PRENATAL DIAGNOSIS Prenat Diagn 2008; 28: 828–832. Published online 25 July 2008 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/pd.2067 Acceptance of preimplantation genetic diagnosis for β -thalassemia in Lebanese women with previously affected children Chantal Farra 1,2 , Anwar H. Nassar 3 *, Ihab M. Usta 3 , Pascale Salameh 1 , Mirna Souaid 1 and Johnny Awwad 3 1 Genetics Laboratories, Chronic Care Center, Hazmieh, Lebanon 2 Department of Laboratory Medicine and Cytogenetics, American University of Beirut Medical Center, Beirut, Lebanon 3 Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon Objective The aim of the study was to assess the rate of acceptance of preimplantation genetic diagnosis (PGD) as an alternative to prenatal diagnosis in Lebanese women with previously affected children with homozygous β -thalassemia. Methods Women with a previously affected child attending a nongovernmentally funded thalassemia care center between 1 June 2005 and 31 May 2007 were offered a genetic counseling session. This was followed by administering a questionnaire through direct interview. Results All 97 women approached accepted to participate in the study (100% response rate). Sixty eight per cent of women considered PGD a better alternative to prenatal diagnosis. The most important perceived advantage of PGD was the avoidance of termination of an affected pregnancy. Conclusions PGD is an acceptable alternative to conventional prenatal diagnosis in women at risk of conceiving a child affected with β -thalassemia. This is particularly true in countries of the Middle-East where therapeutic abortions for fetal indications are prohibited by the law and religion. Copyright  2008 John Wiley & Sons, Ltd. KEY WORDS: β -thalassemia; attitudes; preimplantation genetic diagnosis; prenatal diagnosis; termination of pregnancy INTRODUCTION Hemoglobin disorders are the most common mono- genic diseases requiring prenatal diagnosis. Affected individuals with β -thalassemia in particular exhibit pro- found chronic anemia necessitating life-long blood trans- fusion and expensive chelating agents. Until several years ago, prenatal diagnosis was the only way of predicting the birth of an affected child for couples at risk of transmitting thalassemia. Other reproductive choices include accepting an affected child, terminat- ing an affected pregnancy, accepting gamete donation, adoption, or remaining childless (Fletcher, 1988). Pre- natal diagnosis involves DNA analysis of fetal cells obtained by chorionic villus sampling in the late first trimester or by amniocentesis in the second trimester of pregnancy (Chan et al., 1997). As a result, couples often face considerable stress and anxiety linked to the procedure-related complications such as pregnancy loss, the waiting time to obtain the final molecular diagno- sis, and the difficult decision of terminating an affected pregnancy. Even worse, couples are aware that such dilemma may have to be faced repeatedly with every consecutive pregnancy (Soussis et al., 1996). Because the psychological implications of pregnancy termination *Correspondence to: Anwar H. Nassar, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon. E-mail: an21@aub.edu.lb can be enormous and the grief experienced can be com- parable to neonatal death (Kenyon, 1988), the concept of preimplantation genetic diagnosis (PGD) was introduced offering the advantage of selecting unaffected embryos prior to conception. The diagnosis of single-gene disorders in human preimplantation embryos was first introduced in 1989 (Handyside et al., 1989). Patient acceptability is one crucial determinant of PGD value and of its ultimate use- fulness as an alternative to prenatal diagnosis in couples at risk of transmitting β -thalassemia to their children. A number of studies have examined the acceptability of PGD for single-gene defects and found significant disparity in attitudes amongst different populations and cultures investigated (Pergament, 1991; Miedzybrodzka et al., 1993; Palomba et al., 1994; Chamayou et al., 1998; Alkuraya and Kilani, 2001; Hui et al., 2002; Lav- ery et al., 2002; Alsulaiman and Hewison, 2006). The extent to which PGD is acceptable to the Lebanese population remains as yet unexplored. As cultural, reli- gious, and legal considerations play a decisive role in a couple’s reproductive choices, we sought to investi- gate the acceptance rate of Lebanese women who have already given birth to an affected child with homozygous β -thalassemia for PGD and to explore the motivating factors behind their attitudes. We, therefore, report the findings of a survey designed to assess whether PGD is an acceptable alternative to prenatal diagnosis in these women. Copyright  2008 John Wiley & Sons, Ltd. Received: 30 April 2008 Accepted: 27 June 2008 Published online: 25 July 2008