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Is Embryo Biopsy Right for Everyone?
Pre-implantation genetic testing helps prevent certain genetic diseases and disorders from being passed along to a child. Dr. Mary Ramie Hinckley discusses who can benefit from an embryo biopsy and how the process works.
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Learn more about Mary Ramie Hinckley, MD, REI
Mary Ramie Hinckley, MD, REI
Dr. Hinckley is a board certified Reproductive Endocrinologist who completed her training at Stanford University Medical Center. She says her greatest joy is helping patients to realize their dreams in creating a family, but she also enjoys participation in clinical and laboratory studies.Learn more about Mary Ramie Hinckley, MD, REI
Transcription:
Bill Klaproth (Host): An embryo biopsy or preimplantation genetic testing is a procedure used prior to implantation to help identify genetic defects within embryos. Now this serves to prevent certain genetic diseases or disorders from being passed on to the child, but is an embryo biopsy right for everyone? Let’s find out with Dr. Mary Ramie Hinckley a physician at Reproductive Science Center of San Francisco Bay. This is Fertile Edge, a podcast by Reproductive Science Center of San Francisco Bay. I’m Bill Klaproth. Dr. Hinckley, so what is an embryo biopsy?
Mary Ramie Hinckley, MD, REI (Guest): Well hi Bill. An embryo biopsy is the process by which we would take a few cells from an embryo and run genetic tests on them to determine if the embryo is healthy. Now the most common type of biopsy that is done is one in which we will take a few of the placental cells or the cells destined to be the placenta; not the cells of the baby, a run a chromosome count on them. We will check to make sure that an embryo has the proper number of chromosomes.
Now, if it has an improper number of chromosomes, that can cause most commonly and embryo not to implant. Second most commonly, it might cause a miscarriage. And then the third most common thing it might cause is a fetus with a genetic problem or a baby that’s born with a genetic disorder. So, we can screen the embryos to test them to find out if they are healthy and have a chance of being a healthy baby and then we can let the patient know about each embryo and what it’s determination is.
Host: So, this sounds like something every parent would want to know. Yes?
Dr. Hinckley: Well it does sound like really important information and actually most states enact certain tests when you are pregnant to be able to test the pregnancy to see if it’s healthy. And they are checking for these very same things. What we do in our field, is allow the patient to have this information before the embryo is transferred. So, at a preimplantation stage so that it could avoid some of the hardship that comes from a negative pregnancy test or a miscarriage or even some of the decisions and the issues that come with finding out you have a baby with a problem when you are pregnant.
Host: So, this seems like a hot topic right now. Why do you think there is so much attention on this happening right now?
Dr. Hinckley: Well, really when IVF started 40 years ago, our success rates were not so good. After a few years, we were finally getting into the 20% range per transfer. But nowadays, with the use of this technology, we can get success rates in the 60s to 70% per transfer. Think about that in terms of any other field of medicine. If the success rate for treating cancer or diabetes were about 20-30% and over a short period of time the success rate increased to 60-70%. That would be incredibly newsworthy. And so I think it is for our field as well, we finally figured out something that can make a considerable difference in the outcomes of the medical treatment we do.
Host: Right. That totally makes sense. So, are there patients that absolutely should do this?
Dr. Hinckley: Well, there is a lot of controversy and that’s part of why there is attention on it. Because on the one hand, it can really improve success rates but on the other hand, there’s questions about whether we are rolling it too quickly, whether there has been enough research. Is this ready for prime time? Have we refined the technique? Are we good enough? And I do think in our field, we’ve had some challenges about rolling out new technology so quickly that we haven’t done a really thorough testing of the technique and its pros and cons. And so I do think that there is a population of patients that would benefit from it absolutely. And if we can help those patients see that they are in that group and have them take advantage of this technology; I think that’s one way we can make sure this new technology is getting to the right people at the right time.
And the patients that I think of that are in the group that should consider doing this are patients that have the potential to make a number of embryos. If a patient is only making one embryo; then we are really not helping them select the best embryo for transfer by doing this. if they are making a lot of embryos and we are trying to help them get pregnant as quickly and efficiently as possible; then this is a way in which we can choose the one that is associated with the best success.
Now all of those other embryos, they are healthy, we can still use. And I’m not advocating that they discard those. But that we can find the best one, the quickest to get back into them. And I think that that can really help patients. I also think patients that have been through multiple miscarriages and the emotional impact of that, the time it takes just to go through a miscarriage; those are very challenging and so patients that have been down that road can have a much lower chance of miscarriage if they use preimplantation genetic testing for aneuploidy or screening for abnormalities that cause miscarriages.
