The use of preimplantation genetic testing for aneuploidy (PGT-A): a committee opinion

Penzias, Alan S.; Bendikson, Kristin; Butts, Samantha; Coutifaris, Christos; Falcone, Tommaso; Fossum, Gregory; Gitlin, Susan; Gracia, Clarisa R.; Hansen, Karl R.; Barbera, Andrew R. La; Mersereau, Jennifer; Odem, Randall R.; Paulson, Richard J.; Pfeifer, Samantha M.; Pisarska, Margareta D.; Rebar, Robert W.; Reindollar, Richard H.; Rosen, Mitchell P.; Sandlow, Jay; Vernon, Michael; Widra, E.A.

doi:10.1016/j.fertnstert.2018.01.002

Cited by 269 publications

(89 citation statements)

References 46 publications

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“…The concept of selecting euploid embryos for transfer is an attractive proposition in light of the issues mentioned above. Recent implementation of diagnostic techniques allowing comprehensive chromosome screening combined with trophectoderm biopsy at the blastocyst stage, is expected to increase the effectiveness of PGT‐A, but its routine use is still not unanimously recommended . Recent studies have shown that PGT‐A may not improve overall pregnancy outcomes, so the technique remains disputed.…”

Section: Introductionmentioning

confidence: 99%

Preimplantation genetic testing legislation and accessibility in the Nordic countries

Hreinsson¹,

Lundin

Iwarsson

et al. 2020

Acta Obstet Gynecol Scand

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Introduction:Assisted reproduction technologies are being rapidly developed and implementation of preimplantation genetic testing (PGT) has allowed patients with genetic disorders to initiate pregnancies while minimizing or eliminating the risk of transmitting these disorders to their offspring. Testing for numeric chromosomal anomalies has been proposed as a way to increase efficacy in assisted reproduction; however, this remains disputed. Legislation is lagging behind the rapid developments in this field. Material and methods:We conducted a structured online survey of legislation and accessibility to preimplantation genetic testing in the Nordic countries to compare the regulation and uptake of this technique. The survey was designed and answered by the authors. Results: Key elements in the regulation of preimplantation testing for monogenic disorders and structural rearrangements are similar in the Nordic countries, although accessibility varies since only Denmark, Finland, and Sweden have national clinics offering treatment. In addition, Denmark and Finland have private clinics offering PGT. Regulation is the most stringent in Norway where a national board evaluates all couples seeking treatment. Treatment volumes vary between the Nordic countries, with Norway and Finland having lowest treatment numbers. Preimplantation genetic testing for aneuploidy in the embryo varies between the Nordic countries: Finland and Iceland allow this form of treatment, Denmark and Sweden offer it only in the form of a research protocol, and Norway does not allow it at all. Therefore the number of treatment cycles involving testing for embryo aneuploidy are lower in the Nordic countries than in other countries where this treatment option is more common. Conclusions: Science needs to inform politics regarding the rapidly evolving field of reproductive medicine and we recommend harmonization of legislation and accessibility between the Nordic countries. | 717 HREINSSON Et al.

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Section: Introductionmentioning

confidence: 99%

Preimplantation genetic testing legislation and accessibility in the Nordic countries

Hreinsson¹,

Lundin

Iwarsson

et al. 2020

Acta Obstet Gynecol Scand

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“…Potentially, the number of non-essential biopsy cases should be eliminated. This may include reviewing ASRM’s guidance on the use of PGT-A [ 35 ]. Embryos with breached zonae should be isolated and not transferred until more information regarding SARS-CoV-2 is reviewed.…”

Section: Recommendations: Potential Modifications To Reduce the Risksmentioning

confidence: 99%

“…Potentially, the number of non-essential biopsy cases should be eliminated. This may include reviewing ASRM’s guidance on the use of PGT-A [ 35 ].…”

Section: Recommendations: Potential Modifications To Reduce the Risksmentioning

confidence: 99%

Cryopreservation and IVF in the time of Covid-19: what is the best good tissue practice (GTP)?

