Introducing the Generation screen
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Simple
- A single tube of blood drawn from the patient;
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Convenient
- Blood can be collected in one of our collection centres from as early as 10 weeks;
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- >99% Accuracy for Trisomy 21, 18 & 13
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Australian
- Your patient’s Generation test is performed in Australia.
(Generation Plus test with microdeletions is performed in California.)
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Reliable
- It has the lowest reported test failure rate of any NIPT (0.1%)6;
- NATA/RCPA accredited
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Fast
- Results for Generation tests are reported 5-7 days from sample collection.
- The Generation Plus test including microdeletions is reported 9-14 days from collection due to sample transport times to California.
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Cost Effective
- The standard Generation test is available at $395*
- Generation Plus including microdeletions, please enquire for pricing.*
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Extended Services
- Exclusively able to be bundled with other advanced scientific services such as cord blood stem cell banking for your baby at birth
*Prices subject to change.
What is Generation?
Generation is a highly efficient, accurate, non-invasive prenatal screening test, based on Whole Genome Sequencing (“WGS”) with proprietary algorithms, that analyses circulating cell-free fetal DNA from a maternal blood sample from as early as 10 weeks gestation.
The clinical utility and benefit of the Generation test has been demonstrated in all pregnant women – regardless of age or risk category – in numerous publications, including studies in the New England Journal of Medicine, as well as reports with cohorts of over 34,000 patients6,7,8,9.
Clinical best practice guidelines from Australian and international medical societies recommend that all pregnant women, regardless of risk status, be offered the opportunity for discussion and choice regarding NIPT and other available prenatal screening and diagnostic tests3,4,5.
The benefits of whole genome sequencing
The benefits of whole genome sequencing
WGS provides precise counts across the genome – this is the basis for the high performance of the Generation test
The Generation NIPT analyses millions of reads from sequencing data across the genome, enhancing the precision and accuracy of the test results.
Unlike other tests that use restricted sequencing techniques, the whole genome sequencing approach generates rich and comprehensive results with more than 99% accuracy for trisomes 21, 18 and 13.
Generation has the lowest reported test failure rate
Generation has the lowest reported test failure rate
* based on local experience
Test failures matter in NIPT, as they increase the risk of false negative and false positive results. There is the potential to increase false negative results if no action is taken following a test failure. A higher rate of aneuploidy in test failure samples also means that there is potentially increased invasive test utilisation for those returning a “high risk” result with other testing modalities.
Test failures also lead to increased turnaround times and clinician visits, with high failure rates demonstrated for redraws from these patients12.
What does the Generation NIPT test for?
What does the Generation NIPT test for?
The Generation NIPT screens for the most commonly seen and tested chromosomal anomalies, including trisomy 21 (Down syndrome), trisomy 18 (Edwards syndrome), trisomy 13 (Patau syndrome) and sex chromosome aneuploidies.
If Generation Plus* is requested, the following list of common microdeletions are also tested for:
- DiGeorge syndrome (22q11.2 deletion syndrome), which is commonly associated with heart defects, cleft palate, immune system disorders and intellectual disabilities.
- Angelman syndrome, which is commonly associated with significant developmental delay and learning disabilities, seizures and hyperactivity.
- Prader-Willi syndrome, which is commonly associated with mild to moderate intellectual disabilities, poor muscle tone and feeding difficulties in infancy that progresses to behaviour issues and compulsive over-eating in childhood.
- Wolf-Hirschhorn syndrome, which is associated with intellectual disability, characteristic facial features, seizures and delayed growth and development.
- Cri-du-chat syndrome, which is associated with intellectual disability, developmental delays, characteristic facial features and a high-pitched, cat-like cry in newborns.
* Please enquire for the cost of Generation Plus. This test option should be considered only when there are specific indications of an increased risk of one of these microdeletion syndromes. Typical clinical indications include, but are not limited to:
- Ultrasound imaging suggestive of a specific microdeletion syndrome.
