Patient History Form For Non-Invasive Prenatal Testing (Nipt: Fill & Download for Free

In a hundred years, there will be no such thing as disease.My dad is 86, but when he was born, life expectancy in the U.S. was just 57 years old. Now it’s 80. Since 1900, global life expectancy has more than doubled. It’s now approaching 70 years. A baby born today will be the first 150-year-old. And no country in the world has a lower life expectancy than the countries with the highest life expectancy in 1800.The main reason for this is medical discovery. Major breakthroughs are made every day, and the pace of discovery continues to accelerate. But we often take for granted all the advances in medicine and healthcare that have extended our lifespans. The economics of the healthcare system are, admittedly, broken, so people fixate on the negative—but in terms of discovery, it’s never been better. Countless new drugs are saving people's lives every day— but they never would have been developed without the support of clinical trials.That’s why, contrary to the naysayers, we’re actually living in the golden age of healthcare right now.1. Immuno-oncology is the most promising approach to cancer treatment today.Put simply, immuno-oncology (IO) is the study and development of treatments that take advantage of the body’s immune system to fight cancer.As a living, dynamic system, the immune system is able to detect cancer anywhere in the body, which is especially important in treating patients with cancers that have spread or metastasized to other organs. IO works by augmenting the immune system’s natural ability to see and eliminate cancer cells much in the same way it protects us against infection from viruses and bacteria.And the research is exploding with potential…and results.The FDA has recently approved IO therapies for nearly 20 types of cancer, including advanced tumors, blood cancers, and cancers with a specific genetic defect resulting in a high frequency of mutation. There are also numerous ongoing clinical trials to test the benefits of IO agents in many other types of cancer. Linear Clinical Research, for example, is helping patients with rare and advanced forms of cancer in Western Australia access relevant clinical trials under the Australian Genomic Cancer Medicine Program—without having to travel great distances.We used to think of cancer as a death sentence—but thanks to IO, we may need to start rethinking our assumptions.2. Increased R&D financing means new discoveries and treatments for people with rare diseases.A few decades ago, drug companies focused primarily on developing drugs for the most common diseases—and there was a major economic incentive to do so.But this all changed in 1983 when Congress passed the Orphan Drug Act (ODA)—a landmark health bill aimed at motivating pharmaceutical companies to develop drugs for people whose rare diseases had been ignored.Now, we gain understanding on a molecular level, and therefore set ourselves up for cure, of a new rare disease every day. This is unprecedented in the history of healthcare.The ODA created financial incentives for drug manufacturers, including tax credits for costs of clinical research, government grant funding, assistance for clinical research, and a seven-year period of exclusive marketing. At the same time, federal programs at the FDA and the NIH began encouraging product development, as well as clinical research for products targeting rare diseases.Since 1983, the ODA has resulted in the development of more than 250 orphan drugs, which now are available to treat a potential patient population of more than 13 million Americans. In contrast, the decade before 1983 saw fewer than 10 such products developed without government assistance.Because of the ODA, promising treatments are available to people with rare diseases who once had no hope for survival.3. Advanced diagnostic tools mean earlier treatment—and even prevention—of serious diseases.I have three kids between the ages of two and eight. And during each pregnancy, there were different standard practices regarding prenatal testing.When my wife was pregnant with my eight-year-old, the common practice was amniocentesis—which involves putting a huge needle in the uterus to extract fluid. While this was an effective method to test for certain disorders like Down syndrome, it also came with a huge risk of complications—like miscarriage.I remember my wife and I feeling conflicted. Do we get the information and take the risk, or just cross our fingers that our kid was healthy?Just two years later, with