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Rahaei Z, Sahami MA, Bidaki R. Fear of abortion and emotional divorce in women with minor thalassemia: a population-based study in Yazd, Iran. BMC Womens Health 2021; 21:401. [PMID: 34876099 PMCID: PMC8650565 DOI: 10.1186/s12905-021-01551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background Thalassemia is the most common genetic disorder in humans that can be controlled and treated by, premarital screening, prenatal diagnosis and abortion. Aortion can be a critical issue for many families based on the cultural and religious backgrounds and have different consequences for couples, such as emotional divorce. Therefore, the present study aimed to investigate the association between fear of abortion and emotional divorce in women with minor thalassemia in Yazd City, Iran. Materials and methods This retrospective study was conducted on 61 women with minor thalassemia (case group) and 100 healthy women (control group), who referred to health centers in Yazd. The census sampling was applied to select the case group and multistage (cluster andsimple) random sampling was adopted to select the control group. Data were collected using Gutman Emotional Divorce Questionnaire and a researcher made scale for measuring fear of Abortion. Data were analyzed by SPSS using descriptive statistics and chi-square, independent t-test, Pearson correlation, and linear regression. Results The mean scores of emotional divorce (6.62 vs. 4.26) and fear of abortion (25.85 vs. 17.4) were higher in the case than control group (P ˂ 0.01). There was a positive and significant correlation between fear of abortion and emotional divorce in the case (P ˂ 0.05, r = 0.275) and control (P ˂ 0.05, r = 0.570) groups. Fear of abortion in the case group predicted 25% of the variance in emotional divorce. Conclusion Given the high level of fear of abortion in women with minor thalassemia and its effect on increasing the emotional divorce, designing and implementing psychological interventions with ongoing follow-up are recommended for thalassemia carrier couples.
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Corda V, Murgia F, Dessolis F, Murru S, Chervenak FA, McCullough LB, Monni G. Professionally responsible management of the ethical and social challenges of antenatal screening and diagnosis of β-thalassemia in a high-risk population. J Perinat Med 2021; 49:847-852. [PMID: 33721919 DOI: 10.1515/jpm-2021-0021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/16/2021] [Indexed: 01/19/2023]
Abstract
Thalassemias are among the most frequent genetic disorders worldwide. They are an important social and economic strain in high-risk populations. The benefit of β-thalassemia screening programs is growing evident but the capacity to diagnose fetal β-thalassemia exceeds the treatment possibilities and even when treatment before birth becomes feasible, difficult decisions about the relative risks will remain. This paper can be of practical and ethically justified aid when counseling women about screening, diagnosis, and treatment of β-thalassemia. It takes in consideration various social challenges, medical issues such as antenatal screening, preimplantation genetic diagnosis, prenatal diagnosis, non-invasive prenatal testing and prenatal therapy. We also describe the Sardinian experience in applying and promoting high-risk population screening and diagnosis programs and future trends in the management of β-thalassemia.
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Affiliation(s)
- Valentina Corda
- Department of Obstetrics and Gynecology, Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy, Microcitemico Pediatric Hospital "A. Cao", Cagliari, Sardinia, Italy
| | - Federica Murgia
- Department of Obstetrics and Gynecology, Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy, Microcitemico Pediatric Hospital "A. Cao", Cagliari, Sardinia, Italy
| | - Francesca Dessolis
- Department of Obstetrics and Gynecology, Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy, Microcitemico Pediatric Hospital "A. Cao", Cagliari, Sardinia, Italy
| | - Stefania Murru
- Laboratory of Genetics and Genomics, Microcitemico Pediatric Hospital "A. Cao", Cagliari, Sardinia, Italy
| | - Frank A Chervenak
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell and Lenox Hill Hospital, New York, USA
| | - Laurence B McCullough
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell and Lenox Hill Hospital, New York, USA
| | - Giovanni Monni
- Department of Obstetrics and Gynecology, Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy, Microcitemico Pediatric Hospital "A. Cao", Cagliari, Sardinia, Italy
