My First Months at Cayman Fertility Center

It has already been over two months since I started working at Cayman Fertility Center (CFC). Time has flown by, as it always does when new, exciting, and wonderful things happen. Working here quickly felt “normal,” which is a great feeling considering I left my old life in Germany behind: friends, family, a good job, a nice apartment… all for the dream of trying life abroad. Ideally somewhere sunny with the sea ever-present, where it feels like a vacation before and after work.

After our two-month internship in 2011, my husband and I never let go of the dream of returning to Grand Cayman. Thankfully, the island with its diverse population has welcomed us wonderfully, and we feel right at home. Of course, at first, you notice the things that are very different from Germany. At CFC, I had to quickly get used to the differences. While many aspects of fertility treatment are similar to Germany, such as stimulation plans for IVF patients and the medications, there are significant differences, like the availability of preimplantation genetic testing (PGT) and egg donation, which are not as accessible in Germany.

 

I find it fantastic to have these options to offer my patients, helping them achieve their dream of having children. In Germany, undergoing preimplantation genetic testing is still associated with many hurdles. Due to the Embryo Protection Act and the Genetic Diagnostics Act, there needs to be a medical indication, such as a genetically proven hereditary disease of one of the parents, approval from an ethics committee, and a specialized IVF clinic authorized to perform PGT. This process takes a lot of time and money in Germany.

 

PGT-A (Preimplantation Genetic Testing for Aneuploidy) is a genetic test performed during IVF to screen embryos for chromosomal abnormalities before they are transferred to the uterus. Aneuploidies, deviations in chromosome numbers, can lead to miscarriages, birth defects, or genetic disorders. PGT-A identifies embryos with the correct number of chromosomes, increasing the chances of a successful pregnancy and the birth of a healthy baby.

 

The process involves several steps:

1. Egg retrieval and fertilization: Eggs are retrieved from the ovaries and fertilized with sperm in the lab.
2. Embryo development: Fertilized eggs develop into embryos.
3. Biopsy: At a specific development stage (usually on the fifth or sixth day), a few cells are taken from each embryo.
4. Genetic analysis: The biopsied cells are tested for chromosomal abnormalities.
5. Embryo transfer: Only embryos without chromosomal abnormalities are selected for transfer to the uterus.

 

PGT-A is particularly useful for couples who have experienced repeated miscarriages, are older, have a history of genetic disorders, or have had multiple unsuccessful IVF cycles with morphologically perfect embryos (Gardner Score AA) that failed to result in a pregnancy. Seeing the benefits of PGT-A firsthand here on the Cayman Islands, I sometimes wish it had been more accessible in Germany. For some couples, despite having perfect-looking embryos, PGT-A reveals that many embryos are aneuploid and not suitable for transfer, providing possible explanations for repeated implantation failures.

 

Besides PGT-A, there are other types of preimplantation genetic testing:

– PGT-M (Preimplantation Genetic Testing for Monogenic Disorders): Screens embryos for specific monogenic diseases like cystic fibrosis or hemophilia.

– PGT-SR (Preimplantation Genetic Testing for Structural Rearrangements): Detects structural chromosomal anomalies like translocations or deletions.

 

Patients undergoing IVF, investing significant time and money, would certainly appreciate having the option of preimplantation genetic testing and discussing all pros and cons with their doctor. Therefore, I am thrilled to have expanded my knowledge and expertise with this important tool in my daily work and I am looking forward to utilizing this expertise to better support and guide my patients through their IVF journey.

 

– Dr Hinzmann