our next kid, the doctor recommended against amniocentesis, because at that point blood tests had a higher confidence level, though plenty of uncertainty remained.By the time my wife was pregnant with our third kid, the doctor said there was no need for amniocentesis at all—they had 99.999% confidence that they could get all the necessary information from blood tests alone.It seems barbaric when you think back on it, the idea of putting a huge needle into a pregnant woman. But it was common practice less than ten years ago. Today, doctors can test for even more genetic abnormalities earlier, through prenatal blood testing. Known as non-invasive prenatal testing (NIPT), this approach gives women more time to make decisions about their pregnancies while helping alleviate health risks.This rapid breakthrough was possible in large part due to diagnostic testing. In fact, one of our customers, Illumina, at my eClinical software company, Medrio, was heavily involved in making NIPT possible.This isn’t a story you’ll see on the front page of any major newspapers—the press often focuses on the negatives. For instance, the potential ethical issues involved, like sex-selective abortion and people with Down syndrome.But in reality, diagnostic breakthroughs have caused far more benefits than potential negative effects. In fact, one of our customers was approached by the CDC a few years ago asking for diagnostic tests for Zika. At the time, Zika was spreading like crazy, and the CDC was concerned that it had infected blood donations throughout the U.S. So, using our software, our customer ran the clinical trial and came up with a test. It worked. Suddenly, there was an easy way for them to test all the blood samples and prevent tens of thousands of people from getting Zika.People are attracted to negative stories, and so are journalists. And it’s true that healthcare in America is pricier than it should be. But from a discovery standpoint, there’s so much good happening in the healthcare space today.The breakthroughs being made today are likely to save your life—literally.

This answer may contain sensitive images. Click on an image to unblur it.Here are the various disadvantages, pitfalls and downsides of using an egg donor :(1) In most traditional Asian cultures, the primary duty of a wife is to bear sons for her husband and his family, so at to continue the family lineage. Hence, a childless woman may be subjected to emotional blackmail and psychological pressure from her husband and in-laws to undergo egg donation to conceive a child. There are serious implications for the happiness of the marriage and welfare of the child, if the wife is an unwilling partner to egg donation.(2) Identity confusion and emotional distress of the child, if he/she suddenly and unexpectedly finds out the truth of his/her conception, for example through a family quarrel. For many donor-conceived teenagers and adults, life-long emotional trauma and personal-identity crisis often result from learning the truth after childhood, as reported by many psychological studies and the news media.(3) Risk of accidental incest between half-siblings conceived by the same egg donor. In particular, there is a phenomenon known as Genetic Sexual Attraction (GSA), which is spontaneous sexual attraction between close relatives such as siblings or half-siblings separated at birth, who first meet as adults.(4) Difficulty of maintaining secrecy even with anonymous donors, due to widespread availability of cheap direct-to-consumer DNA testing and associated Genealogy / Ancestry websites. With the advent of DNA sample home-collection kits, it is easy for anyone with suspicions of his/her parentage to surreptitiously collect biological samples from his/her "presumed" parents without their knowledge and consent, and send them for anonymous DNA testing overseas.(5) Possible transmission of unknown genetic defects from an anonymous egg donor to child. Very often, the only information on the family health history of an anonymous egg donor comes from a questionnaire form filled up by the donor herself. It is difficult to verify the truthfulness of such information. Foreign IVF clinics often exploit patients' fears of unknown genetic defects, to push them to do expensive embryo genetic testing (PGS / PGT-A); instead of recommending cheaper alternatives such as genetic testing of the donor's blood sample or NIPT (Non-Invasive Prenatal Testing).(6) Claims that a woman receiving egg donation can pass some of her genes to the child are false, and have no scientific basis.

