Invasive prenatal trio exome sequencing

$3,885.00
Unit price per

For financing options, please see the Financing tab below.

This DNA test is currently available by appointment only. Please contact Merogenomics using link below.

An invasive prenatal trio exome sequencing DNA test assesses all genes within the genomes of the fetus and biological parents towards a diagnosis of any disease that cannot be obtained by other standard medical means.

In order to obtain the DNA testing kit under medical supervision (required), the purchased test includes a bill to be presented at your selected clinic. Test prices can vary between different medical clinics. PATHOGENIC RESULTS WILL REQUIRE A GENETIC COUNSELING SESSION PRIOR TO MEDICAL MANAGEMENT.

Clients will also be given a checklist of topics to facilitate informed consent. Test purchase should take place after consultation with a Merogenomics representative in order for the client to be best prepared for informed consent. Informed consent and education towards its understanding will be required by the clinic. IF YOU HAVE NOT CONSULTED MEROGENOMICS ABOUT YOUR DNA TEST PLEASE BOOK A FREE APPOINTMENT USING THE LINK BELOW PRIOR TO TEST PURCHASE!

All international or Canadian clients in a region without a supported medical clinic, please book a meeting with Merogenomics to discuss the use of your preferred local doctor.

Exome sequencing is the process of decoding the order of nucleotide bases in the DNA of all of the genes in the human genome (less than 2% of the genome, but containing most of the known disease-causing variants), and is currently the most comprehensive gene panel. Variants (changes) observed in the DNA between different individuals afford insight into the variation in specific traits of these individuals. As some traits have an impact on human health, exome sequencing can provide valuable information about human disease that is currently unobtainable or very challenging to obtain by other standard medical means, including more targeted genetic testing. This test is specifically for the diagnosis of an unborn fetus and also includes the exome sequencing of both biological parents. Test prices can vary between different medical clinics. Volume discounts available.

Exome sequencing provides the overview of alterations in an individual’s DNA code in all of the genes found in the human genome
This test is used for clinical purposes and should not be regarded as investigational or for research
The test must be ordered by a medical doctor who will oversee the clinical report based on the DNA sequence interpretation
The test is for a pregnant woman with an indication of a suspected genetic condition affecting the fetus based on prior test results and supporting family medical history. The test requires an invasive procedure to collect amniotic fluid in order to obtain fetal DNA. Amniocentesis carries a small but real risk of pregnancy loss
The test also required blood or saliva samples from both of the biological parents of the affected fetus, and the DNA sequencing results are interpreted as a family. The data is analyzed to identify differences and similarities in DNA between the parents and the fetus in a bid to discover the genetic causes of the condition affecting the fetus and to determine potential medical management changes prior to or post birth. The trio test option provides a 2x higher detection rate than proband patient only
Accurate assignment of family relationships is necessary for the successful analysis of the family prenatal trio exome sequencing. The biological relationship between submitted family samples will be assessed to ensure that the parental relations were correctly identified. If a discrepancy is identified (for example, the father of the fetus is not the biological father), the ordering physician will be notified and the prenatal trio full exome sequencing will be cancelled
The purpose of the test is to determine if a genetic diagnosis can be uncovered, leading to a condition diagnosis and potential medical management changes
Suspected conditions compatible with exome sequencing include:
- Congenital anomalies
- Developmental delay
- A previous family history or family consanguinity with positive screening results
This test does not provide secondary findings unrelated to the condition being diagnosed unless further requested by the ordering physician. This test does not provide pharmacogenetic information. The test does not provide information on traits that are not medically relevant, such as eye color, fitness performance, and tasting. The test does not analyze ancestry
This test is not for individuals interested in proactively screening the fetus for health predispositions and no such test is offered by Merogenomics. Please refer to the "DNA Tests for health risks" section for a screening test that can be used post-natally
Anonymized patient/client clinically-relevant information will be included in public databases to help with the future medical analysis of human genomes. Databases contain cumulative results from around the world and do not include information that can personally identify the patient/client
The test might not provide a diagnosis if either the causes of the condition are not genetic in nature, or the causative variant is not identified. Even with a successful DNA diagnosis, it is possible that the information might not help in predicting a prognosis or change medical management or the treatment of the disease
The test can be paid for directly by the patient/client. Insurance billing is available and can be investigated up-front to determine out-of-pocket expenses. Institutional billing is also available for organizations that prefer to bill patients/clients directly

