Question about CVS/Amnio

[Harold's Wife]

Hi ladies.

Do I have to ask for the CVS test or will my Dr. offer it to me? I will be 36.5 when I deliver, this is my 2nd IVF pg, and with my first I was not offered, nor did I know to ask, but now I am definitely more aware!

Thanks!

[Tia38]

Depends on your clinic (and possible insurance). If you are interested ask. CVS has an early time window, so ask sooner rather than later. I would ask about ALL testing/screening options so you can make a plan that works for you.

With my first pg (39 at conception and delivery) I thought I definitely wanted CVS. After reading and talking to doc I decided to start with Nuchal Scan (as early as possible) and if that raised flags to ask for CVS. It came back okay so I decided no CVS, and to defer amnio decision until after "big" u/s at 18w. That also looked okay so no amnio for me. DD is 20 months.

Now pg at 41 (due the day before I turn 42) I am following same strategy this time. Nuchal scan went okay and I'm waiting on my "big" u/s at 19w to decide on amnio.

Here's a link to info at my clinic, which may not be the same as yours, but might be good background:

http://www.mgh.harvard.edu/vincent/prenatal.htm

(See the "over 35 at delivery" link.)

There's no right/wrong answer on what tests to do.

Congrats on your pg!

Cheers,
-Tia

[BC-GoMom]

no cvs here before either, but it is done earlier in the pg... so find out now.... best to you... give us an update and Congrats!

[wintergirl]

Did you decide to do CVS? I didn't want to risk it when I learned that it causes miscarriage 1%-3% of the time, too high for my comfort for what I went through to get pregnant! I did the first trimester blood screening along with the NT scan at 13 weeks, and the numbers came out so low that it was recommended I really don't need an amnio as chances of having a Downs baby matched a 20 yr old's (and I'm 39).

[Harold's Wife]

Hi ladies, thank you for your replies, and extra thanks to Tia for all the info, really helped!!

I have just been released from my RE and have my first appt with my OB next week, so I will update then, but I do plan on getting the NT right away as I am just over 8 weeks and it seems that it's best done by week 13.

Thanks for the congrats, we are thrilled!

[wcl]

Tia (sorry for the barge on your thread, Harold's Wife),

Would you mind sharing the nuchal numbers you got for your first child, your DD? I realize she's four years younger than you were at conception, but I'm concerned about my daughter who is 35 (will be 36 by her due date), is 13 weeks now with her second, and has just gotten results from her NT/ blood tests. NT=2mm. T21=1/3452. T18=1/8141. It's a screen negative result. But she was offered amnio because of her age--and currently is agonizing over what to do.

I think she will follow the same test strategy you outlined. Nuchal first, then quad screen, then decide if amnio makes sense. But it might help her to know that one person over 35, at least, decided not to do an amnio based on negative screens--and her baby was fine.

I trust all will be well with your second, too! Thanks for whatever you can tell me. And thanks also for the link to the excellent Harvard article. I've sent it to my daughter.

wcl

[Tia38]

wcl -- come see my thread http://www3.fertilethoughts.com/foru...d.php?t=620340

i am currently a bit nervous about the whole thing.

also look back on this board (35+ pg) and you will find more posts on the topic.

to answer your question.... my DD is fine. my 'odds' were not as good as your daughter's odds -- and i did not do an amnio.

with DD i don't recall the nuchal thickness, but it was under 2mm, and might have been under 1.5 -- don't remember. i don't have my #s in front of me but they were (ballpark) TS21: 1/2000 TS13+18: 1/400 (which were improved from age alone #s). I did next us at 18w. Everything "was fine" (all organs and other things they check) and there were no soft markers for any of the trisomies. I believe they look for heart deformations, club feet, clenched hands and probably some other things...

You should read up on the quad screen... I believe it is notoriously questionable for 35+ but don't recall details.... I think part of the nuchal scan b/w is a subset of the quad? I knew it all the first go around, but don't recall the details this time.

Jump forward... at 41 my current #s (nuchal thickness was fine and nasal bone was present) are (about) 1/1000 for Downs (which is fine by me), and 1/200 for the other two trisomy combined.... so a half percent which is making me nervous. i had next u/s scheduled for 19w and OB suggested moving it up a week to 18w.

But I still am waiting on the next u/s to see if there are soft markers or other indications before deciding to have an amnio.

cheers,
-tia

WARNING: POTENTIALLY SENSITIVE TOPIC DISCUSSION FOLLOWS. IT'S NOT MEANT TO UPSET FLAME OR DISMAY ANYONE.
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To be blunt, Downs, while presenting its own set of challenges, is compatible with life. As I understand it, the other two (13+18) are not... even if you deliver a live baby the prognosis is very poor.

Before doing an amnio folks should consider what they will do with the information. Many will not do amnio because they will carry to term no matter what. Others will do the amnio even if they will carry to term so that they can be informed.

For those who may decide not to carry to term they should be aware that in most states (possibly all? definitely in MA) there is a cutoff after which the decision is out of the mother's/parent's/doctor's hands. So if you fall in this category you should find out if there is such a 'deadline' in your state. I hope no one reading this is faced with such a decision (including myself), but wanted to raise the issue, even though it is an uncomfortable one.

I've been told it can take 10 days (I assume business days) to get amnio results, so you need to factor that into your timing as well.

Sorry if my post has upset anyone. I have mixed feelings on the whole thing, am not currently faced with the situation, but do like to know the options (and constraints) before I find myself in a situation.

[mmi]

I chose amnio as my dr is very much pro amnio, not for the decision of abortion but he has seen too many people wait till the baby was born and then be faced with emotional decisions that they do not have time to fully educate themselves about beforehand. Friends of ours is an OB and even his staff/himself missed their childs anomoly, so even with scrupulous ultrasound, you don't know for sure. As far as miscarriage, it is really operator issues... so if you chose it.. ask you dr what HIS miscarriage or complication rate is. Like any skilled physician, many are great at it, others may not be as technically great at it. good luck with your decision.

[Tia38]

A site someone has pointed me to recently on amnio:

http://www.trisomy18.org/site/PageSe...=parents_amnio

[wintergirl]

Originally Posted by wcl

But it might help her to know that one person over 35, at least, decided not to do an amnio based on negative screens--and her baby was fine.

I'm 39 and decided not to do amnio because my blood screen came out screen negative. I called genetics to get the exact #'s and they are less than 1 in 2,201 for Downs and less than 1 in 4,601 for trisomy 13/18. The genetic counselor told me the #'s were as good as a 20 yr old's so I decided not to do amnio (although when I got pg I thought for sure I would). My baby isn't due till Jan but everything is pointing to him being very healthy.