It is important to perform a detailed assessment on the couple before starting treatment.
Drug treatment is applied first to prepare the mother candidate in this procedure, which is carried out simultaneously with IVF treatment. Although dependent on the female’s age and ovary capacity, the treatment is applied by stimulating the ovaries for 7 to 10 days with abdominal injections. Once there is an adequate level of ovary response a final injection to control ovulation will be administered. 35-36 hours after this final injection the eggs will be collected for fertilisation with the father candidate’s sperm. Three days after fertilisation, a microscope-assisted cellular biopsy will be performed on the embryos, which by now have reached 6 to 8 cells. During this procedure the exterior shell of the embryo is perforated with laser beams to collect one or two cells. These cells are processed with a special method and sent to the genetics laboratory.
First, the gender of all the embryos is determined, once identified the good quality embryos of preferred gender are then transferred to the mother candidate’s uterus. Once the embryo(s) of preferred gender are transferred to the uterus, if any, the remaining embryos can be cryo-preserved (frozen) in the laboratory for future use.
1) Initial Consultation: This is the stage in which patient expectations will be evaluated and clinical condition will be reviewed followed by the identification of pre-treatment tests and procedures. The initial consultation is very important to achieve successful results. Actual and potential risks will be considered to find the right solution. Patients will be informed about their chances of conceiving after an assessment of their egg reserves. Treatment will begin on suitable couples who qualify for the treatment.
2) Drug Treatment: The second stage after initial consultation is drug treatment. The specific drug treatment will commence in order to achieve egg development and develop an adequate number of eggs. Patients can use these drugs at home. However, on certain days patients will be required to undergo an ultrasound inspection and blood hormone level test. The ultrasound device cannot detect the eggs however, it can show the small fluid filled pouches called follicles, which contain the egg. Follicles that have reached the adequate number and size with drug treatment will then be subjected to a maturing injection known as a splitting injection (this injection usually contains HCG hormone). HCG might not be preferred for certain patients with excessive follicle development. Likewise, in some cases, embryos may be frozen and the transfer could be postponed to the following month. This approach protects the patient from IVF-related hyper-stimulation syndrome (OHSS- ovarian stimulation syndrome)
3) Egg collection and Microinjection (ICSI): Vaginal ultrasound assisted egg collection shall commence under anaesthesia 35 to 36 hours after the IVF patient has been given the final maturing injection. The same day collected mature eggs will be fertilised by injecting a single sperm inside each egg, using the microinjection method.
4) Biopsy and genetic analysis: The day to perform biopsy is determined according to the type of the genetic analysis to be performed. If the embryos will be performed PGD (Pre-Implantation genetic Diagnosis), biopsy is performed 3 days after egg collection when the embryos are at 6-8 cell stage; one or two cells are obtained and sent to examination in appropriate conditions. A total of 5-7 or 9 chromosomes types, including two types of sex chromosomes from 46 chromosomes in other words 24 kinds of chromosomes that the embryo have can be assessed with PGD. If CGH (Comparative Genomic Hybridization-comparative genomic hybridization) will be preferred as a genetic analysis method biopsy is performed on the embryos of good quality that reached the fifth day and cell group from the cell layer called trophectoderm of these embryos are obtained by biopsy and sent to examination in appropriate conditions. All chromosomes that the embryo has are evaluated in CGH method. However, the embryos that were performed should be frozen individually if CGH method is preferred and in this case the transfer procedure can be planned in the next menstrual period. 1-2 cells or a group of cells will be removed from the embryo’s trophectoderm layer with the help of laser 3 days after fertilisation, when embryos reach 6 to 8 eight cells; or 5 days after in the blastocyst stage. Later cells suitable for the genetic procedure shall be chosen and placed inside a special fluid. Processed cells will eventually be analysed at the genetic laboratory.
(*) Our abortion or live birth rate occurring due to technique or wrong/faulty diagnosis and developing after is 0% in the gender selection applications we have performed until today. On the other hand, this ratio reported to be 0.06% in the patient population performed in prestigious IVF centres operating across Europe including the cases that gender selection was performed (**).
(**) C. Moutou, V. Goossens, E. Coonen, M. De Rycke, G. Kokkali, P. Renwick, S.B. SenGupta, K. Vesela, and J. Traeger-Synodinos. ESHRE PGD Consortium data collection XII: cycles fromJanuary to December 2009 with pregnancy follow-up to October 2010. Human Reproduction, Vol.29, No.5 pp. 880–903, 2014