Merogenomics provides background education towards patient/client informed consent
The collection kit can be for a saliva or a blood sample for both biological parents, with prepaid shipping included. The amniotic fluid sample (20 mL) is shipped by the collection clinic using a sterile container
Services are fully insured, and are HIPAA, CLIA and CAP compliant
The test will provide the DNA code of nearly the entire exome (all of the genes in the human genome, or 2% of the genome), using the current best sequencing systems, stored on cloud for the patient/client by the company
The results are available within 3-4 weeks
A concise clinical report signed by a medical geneticist is delivered to the ordering doctor only, and then subsequently discussed and shared with the patient/client
The report will include primary findings that are directly related to the cause of the disease for the fetus. No further analysis of the exome is done
Secondary findings unrelated to the medical condition but which might impact the fetus’ health can be reported for the client if requested by the ordering physician. It includes findings in a set of 59 genes as recommended by the American College of Medical Geneticists (ACMG) for incidental findings, excluding adult-onset conditions. This is a list of genes that are linked to different disease developments for which intervention or disease treatment options are available
This test is available as early as 11 weeks into the gestation period
The decoding and interpretation of the exome is done utilizing industry gold-standard tools and databases, which also include proprietary systems developed in-house – one of the key determining factors of test quality for medical use
Previous medical information of the fetus/family already collected by the ordering physician will be incorporated into the analysis
Follow-up management will be suggested based on the patient’s diagnosis and available medical history
The databases used for DNA sequence interpretation are regularly updated, and novel findings pertaining to currently unknown variants identified in a patient/client will be delivered to the ordering physician who will be continuously notified for the duration of the DNA’s data storage by the company

To obtain or confirm a diagnosis when other standard testing methods fail to provide a clear answer. A diagnosis is made for DNA variants considered strong causal candidates for a genetic disorder, or variants associated with increased disease risks. Studies show that the sequencing approach often leads to a diagnosis more quickly and with lower overall costs than other methods, with exome sequencing being 2-3 times more likely to identify the underlying cause of a patient’s genetic disease than traditional approaches
The diagnosis can provide the possibility of guiding or influencing medical care management as follows:
- Treatment of the already existing condition prior to and/or post birth
- The patient can potentially be released from unnecessary clinical surveillance including potentially invasive diagnostic procedures
- Interventions could be made to prevent the worsening of the condition from developing prior to and/or post birth
- Preparation for the outcomes can be addressed, whether through education, preparation for delivery complications, or by seeking clinical trials post birth
The diagnosis might influence the considerations of additional family members regarding testing, or affect reproductive decisions to avoid passing the same DNA alterations to future offspring
The patient/client data is securely stored on cloud for subsequent re-analysis. Data is never sold, or shared with any third-parties unless specifically requested by patient/client. Such data sharing will require a separate consent form to be signed by the patient/client in addition to the one that is signed to obtain the test
The entire process closely follows the Canadian and American guidelines, therefore there is a high level of proper accountability for the clinic
The test offers a diagnostic success rate of up to nearly 40%

