See what you missed at ASRM 2024 with the ASRM 2024 Recorded Bundle 

Menu
Close Close Icon
ASRMed talks Logo

Genetics: Counseling Fertility Couples About Their Evaluation

View more ASRMed Talks

Video

Title:Genetics: Counseling Fertility Couples About Their Evaluation

Runtime: 6 min 25 sec

Speaker: Caitlin Hebert, RN

Transcript

This transcript was automatically generated.

Caitlin Hebert discusses fertility counseling, the importance of carrier screening, and overcoming barriers for patients while highlighting the role of genetic counseling.

Hi, my name is Caitlin Hebert. I'm a nurse and a clinical educator at Shady Grove Fertility. I'm also the current chair of the nurse professional group at ASRM.

In my not-so-distant past, my husband and I decided we were ready to start having kids, and we did what a lot of people who are getting ready to have kids do. We started telling everyone that we were getting ready to have kids. We're telling the neighbors, we're telling our parents, we're telling our friends, which it's kind of awkward if you think about it.

You're like, hey, guess what we're doing? A lot, a lot. But I'm actually really glad that we did this because we reached out to my mother-in-law, and we're telling her about what's going on, and she pulls me inside it, and she goes, hey Cait, you know, we're carriers for Tay-Sachs, so you should really look at getting tested. And I was like, whoa, I'm not even pregnant yet, and I might have a kid that has this really scary disease.

And it's under this very personal context that I want to talk to you today about counseling fertility couples about their evaluation. I'm going to talk to you a little bit about some of the intrinsic and extrinsic barriers that you're going to have to be aware of when you're counseling patients. I'm going to talk to you a little bit about the limitations of the test, as well as our own as healthcare providers.

And finally, I want to talk to you a little bit about counseling with treatment as related to this evaluation. So, obviously, I had a huge incentive to do carrier screening, right? But not all of our patients do. And in fact, that makes sense, right? And we as humans are not very good at judging risk.

And so we should be aware of that when we're talking to our patients. You know, we're a species that's used to saying like, oh, there's a bear. That's a problem.

I know that's risky. We have a much harder time judging risk in relationship to theoretical ideas. And there's also this thing fairly well established in social science called an optimistic bias.

And an optimistic bias basically says that we believe good things will happen to us and bad things won't. I definitely won't get cancer, and I will absolutely have the smartest child in the classroom, despite what evidence, professionals, the data suggests. So when we're counseling patients about whether they should pursue this testing or things like that, we have to be aware that they are coming into that conversation not very well able to establish risk and with that optimistic bias.

So that's an important piece when you're talking to them. So that's an intrinsic barrier, but what about an extrinsic barrier? So a 2017 study by Gilmore et al. found that women who were eligible for carrier screening opted not to do the carrier screening, not because they were against it or didn't understand the rationale, but for logistical reasons.

So when I went to do carrier screening, I found out, I talked to my insurance, and it was going to cost me hundreds of dollars. So even though I was trying to save every single dollar bill because I was getting ready to have a kid, I'm now having to spend lots of money on something that's a theoretical risk. And on top of that, lots of patients may have to travel to a separate place to have this blood drawn.

Or they may also not have, they may not be able to start treatment until they've completed this testing, right? They need to have decided that they want to do the testing. The testing may take a few weeks to get those results back. They may have to have all these things, and whether you recognize it or not, they perceive that as a barrier to getting started.

So that's a logistical reason that they are not pursuing this treatment. So how do we overcome that? Well, of course, we're going to counsel them if they are going to do this treatment to get started with that as early as possible so that there isn't the delay in treatment. And we should also be using our platform to help remove some of those logistical barriers.

Talking to insurances, hey, we should cover this because we think it's a valuable thing. Or making partnerships with these labs to make it more affordable or drawing it in-house so patients don't have to travel to get these testing. It's really important for us to be cognizant of those intrinsic and extrinsic barriers so that we can make things as effective as possible.

Now, I have some good news. I came back totally negative for all the tests. And I was like, woohoo, that means nothing can go wrong.

And that was actually really helpful for me to talk to a genetic counselor in relationship to that result. Because they were able to go over things like residual risk with me, right? And they were able to talk to me about the limitations of the testing itself and really go into detail. And more than that, too, we were able to establish a relationship where I knew if something did come back that fell outside of these expected parameters, I could always go back to that genetic counselor and continue this discussion having that relationship.

So not only was it important for me as a patient to understand the limitations, but it was also important for me as a healthcare provider to recognize my own limitations and how important it was to really have a genetic counselor go through all these things and be a part of that interdisciplinary team. I think we all know that genetics is getting increasingly complex. Like I said, there's add-on testing we heard.

