Once informed of one’s genetic risks, the idealized representation of pregnancy dissipates. The information that a genetic risk exists and the availability of genetic testing or screening may increase the social pressure to seriously consider and apply for screening (van Elderen et al. 2010). The psychosocial impact of genetic risk and carriership Regardless of whether preconception screening for certain autosomal recessive disorders is implemented, couples may be confronted with a genetic risk during PCC based on their family history. Couples who attend the Clinical Genetics department are anticipating

learning about HKI-272 order their genetic risk, whereas learning about an increased genetic risk during PCC may catch couples by surprise. Studies evaluating the psychological impact of PCC are scarce. The few studies that were conducted expected PCC to elicit anxiety; however, it was found that anxiety levels did not increase after preconception Raf inhibitor counselling (de Weerd et al. 2001; De Jong-Potjer et al. 2006), and in this website contrast, some subgroups experienced a decline in anxiety after preconception counselling. In Clinical Genetics, more research has focused on the psychological impact of genetic risk and carriership. Various modes of inheritance also present

with a variety of psychosocial issues that may be relevant in aiding couples deciding about engaging in further genetic testing. Furthermore, depending upon the mode of inheritance, different reproductive options may apply that each have differing psychological challenges. The PCC counsellor should be aware about these issues to adequately prepare couples for the decisions and implications that may follow genetic screening or testing. In case of a balanced chromosomal rearrangement (e.g. translocation, inversion)

Olopatadine in the family, couples may present for carriership testing. These couples may be referred for PCC after recurrent miscarriage or a previous affected child (due to an unbalanced chromosomal rearrangement). Depending on the type of balanced chromosomal rearrangement in the parent, recurrence risk for an unbalanced chromosomal rearrangement in the offspring may be lower or higher (McKinlay Gardner and Sutherland 2004). It is our experience that some couples with recurrent miscarriage and couples with a previous child with a de novo unbalanced chromosomal rearrangement may hesitate about prenatal diagnosis (PND) due to the (small) miscarriage risk of invasive prenatal diagnosis. Some of them express the wish to perform advanced ultrasound examination, which is not the golden standard for chromosomal aberrations. In addition, women with a high recurrence risk of miscarriage may experience high levels of anxiety (Vansenne et al. 2011).