An invasive procedure is required to obtain a sample for fetus diagnostic DNA sequencing. Such procedures carry the risk of pregnancy loss, estimated at 0.11% for amniocentesis and 0.22% for chorionic villi sampling
Biological sample quality can influence the scope and quality of the final decoded DNA sequence data, and therefore its interpretation
It is never possible to guarantee that every DNA change in the exome will be found, therefore a negative result cannot rule out the possibility that the patient carries an unexamined mutation
Certain alterations/variants might not be identified due to the presence of highly homologous pseudogenes (inactive genes that are highly similar in sequence to active genes), or other confounding factors such as bone marrow transplantation, a blood transfusion or mosaicism (the presence of different variants in a subset of cells in an individual)
The limitations of the sequencing technology does not allow for the uncovering of large structural changes within the exome, and might require additional technologies in order to be achieved. Exome sequencing typically focuses on the small sequence alterations and might have a limited scope in the analysis of the gross alterations (such as a segment of a chromosome inverting or moving to a new location)
False positive results can occur and all clinically relevant identified alterations are recommended to be validated by separate technology
Each patient/client will present their own unique read depth distribution across the exome. About 5% of the exome will be sequenced with a read depth considered not sufficient enough to make a statistically confident call about the observed DNA sequence
The test does not detect alterations which are not caused by a change in the DNA sequence, such as gene expression, epigenetic modifications, fusion, chromosome conformational changes, X-linked recessive mutations in females who manifest disease due to skewed X-inactivation
The interpretation will be limited to the current state of scientific knowledge of how DNA changes lead to a disease. This scientific knowledge can also contain mistakes
Samples cannot be accepted if the patient/client has undergone an allogenic transplant such as bone marrow or a peripheral stem cell transplantion. A history of hematological disease might exclude test availability in certain circumstances. Contact Merogenomics to discuss potential alternatives
Psychological consequences can be severe with high risk individuals and patients/clients should be screened prior to testing
The test does not consider somatic alterations (non-inherited DNA changes acquired post-birth throughout one’s lifetime)
The test has not been cleared or approved by the US Food and Drug Administration. The FDA does not require this test to go through a premarket FDA review

All tests offered through Merogenomics require a physician to sign a test requisition for regulatory compliance reasons. Once the requisition form is signed by the doctor, the ordering doctor does not have to participate in the process until the receipt of the test results
Merogenomics can provide detailed background information to the ordering physician on the test process. Merogenomics also provides additional education towards patient/client informed consent
The test is for a pregnant woman with an affected fetus based on a prior examination with no clear clinical diagnosis but with ruled out suspect environmental factors as a reason of the observed condition. The purpose of the test is to determine if a genetic basis of the condition affecting the fetus can be uncovered, leading to a diagnosis and potential medical management changes or pregnancy length
Suspected conditions compatible with exome sequencing include:
- Congenital anomalies
- Developmental delay
- A previous family history or family consanguinity with positive screening results
The test results should be interpreted in context with any other available fetus/family clinical findings
It is recommended by sequencing guidelines that the patient/client undergoes genetic counseling prior to and after clinical DNA testing
The DNA sequencing and interpretation takes place in a CLIA/CAP certified laboratory
Patient data is HIPAA compliant, securely stored on cloud for continuous re-analysis, and never sold or shared with third-party companies
The ordering physician will be the recipient of the exome sequencing analysis clinical report. The client will not obtain these results independent of the ordering physician. Merogenomics will not have access to the patient/client report, but can review the report after the receipt of the data if requested by the client
The report is designed with doctors in mind and will be divided into the following sections:
- The first page will have a condensed summary listing all of the clinically relevant results as follows:
  - Pathogenic or likely pathogenic results – the information requiring the utmost attention spanning the entire genome
  - ACMG 59 status – the 59 genes tied to the clinical conditions most strongly recommended by the American College of Medical Genetics and Genomics guidelines to be reported to patients if they are affected and should be requested to be analyzed
  - Variants of unknown significance – DNA changes currently without evidence of clinical impact
  - Structural variants – large scale DNA changes such as gross deletions or duplications
  - A summary of the results and interpretation
- The final pages are devoted to the methods of testing and the limitations of the procedure
Automated periodic reanalysis of unsolved cases. The ordering physician is notified if any new findings related to the case arise
Samples cannot be accepted if the client has undergone an allogenic transplant such as bone marrow or a peripheral stem cell transplant. A history of hematological disease might exclude test availability in certain circumstances
For cancer patients undergoing chemotherapy treatment, the DNA quality may be affected if patient has received treatment in the past 120 days, potentially requiring sample resubmission

The DNA sample is prepared using IDT xGen Exome Panel hybridization capture PCR-amplified Library and sequenced using Illumina HiSeq or NextSeq System at 2X150 read length, with >95% of the exome mappable coverage at >20X, and ~92% of characterized Mendelian disease genes fully covered at >20X
State of the art bioinformatics tools are used for alignment and variant calling
Proprietary methods identify and analyze the following types of variants:
- Small sequence changes:
  - Single nucleotide variants (SNVs, alterations that affect only one nucleotide at a time, also termed single nucleotide polymorphisms or SNPs)
  - Insertions and deletions (indels under 50 bp)
- Variants are classified as pathogenic, likely pathogenic, or of unknown significance according to the established guidelines by the American College of Medical Genetics and Genomics /Association for Molecular Pathology from 2015 (Richards S et al. 2015. Genet Med 17(5): 405–424)
- Best-in-class public and commercial databases and tools used for annotations: HGMD, dbSNP, 1000 Genomes Project, HapMap data and an online search engine
Maternal cell contamination analysis is performed on the amniotic sample