There's all sorts of times where these variants that yesterday weren't pathologic and now today they are. This increasingly complex world demands that we rely on our interdisciplinary teammates so that we as healthcare providers are not living on an island, which we're used to be, right? We're used to being it for the patient, one-stop shop. But by working with our partners, we're not only helping ourselves by freeing up time or making sure they're getting, we're actually helping the patient have a more comprehensive evaluation and consultation in relationship to these results.

ASRMed Talks

Check out more ASRMed Talks
ASRMed talks Logo

Hormonal Induction of Endometrial Receptivity for Fresh or Frozen Embryo Transfer​ Part I

Explore Dr. Paulson's insights on endometrial receptivity and hormonal preparation in IVF, egg donation, and surrogacy, highlighting estrogen and progesterone roles.
ASRMed talks Logo

Hormonal Induction of Endometrial Receptivity for Fresh or Frozen Embryo Transfer​ Part II

Dr. Richard Paulson discusses progesterone administration in IVF, comparing intramuscular and vaginal methods, optimal timing, and recent research findings.

ASRM Academy

ASRM Academy Teaser Image
ASRM Academy Online

Find A Course

View the ASRM Academy Course Catalog

View the Course Catalog
ASRM Academy Webinars teaser
ASRM Academy Digital

Educational Webinars

Panel discussions on topics to enhance your knowledge of all facets of reproductive medicine

View Upcoming Webinars
ASRM Academy Teaser Image
ASRM Academy Online

Certificate Courses and Training Modules

View the specially crafted certificate courses and training modules available from ASRM Academy

View the Courses/Modules
ASRM Academy Teaser Image
ASRM Academy Digital

Podcasts

The ASRM Family of Podcasts were developed with both health professionals and the layman in mind

Subscribe to the ASRM Today Podcast
ASRM Academy Teaser Image
ASRM Academy On the Go

MedTalks

Head to the highlights! Stay up to date with engaging video excerpts from webinars and courses that cover a topic in 7 minutes or less.

View the ASRMed Talks!
MAC 2021 teaser
ASRM Academy on the Go

ASRM MAC Tool 2021

The ASRM Müllerian Anomaly Classification 2021 (MAC2021) includes cervical and vaginal anomalies and standardize terminology within an interactive tool format.

View the MAC Tool
EDGE teaser
ASRM Academy on the Go

ASRM EDGE Tool

Get the EDGE on embryo identification! EDGE allows you to compare your grading of embryos against embryologists in the US and around the world.

Grade Embryos Now

Topic Resources

View more on the topic of genetic screening/testing
Podcast Icon

Fertility and Sterility On Air - TOC: October 2024

Explore the latest in reproductive medicine with Fertility and Sterility On Air. Topics include ovarian tissue cryopreservation, DuoStim debates, 1PN embryos, and ART outcomes. Listen to the Episode
Document Icon

Use of preimplantation genetic testing for monogenic adult-onset conditions: an Ethics Committee opinion (2024)

Preimplantation genetic testing for adult-onset monogenic diseases is ethically allowed when fully penetrant or conferring disease predisposition. View the Committee Opinion
Coding Icon

Codes for Embryo Biopsy

When doing a preimplantation genetic test (PGT) biopsy, can you bill for each day a biopsy is performed or can you only bill once for the cycle? View the Answer
Podcast Icon

Fertility and Sterility On Air - Live from ESHRE 2024: Part 2

Explore fresh embryo transfers, progesterone elevation, and day-seven embryo utility from experts at ESHRE 2024. Cutting-edge fertility insights await! Listen to the Episode
Document Icon

The use of preimplantation genetic testing for aneuploidy: a committee opinion (2024)

PGT-A use in the U.S. is rising, but its value as a routine IVF screening test is unclear, with mixed results from various studies. View the Committee Opinion
Podcast Icon

Fertility and Sterility On Air - TOC: July 2024

Articles this month include: predicting ART complications, laser assisted hatching on vitrified blastocysts, predictive models of miscarriage and more.
Listen to the Episode
Videos Icon

Journal Club Global: Recent clinical trials in Fertility and Sterility from the Asia Pacific region

Join ASPIRE 2024 for a Journal Club Global on PGT-A and IVF. Learn from top experts discussing recent clinical trial data and pregnancy outcomes View the Video
Coding Icon

Coding for an endometrial biopsy/Mock cycle

We had patients request us to bill their insurance for the two monitoring visits and the Endo BX and change the diagnosis code to something that is payable.  View the Answer
Videos Icon

Journal Club Global: Cost effectiveness analyses of PGT-A

Infertility treatments can be financially burdensome, often without insurance coverage, making understanding the cost effectiveness of PGT-A crucial. View the Video
Coding Icon

Coding PGT requisitions to the PGT lab

Do you have any recommended codes to use for PGT requisitions to the PGT lab?   View the Answer
Videos Icon

Genetics: Is Expanded Carrier Screening the Standard of Care?