This answer may contain sensitive images. Click on an image to unblur it.Here are 5 options for Singaporean IVF patients requiring egg donation:Option 1: Seek out your own relatives or close friends as egg donorsStepsInform your doctor that you have found a known egg donor, either a close friend or blood relative. Under Singapore health regulations, you cannot utilize your husband's sister as an egg donor. Although your husband's blood relatives such as nieces and cousins are legally allowed to be your egg donor, this is strongly discouraged due to consanguinity and risks of inbreeding.The doctor will then refer you and your prospective egg donor to a certified fertility counselor in Singapore.After counseling and signing of the appropriate consent and declaration forms, you and the prospective egg donor will be ready to start the egg donation IVF process.AdvantagesAn obvious advantage of using a blood relative such as a sibling or cousin as an egg donor, is that you have a genetic link to the conceived child. Additionally, you would also be familiar with any hereditary genetic diseases that run in the family. Here are the various fractions of DNA that you would share with your child, with different types of blood relatives as egg donor: full sister - 25%(1/4), half-sister or niece - 12.5%(1/8), first cousin - 6.25%(1/16), second cousin - 3.125%(1/32). Note that if you were using your own eggs, you would share 50%(1/2) of DNA with your child.The advantage of using a close friend is that you know her character and what she looks like, traits that may possibly be inherited by the conceived child.DisadvantagesIt may be challenging to find a “young enough” donor among your own circle of friends and relatives, preferably below 30 years old, as recommended by most fertility clinics. Using older egg donors will obviously decrease your chances of success.Egg donation from close relatives may possibly cause awkwardness and tension in future family relationships, particularly at family gatherings during major festivals such as Chinese New Year.There is a lack of egg donor anonymity, and increased chances of the secret of the child’s conception being leaked out, either deliberately or inadvertently by a third party.Option 2: Import frozen donor eggs from an overseas egg bankStepsInform your doctor that you wish to import frozen donor eggs from a foreign egg bank.The doctor will then recommend foreign egg banks that meet the standards set by the Ministry of Health in Singapore. These include requiring all egg donors to undergo infectious disease and genetic testing screening, which must be in compliance with the European Union Tissues and Cells Directive, as well as the Human Fertilisation and Embryology Authority's (HFEA, UK) regulations on egg donation.Contact the foreign egg bank (usually through email), and request them to match you with an appropriate egg donor based on ethnicity, blood group, educational level, and physical characteristics i.e. height and complexion, by providing appropriate details of yourself and your husbandThe foreign egg bank will reply to you with an appropriate list of suitable donors. Make your choice of one donor from this list, and inform the egg bank of your intention to purchase frozen eggs from this particular donor.Make payment to the egg bank, either by credit card or international bank wire transfer.The foreign egg bank will then make arrangements with a courier company to transport the frozen eggs to the IVF clinic in Singapore where you are receiving treatment. Inform your doctor, IVF clinic and lab of the transport arrangement. Upon arrival, the frozen eggs will be stored in a liquid nitrogen tank within your IVF lab.The doctor will refer you for egg donation counseling by a certified fertility counselor in Singapore.After counseling and signing of the appropriate consent and declaration forms, you will be ready to start the egg donation IVF process.AdvantagesDonor anonymity is maintained.There is a wide choice of donors available in foreign egg banks based in Western countries, even Asian and Chinese ones. Increasing demand worldwide has led to egg banks in Western countries recruiting donors of such ethnicity.DisadvantagesBesides the high costs of the frozen eggs, the transportation cost from a foreign country to Singapore is also very expensive, as it requires a special cryogenic container.A special custom permit is required to avoid the imported samples being subjected to x-ray, which could be highly damaging to the frozen eggs. Extensive paperwork may be required which could further add to the already high costs.Despite technological advances such as vitrification, the success rate with frozen eggs is still significantly lower than fresh eggs.Asian/Chinese donors eggs may be more expensive to procure from egg banks based in Western countries, as compared to Caucasian ones, due to the scarcity of Asian/Chinese donors in Western countries. An