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Rhesus (Rh) D alloimmunization may cause haemolytic disease of the fetus and newborn if the fetal Rh blood type is positive. Although the incidence of severe RhD alloimmunization has decreased with prophylactic anti-D immunoglobulin administration during and after pregnancy, sensitization still occurs in a small group of women. In such women, Rh disease will continue to be significant problem and for their babies who may be affected. Preimplantation genetic diagnosis (PGD) may be utilized to avoid materno-fetal blood group incompatibility in an RhD-sensitized woman. Biopsy of a single cell from early cleavage-stage embryos screening for RhD-negative embryos allows the transfer of only RhD-negative embryo(s) into the uterus. This avoids any complications related to haemolytic disease of the fetus and newborn. This article describes the first reported case of an unaffected pregnancy using PGD for Rh disease. IVF and embryo transfer resulted in a clinical pregnancy and the birth of a healthy girl confirmed to be blood type RhD negative. PGD in couples with a heterozygous RhD-positive male partner provides an option for avoiding haemolytic disease of the newborn in RhD alloimmunized mothers.

To learn why some zygotes remain viable after gene transfer while others lyse, we injected DNA into fertilized eggs and compared those that lysed within 1 h of injection with others that retained a normal appearance. Using scanning electron microscopy, we found open holes on the surface of lysed eggs, indicating failure of the plasma membrane to reseal after microinjection. No holes were seen in unlysed eggs, but many of them had membrane alterations suggestive of healed punctures. We also examined aspects of the gene transfer procedure that might influence survival such as the size of injection pipettes and their taper relative to zygote diameter, possible toxicity of the injection medium, the timing of injection, and immediate vs. delayed pipette withdrawal. The only factors that significantly affected cell viability were pipette size and taper, and timing of injection in relation to first cleavage. This suggests that zygote viability correlates inversely with the size of the hole produced by the injection pipette and that damage to the membrane is less successfully repaired as the fertilized egg readies itself for division.