A guide to the PGD process
- Stages 1 & 2: Down-regulation and Stimulation
of the natural female hormonal cycle - Stage 3: Egg Collection
- Stage 4: Fertilisation
- Stage 5: Embryo Selection
- Stage 6: Embryo Transfer
- Stage 7: Post treatment support and pregnancy
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.
- 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.
- 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.
- 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: Fertilization
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.
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