alternative maybe to utilize egg banks located in Asian countries such as Malaysia.Option 3: Look for an egg donor through the internet who is paid secretly, or utilize a foreign agency to send an egg donor to Singapore (strictly not recommended)StepsPayment of egg donors is banned in Singapore. No suggested steps, as you will be breaking the law, and may face a fine or even a jail term for criminal perjury and bribery. Strictly not recommended. The above description is to give a warning of what not to do.AdvantagesFreelance egg donors that you find from internet websites may be much cheaper than using a foreign egg donor agency..On the other hand, utilizing a well-established foreign egg donor agency may be a ‘safer’ option. Most reputable foreign agencies will insist on having a coordinator to accompany the donor to Singapore, to ensure that the donor punctiliously self-administers hormonal injections to stimulate her ovaries, as well as to make sure she fulfills her part of the contract.DisadvantagesSecret under-the-table payments to either freelance egg donors or foreign egg donor agencies are illegal under Singapore law.After paying freelance egg donors, there is no guarantee that they will fulfill their part of the bargain, in which case you have no legal recourse for recovering your money. Because payment for egg donation is illegal in Singapore, you will only implicate yourself in an illegal transaction if you decide to sue the would-be freelance egg donor.It maybe difficult to ensure that the freelance egg donor faithfully follows the painful and tedious procedure of daily hormone injections to stimulate egg production within her ovaries.Utilizing a foreign egg donor agency to send an egg donor to Singapore will be much more expensive. Besides the agency fees, there are also extra traveling and accommodation costs.It may be difficult for illicit payment to either a freelance egg donor or foreign egg donor agency to leak out. But if it does leak out, you will definitely end up in big trouble. Several years ago, a Singaporean tycoon was jailed and fined for paying an Indonesian man to donate his kidney.Additionally, it must be noted that local Singaporean IVF clinics would require both the recipient couple and egg donor to sign a declaration form stating that the donation is altruistic. Hence the crime of perjury would be committed by signing a false declaration.Option 4: Travel overseas for egg donation at a foreign fertility clinicStepsGet a referral letter from your local Singaporean IVF doctor, together with appropriate medical records, which indicate that you should receive egg donation.Contact a foreign fertility clinic of your choice and book an appointment. Send a soft copy of your referral letter and medical records to the foreign fertility clinic via fax or email.Request the foreign fertility clinic to match you with an appropriate egg donor based on ethnicity, blood group, educational level, and physical characteristics i.e. height and complexion, by providing appropriate details of yourself and your husband. These donors may either be in-house at the foreign fertility clinic itself, or sourced from a foreign egg donor agency.The foreign fertility clinic or egg donor agency will reply to you with an appropriate list of suitable donors. Make your choice of one donor from this list, and inform the foreign fertility clinic and/or egg donor agency of your choice.Ascertain the entire schedule and duration of your IVF treatment with donated eggs, and make appropriate traveling arrangements, together with your husband.Sometimes, it is possible for your husband to travel abroad first to deliver his sperm sample, followed later by you to receive the donated eggs.It may be possible to minimize your stay abroad, by getting your local fertility clinic to co-ordinate with the foreign clinic in synchronizing hormonal injections to prepare your womb to be receptive for the egg donation procedure overseas.AdvantagesThe medical fees of foreign fertility clinics are often much cheaper compared to Singapore.Foreign egg donors are permitted to receive generous financial compensation abroad. As a result, there is a wide choice of egg donors of different ethnicity, physical characteristics and educational attainment available.Some local clinics have collaborative ties with foreign clinics that carry out egg donation. Hence, they would be able to advise you on egg donation overseas, as well as co-ordinate with foreign clinics in synchronizing hormonal injections to prepare your womb to be receptive for the egg donation procedure overseas.Preimplantation Genetic Screening (PGS) of embryos, which is highly restricted in Singapore, is readily available overseas. This might be an important consideration for patients receiving donated eggs, since it is unknown whether the anonymous egg donor is carrying any genetic defects.The use of PGS for embryo sex selection may be permitted in foreign