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Monni G, Peddes C, Iuculano A, Ibba RM. From Prenatal to Preimplantation Genetic Diagnosis of β-Thalassemia. Prevention Model in 8748 Cases: 40 Years of Single Center Experience. J Clin Med 2018; 7:jcm7020035. [PMID: 29461486 PMCID: PMC5852451 DOI: 10.3390/jcm7020035] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/15/2018] [Accepted: 02/18/2018] [Indexed: 11/16/2022] Open
Abstract
The incidence of β-thalassemia in Sardinia is high and β-39 is the most common mutation. The prevention campaign started in 1977 and was performed in a single center (Microcitemico Hospital, Cagliari, Sardinia, Italy). It was based on educational programs, population screening by hematological and molecular identification of the carriers. Prenatal and pre-implantation diagnosis was offered to couples at risk. 8564 fetal diagnosis procedures using different invasive approaches and analysis techniques were performed in the last 40 years. Trans-abdominal chorionic villous sampling was preferred due to lower complication risks and early diagnosis. Chorionic villous DNA was analyzed by PCR technique. 2138 fetuses affected by β-thalassemia were diagnosed. Women opted for termination of the pregnancy (TOP) in 98.2% of these cases. Pre-implantation genetic diagnosis (PGD) was proposed to couples at risk to avoid TOP. A total of 184 PGD were performed. Initially, the procedure was exclusively offered to infertile couples, according to the law in force. The success rate of pregnancies increased from 11.1% to 30.8% when, crucial law changes were enacted, and PGD was offered to fertile women as well. Forty years of β-thalassemia prevention programs in Sardinia have demonstrated the important decrease of this severe genetic disorder.
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Affiliation(s)
- Giovanni Monni
- Department of Prenatal and Preimplantation Genetic Diagnosis and Fetal Therapy, Microcitemico Pediatric Hospital, Cagliari 09121, Italy.
| | - Cristina Peddes
- Department of Prenatal and Preimplantation Genetic Diagnosis and Fetal Therapy, Microcitemico Pediatric Hospital, Cagliari 09121, Italy.
| | - Ambra Iuculano
- Department of Prenatal and Preimplantation Genetic Diagnosis and Fetal Therapy, Microcitemico Pediatric Hospital, Cagliari 09121, Italy.
| | - Rosa Maria Ibba
- Department of Prenatal and Preimplantation Genetic Diagnosis and Fetal Therapy, Microcitemico Pediatric Hospital, Cagliari 09121, Italy.
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Cunningham J, Goldsmith L, Skirton H. The evidence base regarding the experiences of and attitudes to preimplantation genetic diagnosis in prospective parents. Midwifery 2015; 31:288-96. [DOI: 10.1016/j.midw.2014.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 09/19/2014] [Accepted: 09/27/2014] [Indexed: 11/16/2022]
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More than 10 Years After the First ‘Savior Siblings’: Parental Experiences Surrounding Preimplantation Genetic Diagnosis. J Genet Couns 2013; 22:594-602. [DOI: 10.1007/s10897-013-9591-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 04/04/2013] [Indexed: 01/08/2023]
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Miller C, Hewison J, Morley S. A comparison of decisions about prenatal diagnosis and pre-implantation genetic diagnosis. J Reprod Infant Psychol 2012. [DOI: 10.1080/02646838.2012.725128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Chloe Miller
- a Leeds Institute of Health Sciences , University of Leeds , Leeds , UK
| | - Jenny Hewison
- a Leeds Institute of Health Sciences , University of Leeds , Leeds , UK
| | - Stephen Morley
- a Leeds Institute of Health Sciences , University of Leeds , Leeds , UK
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van Rij MC, Gielen M, Lulofs R, Evers JL, van Osch L, Muntjewerff N, Geraedts JP, de Die-Smulders CE. Profiles and motives for PGD: a prospective cohort study of couples referred for PGD in the Netherlands. Hum Reprod 2011; 26:1826-35. [DOI: 10.1093/humrep/der137] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hershberger PE, Schoenfeld C, Tur-Kaspa I. Unraveling preimplantation genetic diagnosis for high-risk couples: implications for nurses at the front line of care. Nurs Womens Health 2011; 15:36-45. [PMID: 21332957 PMCID: PMC3408233 DOI: 10.1111/j.1751-486x.2011.01609.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Patricia E Hershberger
- University of Illinois at Chicago College of Nursing and College of Medicine, Chicago, IL, USA.