Pomeroy

Schiewe

2020

J Assist Reprod Genet

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Examine good tissue practices as relates to in vitro fertilization, biopsying, and vitrificationto compare current knowledge of ova, sperm, and embryos as vectors for disease transmission as it relates to our current knowledge regarding the SARS-CoV-2 virus. Unknown risks relating to the SARS-CoV-2 virus and sperm, ova, and embryos necessitate a reexamining of how human IVF is performed. Over the last decade, improvements in cryosurvival and live birth outcomes have been associated with zona pellucida breaching procedures (e.g., blastocyst collapsing and biopsying). In turn, today embryos are generally no longer protected by an intact zona pellucida when vitrified and in cryostorage. Additionally, high security storage containers have proven to be resilient to potential cross-contamination and reliable for routine human sperm freezing and embryo vitrification. Several options to current IVF practices are presented that can effectively mitigate the risks of cross-contamination and infection due to the current Covid-19 pandemic or other viral exposures. The question remains; is heightened security and change warranted where the risks of disease transmission likely remain negligible?

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“…However, the true impact on the cumulative pregnancy rate is not yet fully known, as some discarded aneuploid embryos do have the potential to give rise to healthy babies . Routine use of PGT‐A in infertility treatment is therefore questioned and a subject of intense discussion …”

Section: Introductionmentioning

confidence: 99%

Preimplantation genetic testing practices in the Nordic countries

Hreinsson¹,

Iwarsson

Hanson

et al. 2020

Acta Obstet Gynecol Scand

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Introduction: Preimplantation genetic testing (PGT) is growing in importance and volume internationally. International societies such as the European Society for Human Reproduction and Embryology compile international results and these data are published in scientific journals. We present the first compilation of practices, quality measuress and outcome data from Nordic clinics performing PGT. Material and methods: We conducted a structured online survey of PGT practices in the Nordic countries to compare clinical and laboratory techniques, outcomes and quality measures applied in Nordic clinics. The survey was designed by the authors and answered by the authors and members of the study group. The outcome data represents results from 2018. Results and details were clarified through iteration with responding clinics while maintaining anonymity. Response rate in the study was 80%, with 8 of 10 clinics performing PGT responding. Results: Most of the PGT cycles in the Nordic countries are funded through the public healthcare system with University Hospitals performing the majority of treatments, 716/848, or 84.4%, of oocyte retrievals in this dataset. The genetic analyses are in five cases performed by the affiliated local genetic laboratory, and the remaining three consult with large international private enterprise laboratories. Genetic counseling is widely used. Results in the Nordic clinics compare well with international data. Systematic quality control procedures are in place and the larger clinics and laboratories utilize ISO certification or accreditation in the quality management. Automatic witnessing with detailed electronic documentation of laboratory processes is not utilized in the responding clinics, although a majority uses manual witnessing procedures in the laboratory. The outcome after PGT in terms of clinical pregnancy per transfer is around 40% per embryo transfer and compares well with international data. Treatments offered FET PGT-M OP for PGT-M OPRs (95% CI) for PGT-M FET PGT-SR OP for PGT-SR OPRs (95% CI) for PGT-SR FET PGT-A OP for PGT-A OPRs (95% CI) for PGT-A Clinic 1 PGT-M/SR/A 5 3 60% (22-88) 4 3 75% (28-95) 25 12 48% (30-67) Clinic 2 PGT-M/SR 32 10 31% (18-49) 8 4 50% (21-79) 0 Clinic 3 PGT-M/SR a a a 163 57 35% (28-43) 0 Clinic 4 PGT-M/SR/A 5 2 40% (12-78) 5 2 40% (12-78) 27 8 30% (16-49) Clinic 5 PGT-M/SR 107 41 38% (30-48) 19 8 42% (23-64) 0 Clinic 6 PGT-M/SR/A 20 8 40% (22-62) 18 8 44% (24-67) 4 0 0 Clinic 7 PGT-A 0 0 18 12 67% (43-84) Clinic 8 PGT-M/SR 56 18 32% (21-45) 52 14 27% (17-40) 0Note: In PGT-SR chromosomal status is taken into account when selecting embryos for transfer even if the clinic otherwise does not offer PGT-A.

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The use of preimplantation genetic testing for aneuploidy (PGT-A): a committee opinion

Cited by 269 publications

References 46 publications

Preimplantation genetic testing legislation and accessibility in the Nordic countries

Preimplantation genetic testing legislation and accessibility in the Nordic countries

Cryopreservation and IVF in the time of Covid-19: what is the best good tissue practice (GTP)?

Preimplantation genetic testing practices in the Nordic countries

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