I also think that there are some patients that may want to think ahead about having embryos banked for the future or saved in advance for their second or third child. And for those people, I think it’s really important to consider doing the preimplantation genetic testing so that they know what quality of embryos they have. These are patients that should at least consider it. it think a meeting with an individual doctor to go over the pros and cons of the procedure to really explain it so the patient has informed consent can be critical. But these are patients that in general, I would say, should start to think more seriously about this type of testing.
Host: So, you just laid out great reasons and why someone should consider doing this. How about on the flip side, are there patients that should not do this?
Dr. Hinckley: I do, I do think there are some patients certainly in my practice, that I see on a weekly basis that I would advise them not to do it. Just because we can, does not always mean we should. And I think it’s really important that as physicians we explain that to patients and we help them make the right decision for themselves.
One of the things that can be really challenging about this is an embryo will get a diagnosis and any test in medicine is not 100% accurate and so we have to explain that well to patients so that they understand what the error rate may be. Some patients are not okay with even a 1% error rate and for those patients, I think that embryo testing and embryo biopsy should probably not be used for them. I also think that there are some patients that would prefer to give every embryo the best chance by putting it back in the uterus and seeing if it works. Those are patients that might say you know what, I understand I might get a phone call where they tell me I’m not pregnant and I’ve been on medicines that maybe I wouldn’t have had to be on if I knew ahead of time or they might have to go through a miscarriage and as hard as that is, they say you know what, I’d rather give every embryo the chance and I’ll deal with the miscarriage. For those patients, because there is an error rate of the test; they maybe should consider not doing the test. Patients that might have a hard time discarding an abnormal embryo just because a piece of paper told you it was abnormal after testing; those are patients again that may not be good candidates for this.
And I think it’s critical to understand the local lab that you are dealing with. Here at Reproductive Science Center, we have an absolutely fantastic laboratory that does an immense amount of quality control to make sure that we are taking care of every single embryo to the best of our ability to get an accurate diagnosis on it, to take care of it so that it will survive the freezing, the thawing, the biopsy. If you are at a lab that does not have good success rates with this very technical procedure; you shouldn’t do it. So, you should only be this at a lab where you know that they are highly skilled and that they are doing their absolute best to give every embryo the best chance for survival.
Host: And that’s what’s most important. So, know your lab, another good point Dr. Hinckley. So, let me ask you this. As I said earlier, it seems like every future parent would want this. So, does this cost more money if someone wants to do an embryo biopsy and then does it delay or make the process longer for someone to get pregnant?
Dr. Hinckley: I’m glad you asked that question and that is something I like to talk to patients about when we are looking at the pros and cons of doing the embryo biopsy. In general, the actual biopsy process may cost about three to five thousand dollars more. Now some insurances cover it, but many don’t. And so patients do have to consider is that extra cost going to help you in the long run? A patient who is young, who has a very high chance that each embryo is normal, that may not be worth it for them. However, we do know from studies in our center that we get a higher live birth rate of about 10% even in young patients if we do the biopsy. And so then patients need to think about what does that 10% translate into in terms of time and energy and money?
And for many patients, if they maybe weren’t going to get pregnant on the first try, but now have a higher chance if they are doing the biopsy, this will actually save them money and so again, depending on the age of the patient, the chance that their embryo will be normal, it actually may ultimately save them money and certainly even save them time. Miscarriages take time. Negative pregnancy tests take time. And so if you can get the healthy embryo, the one that’s most likely to be a healthy baby back into the uterus sooner; it may save more time.
Host: So, this sounds like a worthwhile investment to know and potentially raise the odds for a healthy pregnancy. Is that a way to look at it too?
Dr. Hinckley: Absolutely. I mean I think this should be a part of every discussion at the initial visit when a doctor is meeting with a patient to talk about IVF. It doesn’t mean every patient needs to do it and actually, there’s a fair amount of patients that I will encourage them to consider not doing it because it doesn’t really sense for their situation. But if you meet certain criteria, if the pros outweigh the cons, then I think that patients can use this to their benefit to help them create the family they desire and to do so in the most expeditious fashion to get them to that beautiful family that they always dreamed of.