Expedited results are available within 8-14 days for an additional cost
A companion chromosomal microarray test can be added for an additional cost to help identify structural variants (DNA alterations that affect large segments of DNA of more than 50 bp, and can include insertions, deletions, or copy number variations or CNVs: the duplication of a particular DNA segment), that are not captured by the exome sequencing test
A companion mitochondrial DNA analysis can be added for an additional cost
Exome sequencing raw data (FASTQ, BAM and/or VCF), only can be requested without analysis, with or without a filtered variant list. Contact Merogenomics for more details
Extracted genomic DNA can also be submitted for sequencing, when it is isolated from a CLIA-certified laboratory or equivalent. Contact Merogenomics to discuss additional alternatives
Volume discounts are available. Contact Merogenomics for more details

Clinical DNA testing is not a simple straight-forward process compared to commercial, direct-to-physician genetic testing. As a consequence, there are stringent guidelines and criteria that need to be fulfilled in order to ensure that the results of the test, as well as the managing parties involved, are all compliant for subsequent medical oversight.

The client/patient has a consultation with Merogenomics to fully understand informed consent for Clinical DNA testing.
All DNA tests promoted by Merogenomics require a doctor to sign a test order. The client/patient can select one of the clinics for DNA testing. This selection allows for online test purchase. Alternatively, any physician can order the test for a client. Merogenomics can provide background about the desired test to any physician interested in signing the test requisition form. For independent doctors, you will need to book a FREE consultation.
The client picks the DNA test of choice offered by the selected clinic. Alternatively, any DNA test can be selected if ordered by independent doctor.
The client/patient will have the option to purchase the test in full or apply for financing. An invoice is issued to the patient on behalf of an ordering doctor/clinic, allowing the patient to proceed to a clinic to receive the DNA test kit. The DNA test kit can only be obtained upon proof of payment.
For independent doctor orders, the invoice can be issued from the DNA test provider.
The doctor must sign the test requisition form. The ordering doctor is also the doctor who will receive the DNA test results.
The biological sample containing the client/patient’s DNA must be collected (blood or saliva, depending on DNA test).
For blood collection, the blood will be either collected at the clinic of the ordering physician, or at an independent blood collection clinic.
The DNA test kit can be sent by either of the clinics. Sending through an independent blood collection clinic might require extra fee.
The DNA test kit is received by the test service provider. DNA is isolated from the biological sample, checked for quality and sequenced. The DNA code is analyzed for medical interpretation and a report is generated. The ordering physician can then have access to a clinical interpretation of the DNA code.
The report is provided to the ordering physician for medical management consideration. The client/patient can only obtain the results from the ordering physician.
Pathogenic results will require interpretation oversight by a genetic counsellor prior to medical action.
The client/patient can choose either public or private genetic counselling access.
The ordering physician determines medical management of the client/patient.

Purchase of the test can be refunded within 30-days of issued invoice date minus $50 processing fee to cover the costs associated with testing kit (even if the kit was not used by the customer). A refund is not available once the sample has been obtained by the laboratory and DNA testing has commenced.

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Merogenomics is collaborating with a third party institution, Blue Finance, to provide access for eligible customers to convenient, monthly payment options. Contact Merogenomics for more information.

Below are examples of possible monthly payment options for specified duration terms.

Payment options for 12 month term

DNA test cost	Monthly payment
$699	$65
$799	$85

Payment options for 24 month term

DNA test cost	Monthly payment
$2,499	$127
$3,749	$190
$4,099	$208
$5,199	$264
$7,399	$376

Invasive prenatal trio exome sequencing

Dr. Denis Vincent Clinic

Preventous Collaborative Health

Summerwood Medical Centre