Dr. Rob: Hi this is Dr. Rob Kiltz sitting here with Kelly Ketterson from..
Dr. Rob: She’s here to help share and help us learn and increase our knowledge about PGD. What is PGD?
Kelly: Pre-implantation Genetic Screening or Diagnosis, depending on what type of testing you’re doing.
Dr. Rob: It’s all words and it’s important though to understand it and we’re learning and moving to new technology where we typically would do something called “FISH” although it’s still available, you guys offer that also.
Dr. Rob: We’re looking to be able to take a cell from an embryo and…
Kelly: Well, we can either fix it on a slide or put it in a tube and basically we’re looking to analyze the chromosomes in that cell to make sure that the embryo that corresponds to that cell has the right number of chromosomes.
Dr. Rob: So, it allows us to better select embryos that are more likely to create a live-born baby, it can also help identify reasons why someone is not conceiving or maybe miscarrying.
Kelly: Correct. Often one of the things that patients are worried about is not having an embryo to transfer. What happens if I don’t have an embryo to transfer? What I tell patients is that just because you have no normal embryos in a cycle doesn’t always mean that you will never have a normal embryo. It just means that you’re getting to the point that you’re at where your eggs are less and less likely to produce a normal embryo. I think it does help patients make some family building options where they can decide if they want to do another cycle and then do the selection process again or think about using a donor egg or moving on to adoption.
Dr. Rob: So this is a good point, because often we do not know when you see beautiful embryos whether it’s an embryo issue or a uterine factor, environment is very critical. If you had the information that there was a chromosomal abnormality which was more likely the cause of you not conceiving or miscarrying, that would help you to either just continue to be persistent or move onto donor eggs. If you had normal embryos and they were not implanting, this may lead you to other methods which would improve uterine implantation and/or use a gestational carrier.
Kelly: Correct. You bring up an important point because FISH limited us; we could only look at so many chromosomes. We were looking at twelve chromosomes on a routine basis. New technologies to screen embryos, it’s called Erase CGH and this is a way we can look at all the chromosomes. There are chromosomes that when there are the wrong number each cell should have two of the chromosomes that we test for, but if there’s one or three, that’s incorrect for the number of chromosomes, but those chromosomes don’t necessarily implant. Previously, with FISH testing, we were only looking at the chromosomes that would cause a baby to be born with some abnormality, we weren’t’ necessarily looking at chromosomes that would not implant. Now, we can tell when the embryo is abnormal and will not implant.
Dr. Rob: So this technology has been around for a while and you guys have been providing this technique?
Kelly: We’ve been providing it for about two years now. Initially, there are many steps in the technique. You have to take the cell out and instead of fixing it on the slide; you put it into a tube. When you put it in the tube, there’s not enough DNA in that cell to make a diagnosis, so you have to amplify the DNA, so you have to make many copies of the same cell and that was sort of the initial trick to getting the technique to be consistent on the amplification process. The first couple of amplification processes that we tried, we didn’t feel like we’re producing consistent results, so we had to optimize that. So now we feel like for the past year, we’ve really optimized and we look at our diagnosis and we check it again and feel that we are very consistent.
Dr. Rob: Is it to a point where we should be doing this routinely, do you think?
Kelly: We feel that for Day #3 embryos it’s now time to switch from FISH to these methods that will allow us to look at all the chromosomes.
Dr. Rob: I imagine there may be a time where we analyze all embryos for couples to identify these abnormalities and/or looking for the best embryos for implantation. What’s your thoughts on that?
Kelly: We may get there. Right now, I think that I would still stay focused on patients with recurrent Miscarriage, repeated IVF failure, patients who have had a previous anueploid conception or conceived a baby with a known abnormality until we can feel that we can show a benefit to the patients that don’t have one of those diagnosis.
Dr. Rob: You’ve had some experience talking to clients because you’ve acted as a coach for many clients going through fertility treatments. What’s your experience in some of their biggest fears? You mentioned not getting an embryo to transfer, anything else that comes up?
Kelly: I think that not getting an embryo to transfer is the biggest fear. There’s no other side effect to the procedure. The patient doesn’t have to do anything additional to have PGD or there are no additional procedures for them, there are no additional risks to them personally. The biggest risk is that if a patient has few embryos, you do have to take a cell out and there’s a risk to the embryo when you do that. You could potentially have an embryo that is diagnosed as normal but then you can’t transfer it because it doesn’t advance. I think that would be the only other thing that I can think of that would be a concern to the patient.
Dr. Rob: Well, I really appreciate you taking the time to come and visit us and see my fertility center and we talked about doing some monthly seminars, having clients come to our centers and also doing some webinars but you’re also available by telephone for consulting because it really is about connecting and sharing thoughts and ideas and helping people to go through the process and down the journey. It’s all a journey and thank you, Kelly.
Kelly: Thank you.
Dr. Rob: Reprogenetics…we’ll throw some connections and some numbers that we can also connect. What’s your website?
Kelly: It’s www.reprogenetics.com.
Dr. Rob: Don’t forget CNY Fertility www.cnyfertility.com, www.cnyhealingarts.com, and www.mindbodysmile.com. Blessings and enjoy the day, Dr. Rob Kiltz and Kelly.
Dr. Rob: Have a great day.