Host: And that is what it’s all about. Always great to talk with you Dr. Hinckley. Thank you for your time. And to connect with Dr. Hinckley or to learn more please visit www.rscbayarea.com, that’s www.rscbayarea.com. And if you liked what you heard, please share it on your social channels and make sure to check out our entire podcast library for topics of interest to you. This is Fertile Edge by Reproductive Science Center of San Francisco Bay. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): An embryo biopsy or preimplantation genetic testing is a procedure used prior to implantation to help identify genetic defects within embryos. Now this serves to prevent certain genetic diseases or disorders from being passed on to the child, but is an embryo biopsy right for everyone? Let’s find out with Dr. Mary Ramie Hinckley a physician at Reproductive Science Center of San Francisco Bay. This is Fertile Edge, a podcast by Reproductive Science Center of San Francisco Bay. I’m Bill Klaproth. Dr. Hinckley, so what is an embryo biopsy?
Mary Ramie Hinckley, MD, REI (Guest): Well hi Bill. An embryo biopsy is the process by which we would take a few cells from an embryo and run genetic tests on them to determine if the embryo is healthy. Now the most common type of biopsy that is done is one in which we will take a few of the placental cells or the cells destined to be the placenta; not the cells of the baby, a run a chromosome count on them. We will check to make sure that an embryo has the proper number of chromosomes.
Now, if it has an improper number of chromosomes, that can cause most commonly and embryo not to implant. Second most commonly, it might cause a miscarriage. And then the third most common thing it might cause is a fetus with a genetic problem or a baby that’s born with a genetic disorder. So, we can screen the embryos to test them to find out if they are healthy and have a chance of being a healthy baby and then we can let the patient know about each embryo and what it’s determination is.
Host: So, this sounds like something every parent would want to know. Yes?
Dr. Hinckley: Well it does sound like really important information and actually most states enact certain tests when you are pregnant to be able to test the pregnancy to see if it’s healthy. And they are checking for these very same things. What we do in our field, is allow the patient to have this information before the embryo is transferred. So, at a preimplantation stage so that it could avoid some of the hardship that comes from a negative pregnancy test or a miscarriage or even some of the decisions and the issues that come with finding out you have a baby with a problem when you are pregnant.
Host: So, this seems like a hot topic right now. Why do you think there is so much attention on this happening right now?
Dr. Hinckley: Well, really when IVF started 40 years ago, our success rates were not so good. After a few years, we were finally getting into the 20% range per transfer. But nowadays, with the use of this technology, we can get success rates in the 60s to 70% per transfer. Think about that in terms of any other field of medicine. If the success rate for treating cancer or diabetes were about 20-30% and over a short period of time the success rate increased to 60-70%. That would be incredibly newsworthy. And so I think it is for our field as well, we finally figured out something that can make a considerable difference in the outcomes of the medical treatment we do.
Host: Right. That totally makes sense. So, are there patients that absolutely should do this?
Dr. Hinckley: Well, there is a lot of controversy and that’s part of why there is attention on it. Because on the one hand, it can really improve success rates but on the other hand, there’s questions about whether we are rolling it too quickly, whether there has been enough research. Is this ready for prime time? Have we refined the technique? Are we good enough? And I do think in our field, we’ve had some challenges about rolling out new technology so quickly that we haven’t done a really thorough testing of the technique and its pros and cons. And so I do think that there is a population of patients that would benefit from it absolutely. And if we can help those patients see that they are in that group and have them take advantage of this technology; I think that’s one way we can make sure this new technology is getting to the right people at the right time.
And the patients that I think of that are in the group that should consider doing this are patients that have the potential to make a number of embryos. If a patient is only making one embryo; then we are really not helping them select the best embryo for transfer by doing this. if they are making a lot of embryos and we are trying to help them get pregnant as quickly and efficiently as possible; then this is a way in which we can choose the one that is associated with the best success.
Now all of those other embryos, they are healthy, we can still use. And I’m not advocating that they discard those. But that we can find the best one, the quickest to get back into them. And I think that that can really help patients. I also think patients that have been through multiple miscarriages and the emotional impact of that, the time it takes just to go through a miscarriage; those are very challenging and so patients that have been down that road can have a much lower chance of miscarriage if they use preimplantation genetic testing for aneuploidy or screening for abnormalities that cause miscarriages.