- Previous history of a pregnancy diagnosed with, or a child affected with, one of these conditions.
This test is not recommended in an unselected/low risk cohort, where the Generation test should be considered instead. It is recommended that testing for microdeletion syndromes is accompanied by specialised genetic counselling.
Generation and Generation Plus NIPT do NOT test for any genetic conditions not listed above, such as rarer chromosome abnormalities, or family specific mutations (such as cystic fibrosis). Testing for these conditions may be available by invasive methods. Please contact us if you require further information about this. Non-genetic conditions (such as neural tube defects) are similarly not tested for by NIPT.
*Prices subject to change
Prenatal prevalence of reported chromosomal abnormalities
Prenatal prevalence of reported chromosomal abnormalities
Generation NIPT detects 84% of Reported Chromosomal Abnormalities
What are the performance characteristics for Generation NIPT?
Who should be offered the Generation NIPT test?
Who should be offered the Generation NIPT test?
Numerous studies have conclusively demonstrated the benefits for NIPT in women with a high risk pregnancy, including:
- Women aged over 35
- Women with abnormal first trimeseter combined biochemical and ultrasound findings
- Women with a family history of chromosomal abnormalities
- Women with a high risk for invasive testing (e.g. IVF)
In addition, clinical best practice guidelines from Australian and international medical societies recommend that all pregnant women, regardless of risk status, be offered the opportunity for discussion and choice regarding NIPT and other available prenatal screening and diagnostic tests.
Although serum biochemical screening with ultrasound is not as accurate as NIPT, patients should still be offered these tests as they are complementary tests which detect a larger range of abnormalities – including neural tube defects and non-genetic abnormalities. NIPT, biochemical testing and ultrasound testing measure different things; the genetic code versus biochemical function and fetal anatomy respectively.
Generation NIPT is a new powerful investigative tool. Pregnancy is an important time for mothers and their fetuses, with tests, results, and recommendations carrying major clinical implications. Before proceeding with testing, it is important that all clinicians understand the purpose and performance of this test, and how to appropriately explain the results to their patients. We require that patients provide written consent ensuring that these issues have been discussed and understood by the patient and clinician.
The Generation Plus test option should be considered only when there are specific indications of an increased risk of one of these microdeletion syndromes. Typical clinical indications include, but are not limited to:
- Ultrasound imaging suggestive of a specific microdeletion syndrome
- Previous history of a pregnancy diagnosed with, or a child affected with, one of these conditions.
This test is not recommended in an unselected/low risk cohort, where the Generation test should be considered instead. It is recommended that testing for microdeletion syndromes is accompanied by specialised genetic counselling.
Appropriate follow-up after NIPT
Appropriate follow up after NIPT
NIPT is an advanced screening test, which is highly accurate. Test results reporting that a chromosomal dosage abnormality is NOT DETECTED (No Aneuploidy detected) are likely to be true negative results and can continue to be followed up as per your practice’s protocols as appropriate for the pregnancy risk category. All test results where a chromosomal dosage abnormality is DETECTED (Aneuploidy detected) should be followed up by an invasive diagnostic test (biopsy for CVS or amniotic fluid sample) for confirmatory diagnostic testing.
Genetic Counselling Options
Genetic Counselling Options
Genomic Diagnostics provides access for patients with an Aneuploidy detected result to a genetic counselling service. The service, provided in conjunction with myDNA Life is available to those patients who receive an Aneuploidy detected result from their Generation or Generation Plus NIPT test (only for T21, T18, T13 and sex chromosome (X,Y) aneuploidy detected results). This is a high quality, free telephone service designed to enable patients to spend time talking to an expert genetic counsellor to answer any questions they may have about the implications of their test results. Further information about the service can be found by downloading the Generation Genetic Counselling Brochure.
For more complex cases such as microdeletion or other genetic conditions other than T21, T18, T13 and sex chromosome (X,Y) aneuploidy detected results, we recommend you contact your state based genetic counselling services. ( www.hgsa.org.au/asgc/find-a-genetic-counsellor )
How do I organise for my patient to be tested?
