Can the harmony test give conflicting results from NHS screen?

[MacD75]

Just been advised by my midwife that if I go for a harmony test then I shouldn't have the normal NHS screening (nuchal etc) because they can give conflicting results.

When I asked how that could happen she admitted she didn't know, that's just what she'd been told to say.

I don't see how it's possible, different results maybe but conflicting?

So I'm wondering if anyone else has been told this by a health professional (private or nhs)?

I can't help but think it sounds like some attempted cost saving bs by the NHS...

Hmm, the short answer's no. I worried if it might be possible too - not sure about the technicalities of the NHS tests without checking but an NHS midwife advised that being a chromosome test Harmony would definitely be more accurate.

(I had both anyway; Harmony a week before the NHS combined test so had the results in a couple of days of each other so no prolonged wait - for my age Downs risk's allegedly ~1 in 100, NHS said 1 in 290, Harmony 1 in 10,000. Personally I found that reassuring as 1 in 290 is still technically 'high risk' for Downs and I'd already been on the wrong end of a statistic for miscarriage).

If you're not in one of the areas where the NHS is trialling Harmony unfortunately no choice but to fork out if you want it though. Best wishes whatever you decide.

That's right - what your mw is failing miserably to explain is that the Harmony test gives you an essentially definitive result for T21/Down Syndrome. So you could come back low risk from that (1/10000) and still get a high risk from the NHS nuchal scan in which case you'd just ignore the nuchal knowing the accurate test has given you the answer already. But even so, I'd definitely still get the full NHS nuchal screening and scan done - the scan is obviously essential to check growth and body parts etc and the nuchal can actually pick up some really rare conditions or issues that Harmony might not (Harmony is accurate for Downs but not quite so accurate for Pataus and Edwards or other even less common chromosomal mishaps). Good luck anyway - hope all goes smoothly.

Wow, that's shoddy advice!

I was told in my next pregnancy to have the harmony test and also the combined screening, hopefully the harmony will rule out the 3 major trisomies.

My consultant (who is also the fetal medicine director so knows her stuff) told me they'd still want me to have the bloods and scan at 12 weeks as that can still give you an idea of if there are any blood supply issues or a potential growth issue.

Great, thanks everyone. My initial gut feeling was she was talking a load of rubbish, just wanted to see if anyone else had been told the same.

Even the NHS website says their screening can occasionally pick up things harmony won't, so it certainly doesn't tie in with her advice.

My nhs results were 1 in 20.000 a couple of years ago so although im the other side of 40 now I'm hopeful the odds won't have changed much. Still slightly paranoid enough to probably pay for the harmony test tho .

Thanks again everyone!! [amile]

even!

Yeah I'd definitely go for both. I'm planning on 2 12 week scans, one private and one nhs with the bloods too.

My first 22 weeks of my next pregnancy will be very busy with scans and appointments. I'd personally take everything on offer.

I guess though, if you are prepared to pay for the harmony tests which give you a definitive answer why would you need the NHS ones which only give you the odds? Seems like a waste of NHS resources to me, fairly sensible of her to suggest you don't need them.

The harmony test doesn't give a definitive answer, and the NHS own website states their test found something the harmony test missed during trials. So I'm not wasting NHS resources. In fact that suggestion simply confirms my initial thoughts, NHS cost saving bs. They can run the NHS more efficiently to make far more savings than they can by deceiving people into having fewer tests done.

Because the combined bloods and scan give you an idea of other issues apart from the three major trisomies.

You can have a baby with no t13,18 or 21 but still have a club foot, or a high nuctal screen indicating a different chromosomal issue, or the bloods come back suggesting low papp a which can lead to iugr and additional scans can be put in place.

The harmony is great if you are at risk of having a baby with pateu, Edwards or Down's syndrome. Utterly useless for all other issues your baby or placenta might have.

Neither are diagnostic but can give you an insight as to if it's worth shaving a cvs or amnio.

