Interest in choosing the sex of a child has a long history dating to ancient cultures. Methods have varied from special modes and timing of coitus to the practice of infanticide. Only recently have medical technologies made it possible to attempt sex selection of children before their conception or birth.
Because these practices are ethically controversial, clinics are encouraged to develop and make available their policies on the provision of nonmedical sex selection, and to accommodate their employees' decisions about whether or not to participate in such treatment. Practitioners offering assisted reproductive services are under no ethical obligation to provide or refuse to provide nonmedically indicated methods of sex selection. This document replaces two documents previously published by the ASRM Ethics Committee, titled, ‘‘Sex selection and preimplantation genetic diagnosis’’ (Fertil Steril 2004;82:S245–8) and ‘‘Preconception gender selection for nonmedical reasons’’ (Fertil Steril 2004;82:S232–5).
Researchers from the University of California San Francisco and Brigham and Women’s Hospital in Boston, surveying a cross-section of the American public, found that most approve of the use of preimplantation genetic diagnosis (PGD) to identify diseases fatal early in life and diseases that cause lifelong disability. The public, in general, is not supportive of selecting embryos for genetically-based traits, however specific opinions may vary a great deal depending on the race, sex, and education level of those who hold them.
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This study examined the possibility that genetically based sex-determination mechanisms have evolved to ensure a balanced male/female ratio and that this temperature-independent checkpoint might have been unavailable to long-extinct reptiles, notably the dinosaurs. A review of the literature on molecular and phylogenetic relationships between modes of reproduction and sex determination in extant animals was conducted. Mammals, birds, all snakes and most lizards, amphibians, and some gonochoristic fish use specific sex-determining chromosomes or genes (genetic sex determination, GSD). Some reptiles, however, including all crocodilians studied to date, many turtle and tortoise species, and some lizards, use environmental or temperature-dependent sex determination (TSD). We show that various modes of GSD have evolved many times, independently in different orders. Animals using TSD would be at risk of rapid reproductive failure due to a skewed sex ratio favoring males in response to sustained environmental temperature change and favoring the selection of sex-determining genes. The disadvantage to the evolving male sex– determining chromosome, however, is its decay due to nonrecombination and the subsequent loss of spermatogenesis genes. Global temperature change can skew the sex ratio of TSD animals and might have played a significant role in the demise of long-extinct species, notably the dinosaurs, particularly if the temperature change resulted in a preponderance of males. Current global warming also represents a risk for extant TSD species.
Have any new codes been introduced for the lab portion of preimplantation genetic diagnosis (PGD)?
I am trying to identify the correct CPT code for preimplantation genetic diagnosis (PGD). Could you help?
Our clinic is just starting to do PGD. We currently are flying in an embryologist from out of state to do this procedure for our patients. I have a patient who might have insurance benefits for PGD. Since we are not physically doing the procedure, but are flying in/out the embryologist who prepares the slides, then completes the procedure in his/her own lab, can we bill the insurance? For self-pay patients, we currently collect a one-lump fee, and out of that fee, we pay air fare, hotel, eating expenses, and the embryologist’s professional charges and laboratory charges. We haven’t had to deal with a patient and insurance for this type of service before.
What would be the diagnosis code for PGD performed due to a genetic disorder (fragile x syndrome)? Would I use 628.8 for female infertility -- although this is really not correct?
This book aims to expand the awareness and understanding of the emotional sequelae of prenatal/preimplantation diagnosis, prenatal decision-making, pregnancy interruption for fetal anomaly, multifetal reduction for high-order multifetal pregnancies and preimplantation choices involving the selection of embryos.