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Alsulaiman A, Al-Odaib A, Al-Rejjal R, Rijjal A, Hewison J. Preimplantation genetic diagnosis in Saudi Arabia: parents' experience and attitudes. Prenat Diagn 2010; 30:753-7. [PMID: 20593451 DOI: 10.1002/pd.2532] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Preimplantation genetic diagnosis (PGD) has been proposed as an alternative to prenatal diagnosis (PND). This study compares the attitudes towards PGD of four groups of parents in Saudi Arabia: two groups at genetic risk for different conditions but with no experience of PGD procedures and two groups who had experience, either of PGD or of in vitro fertilisation (IVF) for infertility. METHODS One hundred and eighty four participants attending the King Faisal Specialist Hospital and Research Centre (KFSH&RC) in Riyadh were interviewed using a semi-structured questionnaire: 49 had children affected by a haemoglobin disorder, 48 had children with non-syndromic deafness, 37 were attending the PGD service and 50 were attending IVF services for infertility. RESULTS Opinions in the two genetic groups were very similar: families were enthusiastic about PGD and relatively unconcerned about its technical limitations or the desirability of a confirmatory PND. The technical limitations of PGD and the moral status of embryos were of greatest concern to the PGD group. Waiting for the pregnancy result was the most commonly mentioned concern in the PGD and IVF groups. CONCLUSION PGD might be considered for a range of conditions in Saudi Arabia. However, it is not an easy option, and couples must be selected and counselled appropriately.
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Affiliation(s)
- Ayman Alsulaiman
- Department of Genetics, Research Center King Faisal Hospital and RC, Riyadh, Kingdom of Saudi Arabia.
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Hershberger PE, Pierce PF. Conceptualizing couples' decision making in PGD: emerging cognitive, emotional, and moral dimensions. PATIENT EDUCATION AND COUNSELING 2010; 81:53-62. [PMID: 20060677 PMCID: PMC2888878 DOI: 10.1016/j.pec.2009.11.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 09/02/2009] [Accepted: 11/21/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To illuminate and synthesize what is known about the underlying decision making processes surrounding couples' preimplantation genetic diagnosis (PGD) use or disuse and to formulate an initial conceptual framework that can guide future research and practice. METHODS This systematic review targeted empirical studies published in English from 1990 to 2008 that examined the decision making process of couples or individual partners that had used, were eligible for, or had contemplated PGD. Sixteen studies met the eligibility requirements. To provide a more comprehensive review, empirical studies that examined healthcare professionals' perceptions of couples' decision making surrounding PGD use and key publications from a variety of disciplines supplemented the analysis. RESULTS The conceptual framework formulated from the review demonstrates that couples' PGD decision making is composed of three iterative and dynamic dimensions: cognitive appraisals, emotional responses, and moral judgments. CONCLUSION Couples think critically about uncertain and probabilistic information, grapple with conflicting emotions, and incorporate moral perspectives into their decision making about whether or not to use PGD. PRACTICE IMPLICATIONS The quality of care and decisional support for couples who are contemplating PGD use can be improved by incorporating focused questions and discussion from each of the dimensions into counseling sessions.
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Affiliation(s)
- Patricia E Hershberger
- University of Illinois at Chicago, College of Nursing and College of Medicine, Chicago, IL 60612, USA.
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Musters AM, Twisk M, Leschot NJ, Oosterwijk C, Korevaar JC, Repping S, van der Veen F, Goddijn M. Perspectives of couples with high risk of transmitting genetic disorders. Fertil Steril 2010; 94:1239-1243. [DOI: 10.1016/j.fertnstert.2009.08.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 07/20/2009] [Accepted: 08/07/2009] [Indexed: 10/20/2022]
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Karimi M, Johari S, Cohan N. Attitude Toward Prenatal Diagnosis for β-Thalassemia Major and Medical Abortion in Southern Iran. Hemoglobin 2010; 34:49-54. [DOI: 10.3109/03630260903547690] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Karatas JC, Strong KA, Barlow-Stewart K, McMahon C, Meiser B, Roberts C. Psychological impact of preimplantation genetic diagnosis: a review of the literature. Reprod Biomed Online 2009; 20:83-91. [PMID: 20158992 DOI: 10.1016/j.rbmo.2009.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 05/11/2009] [Accepted: 09/15/2009] [Indexed: 11/26/2022]
Abstract
Preimplantation genetic diagnosis (PGD) was first reported as successful in humans in the early 1990s and nearly two decades later the psychological impact of PGD has not yet been clearly defined. As PGD requires the use of IVF, this paper provides a brief summary of literature related to the various psychological aspects of IVF followed by a review of the literature related to the psychological and broader psychosocial impact of PGD. The current literature includes attitudinal studies of couples for whom PGD may be beneficial and results suggest that those with traumatic reproductive and genetic histories are more likely to find PGD an acceptable treatment option. A small number of studies have used samples of women and couples who have used PGD. Due to a general lack of homogeneity in scope, method and results, these studies have not provided a uniform understanding of the PGD experience. Promisingly, however, two studies on parents of children born after PGD that explored parental stress show no differences between PGD, IVF and natural conception couples. The paper concludes that the missing link in the literature is a prospective study of PGD using validated psychological scales. Suggestions for future research are provided.