There might have been a misunderstanding. Quite a few private clinics offer Harmony as a package, where you also get a combined screening, i.e. NT and bloods. If so, then there is a little point to have this screening on NHS as well. I had a Harmony + 12 weeks scan with bloods at FMC, and skipped NHS one, as I saw no point. Especially since my NHS hospital was looking at less markers during the scan than FMC. However, if you only get Harmony DNA test without a detailed scan, then you should definitely get NHS screening as well, as it can detect some other issues besides to trisomies, e.g. higher risk of problems with placenta, so you may need growth scans later in pregnancy, and some other things.

Dalzue I didn't realise fmc did bloods for you too. I thought the package was just scans. If that's the case I will probably not have the nhs one then as it is using up resources without needing it.

I agree with Daluze and on that basis had my 12 week testing at the FMC and declined the NHS testing at that stage. My midwife suggested this as she said the FMC results would be different (as they look for more markers) and having two sets of results could be confusing. So we ended up with a number of risk factors: the Harmony results for T21, T13 and T18 and FMC results based on the NT measurement, soft markers and my blood results, again split by the three main Trisomies. They compared the latter to my background risk (based on my age and a previous Trisomy pregnancy I think).
That's the case for the FMC but not sure about other clinics offering the Harmony test.

Kitty, It depends which package you choose. If you have you first viability scan at 10 weeks, then they take bloods both for Harmony and combined screening, and you get a detailed scan and all results at 12 weeks. This is also the cheapest option, btw. But if you start testing later, after it is too late for combined screening, then, obviously, they will only do a scan + Harmony. The risks from combined screening at FMC and NHS (unless you do it in Kings or UCLH) will differ, because FMC (and Kings and UCLH) look at more markers during the scan and take them into account in risk calculation.

Yes that's the package we are wanting the harmony with viability scan then the 12 week scan. I think I'd just assumed it was simply a scan rather than bloods too. When I spoke to my consultant she said to have the nhs 12 week combined but she obviously thought we were just doing the harmony with fmc.

That's really great to know.

The NHS bloods looks at different markers from the harmony test. Harmony is not simply the same as the NHS but with a few extra markers. if that were the case there would obviously be no point having both, and the midwife would know that and would have said that. She did not. It would also mean that there was no chance of the NHS test finding something that Harmony missed, and in the NHS trials their own test picked up things the Harmony missed. I.e. The NHS own tests concluded both could be necessary.

I doubt any consultant would think you were going for a simple scan if you said Harmony. The reason the Harmony is so expensive is because the blood is sent to the USA for testing, which obviously wouldn't be necessary if you were only having a scan.
Packages outside of London are different.

Mac, I thought you were asking about NHS combined screening test vs Harmony in your original post, not NHS NIPT trial. Yes, NHS NIPT trial was a little bit different from Harmony (although very similar), but trial is finished now and it was only running in few hospitals, and you could get the test if you were high risk after combined screening.
However, private Harmony (or other NIPT) packages vary a lot - from DNA tests only up to Harmony + full combined screening, and this sometimes causes misunderstandings.

Your midwife is right that the FMC combined test will give different results to the NHS.

My FMC result was 1:8643 and NHS 1:3200

Harmony came back 1:10000

The FMC take bloods at 10 weeks, which can apparently give a slightly more accurate result, and also look at other soft markers.

Where does this "an essentially definitive result for T21/Down Syndrome" come from??

I'm registered with Uclh and told the midwife booking me in that I was having the harmony followed by nuchal and screening scan at FMC. I wondered whether I should not bother with the Uclh 12w scan/not waste their resources etc but she said to do it anyway as they would want to have their own records. So I had scan plus harmony bloods taken at 10w and then the Uclh 12w scan one day where the sonographer said she was pretty sure it was a girl followed by the FMC 12w scan plus nuchal/bloods screening 24h later. Right at the end of that appointment they said oh and your harmony results mean your risk of the three trisomies are x y z (much lower... effectively ruling them out) and... you're having a boy!

The definitive result comes from the baby's DNA. They will still say "low risk" but it's waaaay more definitive than the combined test results.

I didn't think it was a definitive result but the 1:10000 was a definitive negative (ie they can't give you a definitive positive from harmony)

Aren't they trialling it as a diagnostic test in Australia?