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Are NIPT tests not the same everywhere? How to choose a hospital or facility

Are NIPT tests not the same everywhere? How to choose a hospital or facility

This article is about how to choose a hospital or facility. How do I find a place to do an examination?
You may think, "It's the same NIPT test, so it's the same everywhere," but each hospital or facility has different support and features.

NIPT (New Prenatal Test) has been available in Japan since 2013, and the number of tests has been increasing every year, with approximately 8,000 tests performed in 2013 and 13,000 in 2016.

The number of hospitals and facilities implementing the program has similarly continued to grow and will continue to grow as demand increases.

However, as the number of hospitals and facilities continues to grow, it is difficult to know where to perform the tests.

No one wants to go through an important test that they regret, one that could change their future.

How do I find a place to inspect?

Why choose a hospital or facility?

You may think, "It's the same NIPT test, so it's the same everywhere," but each hospital or facility has different support and features.

The most obvious difference is the price of the test. Even the same NIPT test can cost close to 80,000 to 100,000 yen at different hospitals.

Of course, there are reasons for the difference in fees, but looking at the amounts alone, one would question the difference in fees.

There are also differences in support from one hospital to another. Some facilities do not have specialized clinical geneticists on staff, and there are stories of unfriendly genetic counseling.

This is not to say that there are no good facilities, but it is necessary to choose a hospital or facility where you can feel comfortable, where things that are difficult to understand are explained in detail, and where friendly consultation is provided in the event of a positive test result.

Licensed and unlicensed facilities

There are both licensed and unlicensed facilities that offer NIPT testing.

An accredited facility is one that has been approved for NIPT testing by the Japanese Federation of Medical Societies, while an unaccredited facility is one that is not accredited by the Japanese Federation of Medical Societies.

Unlicensed facilities are characterized by fewer restrictions for testing. Licensed facilities must meet one of the requirements to perform NIPT testing.

  1. Fetal ultrasound shows a positive test for chromosomal abnormalities in the fetus
  2. Maternal serum marker test positive for chromosomal abnormalities in the fetus
  3. If you have previously given birth to a child with a chromosomal abnormality
  4. If both parents have an equilibrium Robertson translocation and there is a possibility of a chromosomal abnormality due to heredity

However, at unlicensed clinics that are not within the framework approved by the Japanese Federation of Medical Societies, there is no need to worry about the conditions, and all pregnant women who wish to undergo NIPT testing can take the test.

Another feature is the lower inspection fees. The reasons for the difference in fees described above can mainly be attributed to the difference between licensed and unlicensed facilities.

However, while it is convenient, it is also inconvenient. Some unlicensed facilities only offer the NIPT test, and if the NIPT result is positive, you may have to make your own appointment for amniocentesis, which is the definitive diagnosis.

Of course, there are some facilities that provide hospital referrals or subsidized amniocentesis, but either way, it is a hassle compared to a licensed facility where amniocentesis and other support services are available at the time of a positive result.

Because a series of tests not performed at the same facility can delay response in case of emergency, the Japanese Federation of Medical Societies recommends that tests be performed at an accredited facility.

Although broadly defined, licensed facilities are more supportive. Unlicensed facilities are less expensive and easier to inspect. This will help you to choose the best one for you.

Different facilities can perform different tests.

Licensed and unlicensed facilities differ in the tests they can perform.

Licensed facilities can only perform 13, 18, and 21 trisomy tests, while unlicensed facilities can perform more tests than licensed facilities, including microdeletion and whole chromosome tests, in addition to 13, 18, and 21 trisomy tests.

This is because the content of inspections is determined by the guidelines of the Japanese Federation of Medical Societies. Since licensed facilities belong to the framework of the Japan Federation of Medical Societies, they are not allowed to conduct inspections on their own.

On the other hand, unlicensed facilities are able to perform NIPT testing as well as other tests such as whole-chromosome testing if the user so desires. This is because many of them use overseas testing companies and are not required to follow the guidelines of the Japanese Federation of Medical Societies.

In addition to 13, 18, and 21 trisomies, other chromosomal abnormalities include Klinefelter syndrome and Turner syndrome due to sex chromosome abnormalities, and reciprocal translocations and Robertson translocations due to chromosomal translocations.