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Affiliation(s)
- J C Karatas
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia.
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Farra C, Nassar AH, Usta IM, Salameh P, Souaid M, Awwad J. Acceptance of preimplantation genetic diagnosis for beta-thalassemia in Lebanese women with previously affected children. Prenat Diagn 2009; 28:828-32. [PMID: 18661489 DOI: 10.1002/pd.2067] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of the study was to assess the rate of acceptance of preimplantation genetic diagnosis (PGD) as an alternative to prenatal diagnosis in Lebanese women with previously affected children with homozygous beta-thalassemia. METHODS Women with a previously affected child attending a non governmentally funded thalassemia care center between 1 June 2005 and 31 May 2007 were offered a genetic counseling session. This was followed by administering a questionnaire through direct interview. RESULTS All 97 women approached accepted to participate in the study (100% response rate). Sixty eight per cent of women considered PGD a better alternative to prenatal diagnosis. The most important perceived advantage of PGD was the avoidance of termination of an affected pregnancy. CONCLUSIONS PGD is an acceptable alternative to conventional prenatal diagnosis in women at risk of conceiving a child affected with beta-thalassemia. This is particularly true in countries of the Middle-East where therapeutic abortions for fetal indications are prohibited by the law and religion.
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Affiliation(s)
- Chantal Farra
- Genetics Laboratories, Chronic Care Center, Hazmieh, Lebanon
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15
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Twisk M, Haadsma ML, van der Veen F, Repping S, Mastenbroek S, Heineman MJ, Bossuyt PMM, Korevaar JC. Preimplantation genetic screening as an alternative to prenatal testing for Down syndrome: preferences of women undergoing in vitro fertilization/intracytoplasmic sperm injection treatment. Fertil Steril 2007; 88:804-10. [PMID: 17349641 DOI: 10.1016/j.fertnstert.2006.12.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 12/22/2006] [Accepted: 12/22/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Although the primary goal of preimplantation genetic screening (PGS) is to increase pregnancy rates in women undergoing IVF/intracytoplasmic sperm injection treatment, it has been suggested that it may also be used as an alternative to prenatal testing for Down syndrome. DESIGN Trade-off questionnaires. SETTING Two university centers for reproductive medicine. PATIENT(S) Two hundred forty-four subfertile women. INTERVENTION(S) Scenarios with different pregnancy chances after PGS and with different risk reductions of a Down syndrome pregnancy were presented. MAIN OUTCOME MEASURE(S) Willingness to have PGS performed in the various scenarios. RESULT(S) In case PGS would discover all Down syndrome embryos without affecting pregnancy chances, 83% of the women would have PGS performed. If PGS lowered pregnancy chances from one in five to one in seven, 36% of the women preferred to have PGS performed. If PGS reduced the chance of a Down syndrome pregnancy with 80% without affecting pregnancy chances, 75% of the women would have PGS performed, and 31% of them would refrain from prenatal testing afterward. CONCLUSION(S) Most women favor PGS for Down syndrome screening, even if it is not 100% sensitive. The acceptability depends on the effect PGS has on pregnancy chances, and, to a lower extent on its sensitivity to detect Down syndrome embryos.
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Affiliation(s)
- Moniek Twisk
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands.
