Lead Time for Natural Cycle IVF

[Anonymous]

Anonymous wrote:NP here. 10:58- Do you know if Dr. Stern will see patients who did not do their IVF at GIVF? If so, how far in advance would you need to schedule the procedure? I'm also AMA, and want to get genetic testing done. I would prefer to do it earlier, as long as I wouldn't be unnecessarily incurring more risk of miscarriage.

10:58 here

Yes, I was a Dominion patient and Dr. Stern was more than willing to do our CVS. He consulted with Dr. G (actually Dr. G filled him in EXTENSIVELY regarding our past experiences) and he was overtly kind and caring of us during our time with him (despite the fact that GIVF and Dominion are competitors!).

Setting up the appointment was quite easy...CVS docs do this for a living, they know best that they have a small window of opportunity to do their job, so they are very efficient in getting you scheduled and in for the procedure. The window is typically 11-13 weeks. The patient is the one that MUST be flexible. This has to be priority for you, and you have to go when they say you should go.

And like I said...in our case, Dr. G was involved in getting us set up with Dr. Stern...so, I felt like this was just an extension of all our IVF stuff.

[Anonymous]

Thanks, 10:58! I would prefer to complete the genetic testing as early as possible.

If you don't mind another question -- Do you know if a CVS can test for all the same things as an amnio? Is the CVS limited in any way?

[Anonymous]

There's one thing you can test for with an amnio that you can't test for with a CVS. Spina Bifida or Cystic Fibrosis, maybe? I forget which one. But whatever it is, they can test for it a different way (blood test?) around the same time as the amnio, so in the end you have all the same information, but your rule out everything else at week 11-13.

[Anonymous]

Well...the CVS is limited in some cases. Some embryos will have a mosaicism (some cells that are normal, some that have a genetic issue). Those cells can be restricted to the extra-embryonic tissues (the placenta), meaning that the baby has normal chromosomes.

But this mosiacism will be seen in the CVS analysis- some cells will be genotypically normal, some will be atypical.

If this happens (VERY RARE) you will be asked to schedule a follow up amnio. The amnio only retrieves cells that are shed from the baby...no placental cells. So they will test the baby's cells to determine the genetic make up.

The genetic tests (amnio, CVS) only look for genetic atypia...spinal cord defects, and other anatomical congenital abnormalities must be determined through other methods. For the most part, ultrasound should identify a lot of anatomical issues.

But if you are AMA, the main concern is the higher rate of genetic issues, solely because of your older eggs. You would have to ask a genetic counselor to verify this...but I think an AMA woman's risk for other congenital issues (non-genetic based) are probably the same as any other woman's risk.

And, if you are taking your folic acid during the entire period that you are TTCing...you should be limiting your risk of spinal cord issues.

[Anonymous]

Anonymous wrote:There's one thing you can test for with an amnio that you can't test for with a CVS. Spina Bifida or Cystic Fibrosis, maybe? I forget which one. But whatever it is, they can test for it a different way (blood test?) around the same time as the amnio, so in the end you have all the same information, but your rule out everything else at week 11-13.

Cystic Fibrosis is a genetic test...can be determined through either amnio or CVS, if the parents are known carriers. Most OBs are testing the mother for the CF mutations, these days. If the woman doesn't have the common CF mutations, they don't even bother to test the father.

Even spina bifida is, to a certain extent, probably a genetic issue with the mother...in the folate reductase genes. I have a heterozygous mutation in MTHFR (folate reductase) and my treatment was to take extra folic acid prior to pregnancy and during the pregnancy.

You want to be sure you are getting plenty of folic acid VERY EARLY on in your pregnancy, to help reduce the chances of spinal cord defects. That is why you should be taking folic acid and pre-natal vitamins if you know you are trying to conceive. The window of opportunity to prevent spinal cord defects is so early, usually before a woman knows that she is pregnant.

If you are working with an RE, they should be running all these tests WAY beforehand...so that you are getting the appropriate care and pre-natal care.