countries.DisadvantagesThere is no government co-funding and you cannot utilize your Central Provident Fund (CPF) for fertility treatment abroad.There is also the hassle and costs of overseas travel and hotel stay, which may be minimized if you choose a fertility clinic in nearby Johor Bahru.Knowing that patients are fearful of unknown genetic defects carried by the anonymous egg donor, foreign fertility clinics often strongly advocate patients to do expensive PGS, instead of recommending cheaper alternatives such as genetic testing of the egg donor’s blood sample, and Non-Invasive Prenatal Testing (NIPT). This is not in the patient’s best interest, and is likely an attempt by foreign fertility clinics to make extra money off Singaporean patients.Option 5: Utilize leftover frozen eggs from a local fertility clinicStepsTell your fertility doctor that you wish to receive leftover spare frozen eggs donated by other patients undergoing IVF at the same clinic. Request to be placed on the waiting list.Be prepared to wait for a very long time, as these are generally extremely scarce.AdvantagesSpare leftover frozen eggs are donated altruistically by other IVF patients who have successfully conceived a child, as a gesture of goodwill and desire to help others.DisadvantagesThese are generally very scarce, but can be obtained from three sources: (i) Single women facing premature menopause or undergoing medical treatment that will damage their fertility such as chemotherapy are allowed to freeze their eggs. (ii) A few married couples undergoing IVF choose to freeze their excess unfertilized eggs instead of embryos for religious or personal reasons, as they view frozen embryos as ‘living entities’ that should not be culled through disposal. (iii) Contingency egg freezing is sometimes performed when the husband is unable to produce a usable sperm sample on the day of egg extraction surgery, for example ejaculation failure due to stress.As expected, patients would use their best quality eggs for their own treatment, so the few frozen leftovers would be of questionable quality.Upon receiving altruistic donation of leftover spare frozen eggs by other patients, be wary of being overcharged high medical fees by the fertility clinic, which could in fact "mask" the sale of the altruistically-donated eggs to you.Take note that fertility doctors persuading former patients to altruistically donate leftover frozen eggs to you face a conflict of interest, because they will be earning additional medical fees by performing the egg donation procedure on you. Moreover, such fertility doctors may manipulate and abuse the doctor-patient fiduciary relationship during the donation consent process, by exploiting their former patient's gratitude to them for successful fertility treatment.TipsCurrently, the most popular option for Singaporean women is to undergo egg donation overseas (most commonly in Malaysia). Not only are the medical fees cheaper, but there is also a much wider choice of egg donors of different ethnicity to choose from. Nevertheless, Singaporean patients should beware of foreign fertility clinics exploiting their fears of unknown genetic defects carried by the anonymous egg donor, to push them to do expensive Preimplantation Genetic Screening (PGS) of embryos. There are much cheaper alternatives to PGS such as genetic testing of the prospective egg donor’s blood sample and NIPT (Non-Invasive Prenatal Testing).WarningsIn the Asian cultural context, bearing a male heir for the family is considered the most important duty of the wife towards her husband and family. As such, a childless woman may be subjected to coercive pressure from her husband and in-laws to undergo egg donation to conceive a child.Emotional distress and identity crisis of the child, upon suddenly and unexpectedly finding out the truth about his/her conception.Risks of accidental incest between half-siblings conceived by the same egg donor , and possibility of Genetic Sexual Attraction.Widespread availability of DNA home-testing kits and associated Genealogy / Ancestry websites, makes it harder to maintain secrecy of the child’s conception.Possible transmission of unknown genetic defects from the egg donor to child. The only information about the family health history of an anonymous egg donor comes from a Questionnaire form that is filled up by the donor herself, and this information is difficult to verify. Foreign fertility clinics often exploit patients’ fears of unknown genetic defects carried by the anonymous egg donor, to push them to do expensive Preimplantation Genetic Screening (PGS) of embryos. Patients should be aware that there are much cheaper alternatives to PGS, such as genetic testing of the donor’s blood sample and NIPT (Non-Invasive Prenatal Testing).Claims that a woman receiving donated eggs passes some of her genes to the child are untrue, and should be viewed as a deceptive marketing gimmick by foreign fertility clinics.