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Abstract
It appears that in most Western countries, son preference is somewhat stronger than daughter preference. However, when one considers the preference of women it looks as though the opposite pattern is emerging. There is a considerable social acceptance of 'light' methods of sex selection (such as diets), even though these methods are not proven to be effective. The inclination to use sperm separation methods appears to be greater in the United States than in some European countries. There are indications that a preference for boys or for girls is associated with attitudes towards technology, child-rearing style and the stereotyping of boys or girls.
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Affiliation(s)
- Frank Van Balen
- Department of Education, Faculty of Social and Behavioural Sciences, University of Amsterdam.
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Monni G, Zoppi MA, Axiana C, Ibba RM. Changes in the Approach for Invasive Prenatal Diagnosis in 35,127 Cases at a Single Center from 1977 to 2004. Fetal Diagn Ther 2006; 21:348-54. [PMID: 16757910 DOI: 10.1159/000092464] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Accepted: 08/11/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the changes in the approaches used for invasive prenatal diagnosis for beta-thalassemia and karyotyping at a single center from 1977 to 2004. METHODS For beta-thalassemia, in 1977 placentacentesis, in 1982 amniocentesis, in 1983 fetoscopy and cordocentesis, in 1983 trancervical chorionic villi sampling (TC-CVS), in 1984 cardiocentesis, in 1986 transabdominal CVS, and in 2002 preimplantation genetic diagnosis (PGD) were introduced. For karyotyping, in 1977 amniocentesis, in 1983 cordocentesis and cardiocentesis and TC-CVS, in 1986 TA-CVS and in 1991 hepatic vein sampling were introduced. Rates of approaches used were retrospectively considered, for 5 different groups (1977-1981; 1982-1985; 1986-1993; 1994-1999; 2000-2004). RESULTS 35,127 invasive prenatal diagnoses were considered, and 42 PGD included. For beta-thalassemia 6,547 diagnoses were performed and 42 PGD. Since 1986-1993, TA-CVS was the only approach used except for 42 PGD in the 2000-2004 group. For karyotyping 28,538 diagnoses were performed. Amniocentesis and TA-CVS have been the most frequently used in the last years, while cordocentesis and hepatic vein sampling have shown a decline after their introduction. CONCLUSION TA-CVS is now the only technique used for beta-thalassemia. For karyotype, amniocentesis and TA-CVS are the most frequently used procedures. Obstetrical and laboratory experience, the availability of screening, and other individual factors, have influenced the choice, towards an earlier approach in pregnancy.
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Affiliation(s)
- Giovanni Monni
- Department of Obstetrics and Gynecology, Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy, Ospedale Microcitemico, Cagliari, Italy.
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Kalfoglou AL, Scott J, Hudson K. PGD patients' and providers' attitudes to the use and regulation of preimplantation genetic diagnosis. Reprod Biomed Online 2006; 11:486-96. [PMID: 16274615 DOI: 10.1016/s1472-6483(10)61145-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preimplantation genetic diagnosis (PGD) providers and patients have a vested interest in policy related to the use and regulation of PGD. To understand their experiences and attitudes, 32 in-depth interviews were conducted. Participants included 13 people at risk of transmitting a single-gene alteration to their children (10/13 had actually used PGD to try to have an unaffected child) and 19 PGD service providers (four nurses, five genetic counsellors, two reproductive endocrinologists, two geneticists, two physician-geneticists, two embryologists, and two laboratory directors). Virtually all participants supported the use of PGD to avoid severe, life-threatening genetic illness or to select embryos that are a tissue match for a sick sibling, but their attitudes varied significantly over the appropriateness of using PGD to avoid adult-onset genetic disease, to select for sex, or to select for other non-medical characteristics. There was disagreement within the PGD provider community about whether or not PGD is experimental. Participants were more concerned about overzealous government regulation of PGD creating barriers to access than potential abuses of the technology, and expected the PGD provider community to take the lead in ensuring that PGD is used for ethically appropriate purposes.
