Anora

The Anora course is designed to give healthcare providers, genetic counselors, OB/GYNs, midwives, and other clinical staff a full understanding of miscarriage genetic testing: what it is, when and how to order it, how to interpret results, how to communicate with patients, and how this test fits into the broader picture of women’s health and reproductive care. The goal is to help providers offer clarity and support to patients after the loss of a pregnancy, reducing uncertainty, informing recurrence risk, and guiding next steps with compassion and evidence. We begin with background science: definitions and categories of miscarriage / early pregnancy loss; the role of chromosomal abnormalities (numerical and structural) in causing pregnancy loss; what kinds of abnormalities can happen (trisomy, triploidy, deletions, duplications, unbalanced translocations, uniparental disomy, etc.); how cell-free DNA / SNP microarray methods can detect many abnormalities with higher sensitivity than traditional karyotyping; and the concept of maternal cell contamination (MCC), how it can affect results, and how Anora is designed to detect and rule it out. (Sources: Natera’s Anora test overview & GTR registry) Natera+2NCBI+2

Next is clinical use cases: when miscarriage testing is appropriate — for example, after one or more miscarriages; if a prior chromosome abnormality was identified; in patients who want to understand why the loss occurred; in the absence of obvious risk factors; or when further workup might be avoided if a chromosomal cause is found. The provider learns when not to order — e.g. when findings won’t change management, or when pregnancy loss is extremely early, or when sample quality is poor. Then we go into product details: how Anora works — an informatics-based SNP microarray test method developed specifically for miscarriage testing, which can detect a wide range of chromosome abnormalities including whole chromosome aneuploidies, deletions/duplications (micro and macro), triploidy, parental origin of abnormalities, uniparental disomy, etc. It returns a result in >99% of cases, including differentiating between fetal vs maternal DNA (i.e. detecting and mitigating maternal cell contamination). Natera+2NCBI+2

We then cover ordering and specimen handling: what types of tissue are acceptable (product of conception, fetal tissue, placenta, etc.), requirements for sample collection, how to collect the tissue (at home kits or clinician-collected), storage/shipping requirements, instructions for at-home collection of miscarriage tissue, how to preserve the tissue (refrigeration vs freezing, etc.) to maintain sample integrity. Natera+2Natera+2

A major section is on interpretation of results: what different outcomes mean — when a chromosomal abnormality is detected, what it suggests about cause of miscarriage, how to interpret findings of numerical or structural chromosomal changes; what it means if no abnormality is found (other causes like uterine anomalies, thrombophilia, hormonal issues, etc. must be considered); how to interpret findings in light of maternal cell contamination; how to assess recurrence risk based on type of abnormality; how to differentiate extraneous findings vs those necessitating immediate follow-up or further evaluation.

Then, communication with patients: how to counsel patients before testing — setting expectations (what the test can and cannot tell, that it's not diagnostic of future pregnancies but gives probabilistic risk); how to deliver results compassionately; how to discuss what detected abnormalities imply for future pregnancy planning; how to manage emotional responses (grief, guilt, anxiety); discussing options (if any) for further evaluation; how to discuss limitations when no abnormality is found; how to ensure patients understand next steps, whether further testing or monitoring, or referral to specialists if needed.

Also included is comparative background: comparison to traditional karyotyping, its limitations (culture failure, resolution, inability to detect some microdeletions or duplications, maternal contamination), how SNP-microarray methods (as used in Anora) overcome many of these limitations; evidence basis (studies showing high detection rates, improved yield vs karyotype) and published data on performance. Natera+1

There is a module on ethical, emotional, and cost considerations: patient autonomy, consent, how to approach findings that may implicate parental origin or familial chromosomal rearrangements; when to send referral/genetic counseling; cost or insurance coverage aspects; balancing benefits of information vs potential emotional impact, especially when findings are uncertain.

The curriculum is delivered with multiple formats: video lectures, micro-learning segments, case studies (e.g. single miscarriage vs recurrent loss; very early vs later gestational losses; tissue of varying quality; detection of different types of chromosomal abnormality; maternal contamination scenarios), downloadable reference materials (e.g. conditions list that Anora detects, sample collection instructions, FAQ, patient handouts), and interactive components including quizzes, discussion prompts, perhaps scenario-based assessments.

On the workflow & implementation side: how providers or clinics can integrate miscarriage genetic testing into their practice — who on the care team orders the test, how to train staff; how to manage sample collection logistics; how to follow up abnormal results; how to use results to avoid unnecessary diagnostic work-ups; how to embed information about Anora in clinic websites or portals; how to use email or patient communications to guide patients through the process; how to use swimlane structures in training (Get Started → Genetics Basics → Anora Product Module → Sample Collection & Ordering → Interpretation → Patient Communication → Follow-Up) and include feedback loops.

Finally, by the end of this course, participants will: know when Anora is appropriate; understand how Anora works; be able to order the test correctly and obtain high-quality specimens; interpret results precisely including recognizing limitations or confounding issues; distinguish between findings that require immediate patient counseling vs those where follow-up is lower urgency; communicate results empathetically and clearly; use results to inform recurrence risk and future pregnancy planning; reduce unnecessary testing when cause is already defined; and integrate miscarriage genetic testing into patient care as a tool both for clinical insight and emotional resolution.