Hannah Green, a genetic counselor at NYU, discusses the benefits and limitations of expanded carrier screening, highlighting its impact on clinical practice and patient care. View the ASRMed Talk Video
Videos Icon

Genetics - Extra Testing, Passthrough or Money Maker?

Danielle Soltesz of RMA New York discusses the complex economics and ethical considerations of genetic testing in reproductive medicine, exploring costs, patient care, and sustainability. View the ASRMed Talk Video
Document Icon

Clinical management of mosaic results from preimplantation genetic testing for aneuploidy of blastocysts: a committee opinion (2023)

This document incorporates studies about mosaic embryo transfer and provides evidence-based considerations for embryos with mosaic results on PGT-A. View the Committee Opinion
Videos Icon

Journal Club Global - Revisiting the STAR trial: The Fellows debate PGT-A

We are excited to host a debate covering the pros and cons of PGT-A and how new technologies should be validated before clinical implementation. View the Video
Coding Icon

Sperm DNA Fragmentation

Is there a CPT code for HALO DNA Fragmentation for sperm? View the Answer
Coding Icon

Results Review

What CPT code is most appropriate to submit for Physician Time to review CCS/PGS/PGD results? View the Answer
Coding Icon

ICSI and Embryo Biopsy

How to bill for ICSI or embryo biopsies that occur in different days?  View the Answer
Coding Icon

Embryo Biopsy

Have any new codes been introduced for the lab portion of PGT? View the Answer
Coding Icon

Embryo Biopsy Embryologist Travel Costs

Can we bill insurance for the biopsy procedure? Can we bill for travel expenses? View the Answer
Coding Icon

Embryo Biopsy PGS Testing

What codes are appropriate for PGS testing? View the Answer
Coding Icon

Genetic Counseling

Does ASRM have any guidance for how to bill for genetic counseling services provided by a genetic counselor?
View the Answer
Coding Icon

Assisted Zona Hatching

Can assisted hatching and embryo biopsy for PGT-A; PGT-M or PGT-SR be billed during the same cycle? View the Answer
Document Icon

Indications and management of preimplantation genetic testing for monogenic conditions: a committee opinion (2023)

ASRM has updated its opinion on PGT for monogenic conditions, providing guidance on clinical and technical complexities. View the Committee Opinion
Videos Icon

Journal Club Global - PGT-A - Can non-invasive approaches based on spent medium analysis

PGT-A by trophectoderm biopsy aims to select available euploid embryos for transfer. View the Video
Document Icon

ASRM müllerian anomalies classification 2021

The Task Force set goals for a new classification and chose to base it on the iconic AFS classification from 1988 because of its simplicity and recognizability. View the Committee Opinion
Videos Icon

Journal Club Global - Accuracy of Preimplantation Genetic Testing for Aneuploidies

One of the highest aspirations in reproductive medicine is to develop a technology allowing for ID of embryos that have true reproductive potential.
View the Video
Document Icon

Reproductive and hormonal considerations in women at increased risk for hereditary gynecologic cancers: Society of Gynecologic Oncology and American Society for Reproductive Medicine Evidence-Based Review (2019)

Providers who care for women at risk for hereditary gynecologic cancers must consider the impact of these conditions. View the Joint Statement
Document Icon

Disclosure of sex when incidentally revealed as part of preimplantation genetic testing (PGT): an Ethics Committee opinion (2018)

Clinics may develop a policy to disallow selecting which embryos to transfer based on sex and choose to use only embryo quality as selection criteria. View the Committee Opinion
Document Icon

Transferring embryos with genetic anomalies detected in preimplantation testing: an Ethics Committee Opinion (2018)

Patient requests for transfer of embryos with genetic anomalies linked to serious health-affecting disorders detected in preimplantation testing are rare but do exist. View the Committee Document
Document Icon

Best practices of ASRM and ESHRE: a journey through reproductive medicine (2012)

ASRM and ESHRE are the two largest societies in the world whose members comprise the major experts and professionals working in reproductive medicine. View the Committee Joint Guideline
Membership Icon

Preimplantation Genetic Testing Special Interest Group (PGTSIG)

The ASRM PGTSIG coordinates research, education, and training in preimplantation genetic diagnosis (PGT). Learn more about the PGTSIG