Preliminary tests for couples undertaking PGD are as for IVF (see Chapter 5). A gynaecological and medical history should be taken. Rubella immunity should be checked and immunization offered if necessary. Haematological screening (sickle cell and thalassaemia) and screening for Tay-Sachs disease is offered if appropriate. The male partner should be asked to produce a semen sample for analysis. As for all patients undergoing IVF, PGD patients are tested for HIV and hepatitis B and C before they undergo treatment.
A general and pelvic examination is made, including chlamydia screening and updating of cervical cytology. The body mass index of the woman should be calculated (weight divided by height squared) and weight loss advised for any woman with a body mass index of greater than 30. Women are advised to stop cigarette smoking and reduce alcohol intake, not only in pregnancy, but also because they reduce fertility. Folate supplementation is recommended before conception and during the first 12 weeks of a pregnancy (400//g folic acid per day or if there is a history of neural tube defect or the woman is taking medication for epilepsy 4 mg daily).
Pelvic ultrasound scanning is performed to determine if the ovaries are polycystic (Figure 8.1), since this will affect the ovarian stimulation protocol selected, and for any other gynaecological pathology.
It is our policy also to visualize the endometrial cavity and uterus by hystero-salpingography or hysterosalpingo-contrast sonography using a contrast medium prior to IVF. This is particularly required for women who have had repeated
evacuations of the uterus for recurrent miscarriage or following termination of pregnancy, as these women are at risk of Asherman's syndrome and intrauterine adhesions (Figures 8.2 and 8.3).
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