What is Anora?
Anora is a genetic test that is performed on tissue from a pregnancy that has been miscarried. More than half of all miscarriages are caused by a chromosome abnormality (too much or too little genetic information). Anora uses advanced SNP microarray technology to look for these types of chromosome abnormalities. One of the important differences of the Anora test is that it compares genetic markers from the mother with genetic markers from the fetus if a blood sample from the mother is sent with the tissue. A common cause of inaccurate results from other miscarriage tests is that tissue from the mother is tested rather than tissue from the fetus. As long as the laboratory receives a blood sample from the mother, Anora makes sure that the tissue tested is fetal in origin.
Who should have miscarriage testing?
Miscarriage chromosome testing can be helpful if you:
- Would like to know if a miscarriage was caused by a chromosome abnormality
- Have had more than one miscarriage (although your doctor can order Anora with the first loss)
- Have had a child or previous pregnancy with a chromosome abnormality
The choice to have chromosome testing after a miscarriage is very personal. Although not all doctors will recommend chromosome testing for a pregnancy loss, it can be helpful for couples who have a miscarriage and want to know the cause.
When should I do Anora miscarriage testing?
Chromosome testing is usually done at the time that the miscarriage occurs. Tissue from the pregnancy (also called the products of conception) can be collected at the time of a D&C procedure or can be collected at home after spontaneous loss of a pregnancy. Testing may be possible on prior miscarriages if the tissue has been saved in paraffin. This type of testing may be helpful to patients who have had more than one pregnancy loss. Check with your doctor to see if a sample from a prior miscarriage has been saved.
What if I have a family history of genetic disease?
Most genetic diseases that run in a family are caused by changes within individual genes and not missing or extra chromosome material. Anora is not able to test for specific single gene disorders. You should discuss your family history with your doctor or a local genetic counselor to find out if other types of genetic testing are available to better understand your family history. One exception to this is chromosomal rearrangements, which can sometimes run in a family. It is estimated that about 1 in 500 people have the correct amount of genetic information, but it is arranged in a different way (called a balanced translocation or inversion). A carrier of a balanced rearrangement is healthy, but may be at increased risk for miscarriage or children with chromosome abnormalities. Anora can provide helpful information that indicates a parent may be a balanced translocation or inversion carrier.
What if I have miscarried before?
Miscarriage, although very difficult, is common. It is estimated that about 1 out of every 5 pregnancies ends in a miscarriage. Random chromosome abnormalities are found in about half of all miscarriages. The chance of having a second miscarriage is typically not increased after one loss. If this is your second loss, you may be at higher risk to miscarry in the future. You may want to discuss further testing, including Anora, with your doctor to help determine if chromosome abnormalities could be the cause for pregnancy loss.
My test results found a chromosome abnormality, what do I do next?
If a chromosome abnormality is found, further testing may or may not be indicated. Your doctor will know the next best steps for you.
Most chromosome abnormalities found through miscarriage tests like Anora are NOT inherited; they are the result of random chromosome errors that occur around the time a baby is conceived. These errors do happen more commonly as mothers get older. The specific type of abnormality found through Anora can assist your healthcare provider in determining whether you or your partner might carry a balanced translocation. Your healthcare provider will review the results and discuss whether to pursue a blood test from you or your partner to rule out a balance rearrangement. Carriers of balanced translocations may be at higher risk to have a miscarriage or to have a child with too much or too little genetic information.
What are the benefits of Anora?
Many couples struggle when experiencing a miscarriage; they wonder if they somehow caused the miscarriage to happen. Knowing that a miscarriage was caused by a random chromosome abnormality may help you and your partner begin to heal from the loss of a pregnancy. You may wonder what the chances are of another miscarriage. Chances are low that a random chromosome abnormality will recur. Anora miscarriage testing may give you answers to these, and other questions. If a random type of chromosome abnormality is found, it may mean that other costly medical tests can be avoided.
Anora uses an advanced method of chromosome testing called Single Nucleotide Polymorphism (SNP) microarray and can detect more types of chromosome problems than other miscarriage testing methods.
How do I request Anora from my doctor?
Let your doctor know that you have heard of a test called “Anora” that can look to see if your miscarriage was due to a chromosomal abnormality in the fetus. If they are not familiar with the test and would like to learn more, direct them here or have them contact Natera to order a kit at 1-844-707-4618.
What type of sample do I submit?
Your doctor will submit the sample unless you are collecting the sample at home. For instructions for at-home collection, please click here. We suggest that a sample of your blood (tube is provided in the Anora kit) be sent along with the tissue for the most comprehensive results.
How long do results take to get back to me?
Results are typically returned to your doctor within one week of sample receipt.
How will I know my results are available?
Your doctor will contact you to let you know your results.
Who can I talk to about my Anora Miscarriage test results?
In addition to speaking to your doctor, you are welcome to speak to one of Natera’s board-certified genetic counselors for a complementary information session before or after the test. You can schedule an information session by clicking here.
What is the cost of Anora?
The cost of Anora is based on your insurance coverage. To understand your financial responsibility, please call Natera at 877-869-3052. You may be eligible for a payment plan and/or assistance for financial hardship*.
*Not everyone may qualify. Void where prohibited.
Does my insurance cover Anora?
Insurance coverage for Anora is contingent on your health insurance plan and coverage benefits. Please call Natera at 877-869-3052 in order to verify and check your insurance coverage options.
How do I pay my bill?
Please call Natera at 877-869-3052 in order to settle your balance.
What is an EOB and what amount will it include?
An EOB is NOT a bill. EOB stands for Explanation of Benefits and describes how your insurance plan pays for your test and if there is any additional amount that you may be responsible for. The EOB typically precedes your bill. If you have any questions about your EOB, please call a Natera billing specialist at 877-869-3052.
What is an insurance deductible?
Your insurance deductible is the amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $2,000, you will need to pay $2,000 out of pocket before your insurance begins to cover your health care expenses. If you have not met your deductible by the time you have Anora, you may be required to pay some expenses out of pocket.
How do I begin offering Anora in my practice?
What type of sample should I send?
To run a successful Anora test, acceptable tissue includes chorionic villi, gestational sac, fetal skin/tissue, umbilical cord tissue, and cytogenetic tissue cell pellets. We recommend that a blood sample from the mother be sent with the tissue so that maternal cell contamination studies can be performed simultaneously. Paraffin POC testing is also available on either paraffin blocks or slides. Both parental samples (maternal and paternal) are required for paraffin testing. Please contact Natera at 650-249-9090 for more information on paraffin testing.
How long should samples be stored before shipping and how should they be sent?
Tissue and patient samples should be shipped to Natera as soon as possible. Tissue samples should be stored in the refrigerator overnight until the next possible shipping day. The blood tube (purple top tube) can be stored in the refrigerator for up to seven days. If a blood sample cannot be obtained from the mother, the option of a buccal (cheek) swab is also available. A buccal swab can be stored in the refrigerator for up to 72 hours.
How long does it take to get my patient's results?
Results are typically returned to you within one week of sample receipt.
How can I contact a board-certified genetic counselor if I have questions about a patient result?
Board-certified genetic counselors are available to answer questions about Anora Monday through Friday, 6 AM to 5 PM Pacific Time, excluding holidays. Please call 650-249-9092 and ask to speak with the on-call genetic counselor. You may also email email@example.com with questions.