Although the occurrence of other chromosomal abnormalities is lower than that of 13, 18, and 21 trisomies, it is not an abnormality to be taken lightly.

If you want to check for anything other than 13, 18, and 21 trisomies, you should see an unlicensed facility.

How to choose a hospital or facility

The following is an overview of how to choose a hospital or facility. This is only an example, but we hope you will find it helpful in making your choice.

Response to Positive

The most important aspect of the NIPT test is the "response to a positive".

If it is positive, an amniocentesis is necessary to make a definite diagnosis, but when this happens, the fact that it is positive can cause anxiety, and the woman may not know what to do. You may have a hard time deciding whether or not to have an abortion.

At such times, it is the licensed facility that will provide counseling and support. They will not only provide genetic counseling, but also help you with things that you may not know or be worried about, such as amniocentesis and arrangements for abortion procedures.

In the case of unlicensed facilities that cannot prepare for amniocentesis or abortion procedures, or that do not have a specialized clinical geneticist on staff, you must do everything yourself, including finding a hospital that can.

If it is negative, there is no problem, but in case it is positive, choose a facility that offers amniocentesis, genetic counseling, and other support services.

word of mouth

Even if the support is introduced as excellent, you will not know much about it until you actually experience it. Many times, exaggerations are made, and you may find that "it was different from what you imagined.

To avoid such a situation, it is very important to gather information in advance.

Many of the reviews are based on personal experiences. You can learn more about the actual content, the atmosphere of the facility, and the response of the doctors, which will help you choose the right one.

Choose an institution that has many quality reviews and is trustworthy and reliable.

However, not all reviews are correct. Different people feel differently and may feel that they are different from the evaluations.

Please keep in mind that different doctors in charge may have different evaluations, so please keep this as a reference only.

cost

The NIPT test fee varies greatly from facility to facility: some facilities charge around 90,000 yen for the test, while others charge more than 200,000 yen.

There are a lot of costs involved during pregnancy, and we want to save money for after the baby is born. If it is the same NIPT test, it is common to want to have the test done as inexpensively as possible.

Since this is the easiest place to compare, you may want to start with the cost.

However, in exchange for lower costs, there may be no genetic counseling or support in the event of a positive result.

Do not choose a facility just because it is inexpensive; check the contents before choosing a facility.

convenience

No matter how good a facility's reputation is by word of mouth, it is difficult to come to a clinic in a location with poor transportation access. Long travel times are hard on pregnant women, and they may become ill on the way.

We do not recommend that you go to a place that is far from the station, or even an hour away by car.

Unless you have a special reason, choose a local facility that is close to the station.

Differences by Inspection Company

The differences in NIPT vary not only among hospitals and facilities, but also among testing companies.

In many cases, the specimens are not tested at the facility that performed the NIPT, but are outsourced to an outside company, such as Verinata Health in the United States.

Just as different hospitals can be good or bad, different testing companies can be good or bad. Not to be rude, but the accuracy of the test may vary from one testing company to another. If the accuracy is low, the possibility of a false positive test when the test should be negative is high, and an amniocentesis, which is a definitive diagnosis, may be necessary.

Amniocentesis is a test that has a 0.3% chance of miscarriage; with a 1 in 300 chance of miscarriage, it is a test that should be avoided if unnecessary. A highly accurate test reduces the likelihood of amniocentesis, which in turn reduces the risk of miscarriage.

Outsourcing the testing also means that the time it takes to get the results is different. Verinata Health is a proven company, but it takes time to ship overseas. On the other hand, a domestic testing company will have a shorter transit time and will give you the results sooner. Depending on the testing company, the difference can be nearly a week.

It would be nice if we could confirm this information in advance, as we do with hospitals and facilities, but information is generally not publicly available and is not known. Therefore, we can only refer to word of mouth and referral sites.

Of course, there is no testing company that you should "definitely not" or "cannot trust," but we recommend that you also look into information about the testing company to get as much negative reassurance as possible.

NIPT begins at the point of selection.

Not all NIPT laboratories are the same. Support varies, and you must choose the right one for you.

Some of those who were examined had regrets because of inadequate explanations.

Please do not think, "I don't care where I go," but rather, do your research thoroughly and have a NIPT test that you will not regret.

References