Comprehensive Chromosomal Screening (CCS) & Genetic Testing
At the Center for Advanced Reproductive Medicine & Fertility, our primary goal is to help our patients conceive a healthy pregnancy, and our fertility experts have found that the best chance for such a pregnancy involves Comprehensive Chromosome Screening (CCS). This test analyzes chromosomes in growing embryos — fertilized egg cells — to find any issues of concern, such as:
- If the embryo is developing normally and healthily
- The potential for an embryo’s successful implantation
- The health and status of any other embryos in the batch
What does CCS really do?
CCS is a procedure that involves a biopsy of the embryo’s outer layer of cells at Day 5 or 6 of development so that reproductive genetic scientists can then examine these biopsies to make sure they are healthy — meaning that they have the right structure and number of chromosomes (23 pairs). When embryos have too many or too few chromosomes, it is called aneuploidy (AN-yoo-ploy-dee), which most commonly affects women over 35 and can result in serious, life-long illnesses or conditions for the child, such as Down Syndrome. Often, though, embryos with aneuploidy do not implant in the uterus or, if they do implant, result in miscarriages.
Previous technologies involving types of Pre-implantation Genetic Diagnosis (PGD) and other genetic screenings would require a cell biopsy at Day 3 of development, when embryos may not have enough time to accurately demonstrate their ability to implant and yield a healthy pregnancy. At that point, an embryo is only composed of about eight cells, and a biopsy of one of those eight cells removes a significant portion of the embryo. Moreover, that single embryonic cell might not necessarily represent the full embryo, or that cell may be the most important cell driving the embryo’s growth.
By Day 5, embryos have roughly 200 cells, and embryologists are able to remove more cells to view the cellular structure and chromosomes without compromising the embryo. At Day 5 the embryo is more mature and its true makeup is more evident than at Day 3. Excising 5-10 cells out of 200 cells is far less risky than removing 1 of 8 cells. Additionally, the cells that are biopsied for genetic screening are the trophoblastic cells (the cells that form the placenta), not necessarily part of the fetus, but still provide the information necessary to show the embryo’s health or chromosomal issues. For these reasons, CCS is generally viewed a safer and more accurate procedure than past genetic screening tests.
If there is a concern of genetic disorders, particularly due to family history of hereditary illnesses (single gene defects), our genetic screening lab can also run PGD testing with the larger group of biopsied cells. This way we can determine that embryos have 23 pairs of structurally intact chromosomes, and that the embryos aren’t predisposed to certain genetic illnesses, like Cystic Fibrosis, Alpha-Thalassemia, Sickle Cell Anemia and Tay-Sachs Disease, among many others.
Who needs CCS?
CCS-tested embryos that are found to be healthy have increased likelihood of implantation in the uterus, which of course, indicates the beginning of a successful pregnancy. It is a great asset for women who have had difficulty getting and staying pregnant.
Everyone could benefit from a genetic preview of their child. CCS is particularly beneficial for women who:
- Have diminished ovarian reserve (egg quality or quantity), such as women aged 35 or older
- Have experienced recurrent miscarriages and unsuccessful fertility treatments, including IVF
- Have had a prior pregnancy with aneuploidy (when cells of an embryo have too many or too few chromosomes)
- Are known carriers or whose partners are known carriers of genetic conditions
- Are looking into family balancing: the ability to choose, among healthy embryos, the gender of their next child, assuming there are healthy embryos of each gender
In total, CCS is the best option for any patient who wishes to take every step to strengthen the health of her future child and pregnancy by taking advantage of the most advanced available technology, leaving very little to chance.
How much does genetic screening cost?
Though it is true that in vitro fertilization is already an expensive endeavor, it may seem like paying for CCS is an unnecessary expense, as it is rarely covered by insurance. The reality is that through CCS you are investing in the success of your pregnancy. You pay more up front, but the result is likely to be a healthier baby with a stronger chance of implantation than you might have received if your doctors had simply chosen the best-looking embryo of the bunch. And if CCS finds that you have several healthy embryos, you are able to have chromosomally normal options or a certain gender of embryo for subsequent pregnancies.
The CCS provider we trust allows a fixed cost for screening up to eight embryos. It is uncommon (but certainly possible) for a single retrieval and fertilization process to result in eight viable embryos, so it is a good idea to ask your doctor (and your insurance company) about embryo batching. In this situation, you could possibly undergo more than one egg retrieval and fertilization process to produce several embryos, and test the full batch before transferring the healthiest embryos to your uterus. Embryo batching also allows more potential options: if you are using CCS for family balancing, you have a better chance of a healthy male embryo or healthy female embryo with more eggs retrieved. This may be the most cost-effective strategy, but that certainly depends on your family goals and medical needs.
Update: Be sure to talk to your insurance company about the possibility of going through two IVF processes without an embryo transfer. Some insurers, such as Aetna, may not cover the second IVF process (monitoring, egg retrieval, fertilization) if no embryo transfer took place. This means that embryo batching to make the most of your money for genetic testing could cost you quite a bit more in treatment. Our financial experts can help you determine your options.
Contact us for optimal embryo selection
The Center for Advanced Medicine & Fertility provides treatment for female, unknown, and male infertility. Our options with in vitro fertilization packages include CCS, for which we will send cell biopsies to specialized geneticists who review our patients’ embryos to uncover those with the greatest potential, yielding very high implantation success rates. For more information about CCS and family balancing, call our office at 732-339-9300 or click here to request an appointment with our fertility doctors in Edison, Cranford and Princeton, New Jersey.