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Affiliation(s)
- Andrea L Kalfoglou
- Genetics and Public Policy Centre, Phoebe R Berman Bioethics Institute, Johns Hopkins University, 1717 Massachusetts Avenue NW, Suite 530, Washington, DC 20036, USA
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19
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Abstract
Preimplantation genetic diagnosis (PGD) is an alternative reproductive option for couples at risk of having a child affected with a genetic disorder. Although prenatal diagnosis (PND) has been available for many years, it is not acceptable to many owing to issues relating to termination of pregnancy. PGD involves assisted-reproductive technology, even though most couples undertaking it are fertile. However, if the treatment is successful, the couple will not have to consider PND. PGD is only available at a small number of centres and for a limited number of genetic conditions. It is a complex and time-consuming procedure. The success rate is around 20%, consequently, there is a relatively low chance of success and this requires careful consideration by couples who generally can become spontaneously pregnant. However, PGD is now more widely understood and available to all at the point of referral. This article sets out to explain the PGD procedure, its implications, limitations, and regulation in the UK and to discuss associated dilemmas.
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20
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Monni G, Cau G, Usai V, Perra G, Lai R, Ibba G, Faà V, Incani F, Rosatelli MC. Preimplantation genetic diagnosis for β-thalassaemia: the Sardinian experience. Prenat Diagn 2004; 24:949-54. [PMID: 15614915 DOI: 10.1002/pd.1051] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To report the experiences on preimplantation genetic diagnosis (PGD) in couples at risk for beta-thalassaemia in Sardinia. METHODS 23 couples at risk for beta-thalassaemia were included in the PGD programme with a total of 42 cycles performed. Among these, 11 couples were fertile, while the remaining 12 had associated fertility problems. In vitro Fertilization (IVF), PGD and prenatal genetic molecular confirmation protocols and results are reported. RESULTS All the patients followed the protocol of ovarian stimulation, oocyte retrieval, intracytoplasmic sperm injection (ICSI), embryo biopsy and genetic analysis. A total of 272 oocytes were fertilized in the regular way, and embryo biopsy was performed on 202 embryos. Out of these 202 embryos, 192 (95%) were successful. The genetic diagnosis was performed on 150 embryos (78.1%). Ninety-eight were identified as unaffected and 75 were transferred in 31 cycles. In the infertile patient group, two biochemical pregnancies (11.1% per transfer), in the fertile patient group, four clinical pregnancies, two twin and two singleton pregnancies (30.8% per transfer), were obtained. The genetic molecular results were confirmed in all pregnancies by first-trimester chorionic villus sampling (CVS). CONCLUSION Our study shows that PGD for beta-thalassaemia is an available procedure for couples who wish to avoid termination of pregnancy, except in cases where the IVF cycle efficiency is very poor.
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Affiliation(s)
- Giovanni Monni
- Department of Obstetrics and Gynecology, Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy, Ospedale Microcitemico, Via Jenner s/n, 09121 Cagliari, Italy.
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Katz MG, Fitzgerald L, Bankier A, Savulescu J, Cram DS. Issues and concerns of couples presenting for preimplantation genetic diagnosis (PGD). Prenat Diagn 2002; 22:1117-22. [PMID: 12454970 DOI: 10.1002/pd.498] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The use of preimplantation genetic diagnosis (PGD) to select genetically 'normal' human embryos and to transfer them to the uterus of a woman has generated considerable controversy. Debate has occurred over the implications of PGD, sex selection, safety of embryonic manipulation and eugenics. This study evaluates a range of social and moral concerns of couples towards PGD and assisted reproductive technologies (ART) prior to treatment to obtain unbiased authentic attitudes independent of the treatment cycle and the outcome. METHODS A total of 121 subjects were administered a structured questionnaire after each couple's in vitro fertilization (IVF) or genetic counselling session. Group A consisted of 41 subjects presenting for PGD of single gene disorders (PGD-SG) and group B consisted of 48 subjects undertaking PGD for aneuploidy screening (PGD-AS). A control group consisted of 32 subjects that were about to commence their first IVF cycle. RESULTS AND DISCUSSION All groups found PGD to be a highly acceptable treatment. They expressed little concern about its extension to testing non-disease states such as sex and they were strongly in favour of a shared decision-making model in which couples have considerable autonomy over decisions about the embryo(s) to transfer. Differences between the groups included issues surrounding the transfer of embryos, restrictions to PGD and the destruction of embryos.
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Affiliation(s)
- Mandy G Katz
- Monash Institute of Reproduction and Development, Monash University, Clayton, VIC 3168, Australia.