I also think that there are some patients that may want to think ahead about having embryos banked for the future or saved in advance for their second or third child. And for those people, I think it’s really important to consider doing the preimplantation genetic testing so that they know what quality of embryos they have. These are patients that should at least consider it. it think a meeting with an individual doctor to go over the pros and cons of the procedure to really explain it so the patient has informed consent can be critical. But these are patients that in general, I would say, should start to think more seriously about this type of testing.
Host: So, you just laid out great reasons and why someone should consider doing this. How about on the flip side, are there patients that should not do this?
Dr. Hinckley: I do, I do think there are some patients certainly in my practice, that I see on a weekly basis that I would advise them not to do it. Just because we can, does not always mean we should. And I think it’s really important that as physicians we explain that to patients and we help them make the right decision for themselves.
One of the things that can be really challenging about this is an embryo will get a diagnosis and any test in medicine is not 100% accurate and so we have to explain that well to patients so that they understand what the error rate may be. Some patients are not okay with even a 1% error rate and for those patients, I think that embryo testing and embryo biopsy should probably not be used for them. I also think that there are some patients that would prefer to give every embryo the best chance by putting it back in the uterus and seeing if it works. Those are patients that might say you know what, I understand I might get a phone call where they tell me I’m not pregnant and I’ve been on medicines that maybe I wouldn’t have had to be on if I knew ahead of time or they might have to go through a miscarriage and as hard as that is, they say you know what, I’d rather give every embryo the chance and I’ll deal with the miscarriage. For those patients, because there is an error rate of the test; they maybe should consider not doing the test. Patients that might have a hard time discarding an abnormal embryo just because a piece of paper told you it was abnormal after testing; those are patients again that may not be good candidates for this.
And I think it’s critical to understand the local lab that you are dealing with. Here at Reproductive Science Center, we have an absolutely fantastic laboratory that does an immense amount of quality control to make sure that we are taking care of every single embryo to the best of our ability to get an accurate diagnosis on it, to take care of it so that it will survive the freezing, the thawing, the biopsy. If you are at a lab that does not have good success rates with this very technical procedure; you shouldn’t do it. So, you should only be this at a lab where you know that they are highly skilled and that they are doing their absolute best to give every embryo the best chance for survival.
Host: And that’s what’s most important. So, know your lab, another good point Dr. Hinckley. So, let me ask you this. As I said earlier, it seems like every future parent would want this. So, does this cost more money if someone wants to do an embryo biopsy and then does it delay or make the process longer for someone to get pregnant?
Dr. Hinckley: I’m glad you asked that question and that is something I like to talk to patients about when we are looking at the pros and cons of doing the embryo biopsy. In general, the actual biopsy process may cost about three to five thousand dollars more. Now some insurances cover it, but many don’t. And so patients do have to consider is that extra cost going to help you in the long run? A patient who is young, who has a very high chance that each embryo is normal, that may not be worth it for them. However, we do know from studies in our center that we get a higher live birth rate of about 10% even in young patients if we do the biopsy. And so then patients need to think about what does that 10% translate into in terms of time and energy and money?
And for many patients, if they maybe weren’t going to get pregnant on the first try, but now have a higher chance if they are doing the biopsy, this will actually save them money and so again, depending on the age of the patient, the chance that their embryo will be normal, it actually may ultimately save them money and certainly even save them time. Miscarriages take time. Negative pregnancy tests take time. And so if you can get the healthy embryo, the one that’s most likely to be a healthy baby back into the uterus sooner; it may save more time.
Host: So, this sounds like a worthwhile investment to know and potentially raise the odds for a healthy pregnancy. Is that a way to look at it too?
Dr. Hinckley: Absolutely. I mean I think this should be a part of every discussion at the initial visit when a doctor is meeting with a patient to talk about IVF. It doesn’t mean every patient needs to do it and actually, there’s a fair amount of patients that I will encourage them to consider not doing it because it doesn’t really sense for their situation. But if you meet certain criteria, if the pros outweigh the cons, then I think that patients can use this to their benefit to help them create the family they desire and to do so in the most expeditious fashion to get them to that beautiful family that they always dreamed of.
Host: And that is what it’s all about. Always great to talk with you Dr. Hinckley. Thank you for your time. And to connect with Dr. Hinckley or to learn more please visit www.rscbayarea.com, that’s www.rscbayarea.com. And if you liked what you heard, please share it on your social channels and make sure to check out our entire podcast library for topics of interest to you. This is Fertile Edge by Reproductive Science Center of San Francisco Bay. I’m Bill Klaproth. Thanks for listening.