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Discuss options for prenatal testing, including Generation NIPT with your patient
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Your patient contacts our Customer Care Team on 1800 822 999 to prepay and locate the most convenient collection centre
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Please ask your patient to bring her request form to the blood collection
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The Generation NIPT is performed
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Results are delivered to you via your preferred method
More options for patients
More options for more patients
Generation NIPT provides testing options for more of your patients, including singleton, twin, egg donor and surrogate pregnancies in the first trimester (from 10 weeks). It has been validated for use in both high-risk and low-risk patient populations. Generation Plus NIPT provides additional testing options for microdeletions where clinically indicated. Generation Plus cannot be used in twin pregnancies.
References
1) http://legacy.screening.nhs.uk/fetalanomalies
2) http://www.theguardian.com/society/2016/jan/15/non-invasive-test-for-downs-syndrome-recommended-for-high-risk-women
3) RANZCOG Statement on Prenatal screening and diagnosis of chromosomal and genetic abnormalities in the fetus in pregnancy C-Obs 59. Endorsed by RANZCOG: March 2015
4) ACOG Committee on Practice Bulletins. (2007) ACOG Practice Bulletin No. 77: screening for fetal chromosomal abnormalities. Obstet Gynecol. 109(1):217-227.
5) Society for Maternal-Fetal Medicine (SMFM) Publications Committee. #36: Prenatal aneuploidy screening using cell-free DNA. Am J Obstet Gynecol. 2015; S0002-9378(15)00324-5.
6) Bhatt S. Parsa S, Synder H, et al. Clinical Laboratory Experience with Noninvasive Prenatal testing Update on Clinically Relevant Metrics. ISPD 2014 poster.
7) Bianchi DW, Platt LD, Goldberg JD, et al. Genome-wide fetal aneuploidy detection by maternal plasma DNA sequencing. Obstet Gynecol. 2012; 119:890-901.
8) Futch T, Spinosa J, Bhatt S, et al. Initial clinical laboratory experience in non-invasive prenatal testing for fetal aneuploidy from maternal plasma DNA samples. Prenat Diagn. 2013;33:569-574
9) Bianchi DW, Parker RL, Wentworth J et al. DNA Sequencing versus Standard Prenatal Aneuploidy Screening. N Engl J Med 2014; 370:799-808
10) Zhao C, Tynan J, Ehrich M, et al. Detection of fetal subchromosomal abnormalities by sequencing circulating cell-free DNA from material plasma. Clin Chem. 2015; 61(4):608-16
11) Wong FC, Lo YM. Prenatal Diagnosis Innovation: Genome Sequencing of Maternal Plasma. Annu Rev Med. 2016 Jan 14; 67:419-32.
12) Pergament E, Cuckle H, Zimmermann B, et al. Single-nucleotide polymorphism-based noninvasive prenatal screening in a high-risk and low-risk cohort. Obstet Gynecol. 2014; 124:210-8.
13) Verinata Health, Inc. (2012) Analytical Validation of the verifi Prenatal Test: Enhanced Test Performance for Detecting Trisomies 21, 18 and 13 and the Option for Classification of Sex Chromosome Status. Redwood City, CA.
14) Dar P, Curnow KJ, Gross SJ, et al. Clinical experience and follow-up with large scale single-nucleotide polymorphism-based noninvasive prenatal aneuploidy testing. Am J Obstet Gynecol 2014;211:527.
15) Norton ME, Brar H, Weiss J, et al. Non-Invasive Chromosomal Evaluation (NICE) Study: results of a multicenter prospective cohort study for detection of fetal trisomy 21 and trisomy 18. Am J Obstet Gynecol. 2012; 207(2):137.e1-137.e8.
16) Palomaki GE, Deciu C, Kloza EM, et al. DNA sequencing of maternal plasma reliably identifies trisomy 18 and trisomy 13 as well as Down syndrome: an international collaborative study. Genet Med. 2012. 14:296-305