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Hui PW, Lam YH, Chen M, Tang MHY, Yeung WSB, Ng EHY, Ho PC. Attitude of at-risk subjects towards preimplantation genetic diagnosis of alpha- and beta-thalassaemias in Hong Kong. Prenat Diagn 2002; 22:508-11. [PMID: 12116317 DOI: 10.1002/pd.387] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of the study was to assess whether preimplantation genetic diagnosis (PGD) was an acceptable alternative to prenatal diagnosis in couples at risk of giving birth to a child with alpha- or beta-thalassaemia in an Asian population. METHODS An information leaflet was distributed to the women at risk. They were asked to complete a questionnaire after having an interview with a designated investigator. RESULTS A total of 141 valid questionnaires were analysed; 82.3% of the women considered PGD either the same or better than conventional prenatal diagnosis. Women with an affected child or a subfertility problem were more willing to accept PGD and to undergo this procedure in their future pregnancies. Their main concern about PGD was damage to the embryo during the PGD procedure. The most important perceived advantage of PGD was avoidance of termination of an affected pregnancy. CONCLUSIONS PGD is an acceptable alternative to conventional prenatal diagnosis in women at risk of giving birth to a child with alpha- or beta-thalassaemia in an Asian population. This is particularly true in women with a subfertility problem and in women who already have an affected child.
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Affiliation(s)
- Pui Wah Hui
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Tsan Yuk Hospital, Queen Mary Hospital, Hong Kong, People's Republic of China
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Vergeer MM, van Balen F, Ketting E. Preimplantation genetic diagnosis as an alternative to amniocentesis and chorionic villus sampling: psychosocial and ethical aspects. PATIENT EDUCATION AND COUNSELING 1998; 35:5-13. [PMID: 9832892 DOI: 10.1016/s0738-3991(98)00079-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Social and ethical considerations play an increasing role in decisions about the use of diagnostic technologies. In this article expert opinions of a medical-biological and a social-ethical panel on psychosocial, ethical and social aspects of preimplantation genetic diagnosis (PGD) are discussed. PGD is a new diagnostic technology for identifying chromosomal or single gene defects, which is now available as a medical treatment in several western countries. In contrast to traditional technologies like amniocentesis and chorionic villus sampling PGD offers the possibility for diagnosis before pregnancy. The panels expected PGD to be chosen only in serious situations. IVF was considered to be a barrier for PGD but less so in more serious situations. Destruction of pre-embryos was thought more acceptable than selective abortion, but only marginally. Finally a substantial decrease was expected in the acceptance of handicapped people in society as a consequence of the possibilities of technologies like PGD. Although PGD offers new possibilities for couples at risk of having a child with a genetic defect, it is important that couples are counseled in a way that emphasizes both the advantages and disadvantages of the technology. The general public should be informed about possibilities and impossibilities of preventive diagnosis and the right of future parents not to use genetic diagnosis.
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Affiliation(s)
- M M Vergeer
- SCO-Kohnstamm Institute, University of Amsterdam, Netherlands.
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Soussis I, Harper JC, Handyside AH, Winston RM. Obstetric outcome of pregnancies resulting from embryos biopsied for pre-implantation diagnosis of inherited disease. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1996; 103:784-8. [PMID: 8760708 DOI: 10.1111/j.1471-0528.1996.tb09874.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Pre-implantation diagnosis of inherited disease is now a viable option for some couples at risk of transmitting inherited disorders to their children. Since the pregnancy begins knowing that the embryo is not at risk, the need for repeated terminations is eliminated. Up to 25% of the embryo is removed during the procedure, and so it is important to study the resulting pregnancies. Here we report on the obstetric outcome of our first 16 pregnancies resulting from embryo biopsy and preimplantation diagnosis of inherited disease. SETTING Teaching hospital. SAMPLE The first 16 pregnancies (12 singletons and 4 twins) following pre-implantation diagnosis. RESULTS Three singleton pregnancies were lost in the first trimester. Of the remaining pregnancies, two had no prenatal diagnosis, six cases of X-linked disease had the sex confirmed by ultrasound and chorionic villus sampling was performed in the remaining five. All the singleton pregnancies had an uneventful antenatal course and the birthweights and Apgar scores of the babies were normal. The twin pregnancies presented obstetric complications but these were not unusual. CONCLUSIONS Fifteen healthy infants were born, but for the foreseeable future pre-implantation diagnosis pregnancies should be closely followed up.
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Affiliation(s)
- I Soussis
- Institute of Obstetrics and Gynaecology, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
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