How IVF and PGT are being used to save lives and marriages

Overview

In Africa, especially Nigeria, many marriages face the challenges of breakups due to lack of children. A family is considered complete with children, while infertility is a taboo and children dying after birth is considered a curse in many cultures!

For couples struggling with infertility, in-vitro fertilization (IVF) is often a viable option to conceive a child. Other challenges include the inability to deliver a live birth, e.g., recurrent miscarriages, and the death of children due to genetic defects in the offspring or a life of suffering and pain for both parents and children due to birth defects or some diseased conditions. These concerns are not addressed by IVF alone but coupled with PGT (Pre-Implantation Genetic Testing).

One such concern is the possibility of couples passing-on genetic disorders to their offspring, which can be a source of anxiety for couples, especially those with a family history of genetic disease, such as sickle cell disease.

Cultural beliefs can also present a challenge for some couples. In some Nigerian cultures, especially the Igbo culture, having a male child is highly valued as it symbolizes prosperity, continuity, and strength. But the preference for male children is deeply rooted in the cultural belief that they will inherit the family’s wealth, continue the family lineage, and perform important cultural and religious rites. As a result of this belief, having a male child is regarded as a crucial aspect of marriage. Women who bear male children are considered fulfilled and highly respected in their husband’s house, while women who do not bear male children are not respected, abused, stigmatized, and sometimes divorced. So, the inability of a woman to produce a male child often leads men to marry multiple wives in pursuit of male children, while the woman often has no choice but to suffer in silence, anticipating the day she will lose her husband to another woman. In some cases, the women go to pay dowry on a male child or adopt him into the family. This cultural way of thinking put couples who do not have male children under a lot of pressure from their families.

Even though science has clearly indicated that the male partner is mainly responsible for determining the male gender of the child through his contribution of the X- chromosome, which only he brings to the table of procreation.

However, until this belief changes, the potential of PGT in assisted reproductive technology is huge and can be exploited. PGT enables family gender balancing through sex selection, and has been used to salvage this challenge that burdens couples in marriages in Nigeria. Needless to say that the application of PGT for family balancing seems like an open secret. It is unacceptable and illegal in some countries abroad, e.g., in England. There, every gender is valued as equally a blessing from God!

What is Pre-Implantation Genetic Testing (PGT)?

Pre-implantation genetic testing (PGT) is a process where the embryos created through IVF are screened for genetic abnormalities before they are implanted into the uterus.

This screening can help identify chromosomal or genetic defects that may cause inherited disorders, such as cystic fibrosis, Down syndrome, and sickle cell anemia.

There are two critical types of PGT:

1. PGT-A (formerly PGS: Pre-implantation genetic screening for aneuploidy)
2. PGT-M (formerly PGD: Pre-implantation genetic testing for monogenetic/single-gene diseases)

PGT-A, on one hand, involves screening the embryos for chromosomal abnormalities that could lead to conditions like Down syndrome. PGS is typically used when a couple has a history of recurrent miscarriages or has had difficulty conceiving.

PGT-M on the other hand, involves testing for specific monogenic disorders that are known to run in families. A biopsy is taken from the embryo, and the genetic material is analyzed to identify any abnormalities. The results of the analysis are then used to select healthy embryos for implantation.

PGT-M is commonly used in cases where both parents carry a gene for a genetic disorder and there is a high risk of passing it on to their children.

Finally in addition to the critical types of PGT, as mentioned earlier, it possible to identify the gender gene of an embryo using PGT.

How does PGT work?

PGT is done after the embryos are created through IVF. A few cells are removed from the embryo, biopsy, which are then tested for chromosomal or genetic abnormalities. The results of the test are then used to select the healthiest embryos for implantation.

PGT can be done in two ways:

1. Day 3 biopsy
2. Blastocyst biopsy

In a day 3 biopsy, the embryo is tested on the third day after fertilization, while in a blastocyst biopsy, the embryo is tested on the fifth or sixth day after fertilization.

Blastocyst biopsy is preferred because it allows for more cells to be removed from the embryo, which means more accurate results.

Why is PGT important in IVF?

PGT has become an important part of IVF procedure because it helps identify chromosomal or genetic abnormalities that may be a barrier to a successful pregnancy. It has been estimated that around 50% of embryos created through IVF have chromosomal abnormalities. PGT allows for the selection of healthy embryos, increasing the chances of a successful pregnancy and decreasing the risk of miscarriage.

Is PGT safe?

PGT is a safe and effective way to improve the success rate of IVF. However, like any medical procedure, it does come with some risks. There is a small chance of damaging the embryo during the biopsy, which can result in the loss of the embryo. However, this risk is very low, and the benefits of PGT far outweigh the risks.

Summary benefits of PGT

PGT has several benefits, including:

1. Increased chances of a successful pregnancy: PGT helps identify healthy embryos, which can increase the chances of a successful pregnancy.
2. Reduced risk of miscarriage: By selecting healthy embryos, the risk of miscarriage can be reduced.
3. Prevention of genetic disorders: PGT can help prevent the transmission of genetic disorders to the next generation; and save children who may die from this disorder after birth.
4. Increased emotional well-being: The success of IVF can have a significant impact on the emotional well-being of the couple. PGT can help increase the chances of success and reduce the stress associated with infertility thereby saving many marriages.