD tested embryo that is abnormal, will end up either not implanting at all giving you a negative pregnancy test, or it will implant and you may suffer a miscarriage early on in your pregnancy because you're body's like, nope this one is no good, or you may end up having a baby that won't survive after birth. I had a very early miscarriage in our first failed IVF (without PGD testing) and I wanted to avoid having to go through that again at all costs.
Sidenote: Now I know I mentioned earlier that Down's syndrome was one of the things tested, and there are lots of people with Down's living healthy lives, so I don't know what I would've done had our abnormal embryo had Down's. I believe the doctor's wouldn't recommend going forward with it, but in my opinion that should be your own decision. The other things PGD tests for seemed much more life threatening. Just putting that out there because I know it sounds harsh.
Most abnormal embryos will not result in a pregnancy or healthy baby and my entire reason for wanting to do the testing was to avoid a miscarriage or having a baby with life-threatening complications at birth and not surviving.
Sure you can have a healthy baby without doing PGD testing, it happens a lot of the time, but we had a little more peace of mind knowing that we were putting the healthiest embryo back in, especially since it was our only one!
Reason 2: Expenses
Wouldn't you want to put the embryo that passed the test in first? This will save you the pain of heartbreak if an abnormal embryo was transferred and didn't result in a baby. It will also save you the cost of doing another FET (frozen embryo transfer) cycle and another and another and another. Say you have 5 embryos. For all you know, 4 could be abnormal. That's 4 FET cycles you could've avoided, 4 batches of meds you didn't have to pay for, 4 negative pregnancy tests (or possible miscarriages) you didn't have to go through.
Reason 3: No false hope
Had we chosen not to do PGD testing, we would be sitting here right now thinking we had another embryo on ice waiting to become Lachlan's sibling. However, that embryo wouldn't have resulted in a pregnancy anyway so I would've had to have gone through an FET cycle essentially for nothing. The money saved from that hypothetically failed FET cycle and its meds costs nearly the same as the cost of PGD testing anyway. So that balances itself out in my opinion. Only now, I don't have to go through a miscarriage or heartbreak. I mean, yea, I'm heartbroken that Lachlan won't have a sibling, but that's different than going through all the steps and finances to only end up with a negative pregnancy test and be back at square one.
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So to wrap this up, I would completely recommend doing PGD testing if it's something your clinic offers. You're already here in this chapter of your life doing all this, all these diagnostic tests, all these hoops you have to jump through. You might as well get something sorta-certain out of it; knowing you have created healthy embryos. Hopefully it will bring you some peace of mind in an already stressful, scary, and expensive experience.
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