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Alon I, Bussod I, Ravitsky V. Mapping ethical, legal, and social implications (ELSI) of preimplantation genetic testing (PGT). J Assist Reprod Genet 2024; 41:1153-1171. [PMID: 38512655 PMCID: PMC11143109 DOI: 10.1007/s10815-024-03076-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE Preimplantation Genetic Testing (PGT) has attracted considerable ethical, legal, and social scrutiny, but academic debate often fails to reflect clinical realities. METHODS Addressing this disconnect, a review of 506 articles from 1999 to 2019 across humanities and social sciences was conducted to synthesize the Ethical, Legal, and Social Implications (ELSI) of PGT. This review mined PubMed, WoS, and Scopus databases, using both MeSH terms and keywords to map out the research terrain. RESULTS The findings reveal a tenfold increase in global research output on PGT's ELSI from 1999 to 2019, signifying rising interest and concern. Despite heightened theoretical discourse on selecting "optimal" offspring, such practices were scarcely reported in clinical environments. Conversely, critical issues like PGT funding and familial impacts remain underexplored. Notably, 86% of the ELSI literature originates from just 12 countries, pointing to a research concentration. CONCLUSION This review underscores an urgent need for ELSI research to align more closely with clinical practice, promoting collaborations among ethicists, clinicians, policymakers, and economists. Such efforts are essential for grounding debates in practical relevance, ultimately steering PGT towards ethical integrity, societal acceptance, and equitable access, aiming to harmonize PGT research with real-world clinical concerns, enhancing the relevance and impact of future ethical discussions.
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Affiliation(s)
- Ido Alon
- Department of Development Economics, Autonomous University of Madrid, Madrid, Spain.
- University of Montreal, Montreal, Canada.
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Mayeur A, Benaloun E, Benguigui J, Duperier C, Hesters L, Chatzovoulou K, Monnot S, Grynberg M, Steffann J, Frydman N, Sonigo C. Preimplantation genetic testing for mitochondrial DNA mutation: ovarian response to stimulation, outcomes and follow-up. Reprod Biomed Online 2023; 47:61-69. [PMID: 37202317 DOI: 10.1016/j.rbmo.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/18/2023] [Accepted: 02/20/2023] [Indexed: 03/04/2023]
Abstract
RESEARCH QUESTION How do carriers of pathogenic mitochondrial DNA (mtDNA) respond to ovarian stimulation? DESIGN A single-centre, retrospective study conducted between January 2006 and July 2021 in France. Ovarian reserve markers and ovarian stimulation cycle outcomes were compared for couples undergoing preimplantation genetic testing (PGT) for maternally inherited mtDNA disease (n = 18) (mtDNA-PGT group) with a matched-control group of patients undergoing PGT for male indications (n = 96). The PGT outcomes for the mtDNA-PGT group and the follow-up of these patients in case of unsuccessful PGT was also reported. RESULTS For carriers of pathogenic mtDNA, parameters of ovarian response to FSH and ovarian stimulation cycle outcomes were not different from those of matched-control ovarian stimulation cycles. The carriers of pathogenic mtDNA needed a longer ovarian stimulation and higher dose of gonadotrophins. Three patients (16.7%) obtained a live birth after the PGT process, and eight patients (44.4%) achieved parenthood through alternative methods: oocyte donation (n = 4), natural conception with prenatal diagnosis (n = 2) and adoption (n = 2). CONCLUSION To the best of our knowledge, this is the first study of women carrying a mtDNA variant who have undergone a PGT for monogenic (single gene defects) procedure. It is one of the possible options to obtain a healthy baby without observing an impairment in ovarian response to stimulation.
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Affiliation(s)
- Anne Mayeur
- Service de Biologie de la Reproduction- CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, cedex, F-92140 Clamart, France.; Université Paris-Sud, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France..
| | - Emmanuelle Benaloun
- Service de Biologie de la Reproduction- CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, cedex, F-92140 Clamart, France
| | - Jonas Benguigui
- Service de Médecine de la reproduction et Préservation de la Fertilité, Assistance Publique Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart 92140, France
| | - Constance Duperier
- Service de Médecine de la reproduction et Préservation de la Fertilité, Assistance Publique Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart 92140, France
| | - Laetitia Hesters
- Service de Biologie de la Reproduction- CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, cedex, F-92140 Clamart, France
| | | | - Sophie Monnot
- Université de Paris, Imagine INSERM UMR1163 et Service de Médecine Génomique des Maladies rares, Groupe Hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Michael Grynberg
- Université Paris-Sud, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France.; Service de Médecine de la reproduction et Préservation de la Fertilité, Assistance Publique Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart 92140, France
| | - Julie Steffann
- Université de Paris, Institut Imagine, INSERM UMR1163, Paris, France.; Université de Paris, Imagine INSERM UMR1163 et Service de Médecine Génomique des Maladies rares, Groupe Hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Nelly Frydman
- Service de Biologie de la Reproduction- CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, cedex, F-92140 Clamart, France.; Université Paris-Sud, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - Charlotte Sonigo
- Université Paris-Sud, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France.; Service de Médecine de la reproduction et Préservation de la Fertilité, Assistance Publique Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart 92140, France.; Inserm U1185, Faculté de médecine Paris Sud, France
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Dadkhah A, Kazemi A, Torabi F. Psychological health associated with prenatal screening in low‐risk pregnancy for chromosomal aneuploidy. J Obstet Gynaecol Res 2022; 48:593-598. [DOI: 10.1111/jog.15160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/01/2022] [Accepted: 01/12/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Ashraf Kazemi
- Reproductive Health Department Isfahan University of Medical Sciences Isfahan Iran
| | - Fatemeh Torabi
- Midwifery Department Isfahan University of Medical Sciences Isfahan Iran
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Zhang J, Pastore LM, Sarwana M, Klein S, Lobel M, Rubin LR. Ethical and moral perspectives of individuals who considered/used preimplantation (embryo) genetic testing. J Genet Couns 2021; 31:176-187. [PMID: 34279057 DOI: 10.1002/jgc4.1471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/05/2022]
Abstract
This study examined perspectives on the ethical implications of preimplantation genetic testing (PGT) among individuals who actually (not hypothetically) used or considered using PGT. Most of the prior patient-centered research on PGT ethics used qualitative designs (9 out of the 11 articles) and focused only on single gene testing. This cross-sectional study used an anonymous online questionnaire; 15 items assessed potential ethical concerns involved in PGT decision-making, including clinical indications for PGT, the greater implications of PGT for society, and unused embryo disposition. N = 207 individuals (mean female/male age 35.7/38.9 years, 21% Hispanic or non-White) who had recently used or considered using PGT for single gene (60%) or for chromosomal testing (40%) completed the questionnaire. Most respondents supported PGT screening for disease conditions with childhood or adult onset that are untreatable (64%-85% across items); most opposed PGT for trait selection (76%-81%). Most respondents agreed that PGT aids in parental decision-making (66%-67%), although some expressed concern over potential unforeseen consequences (25%-30%). Regarding disposition of embryos without known genetic abnormalities, most respondents favored freezing indefinitely (86%) or donating to another family (69%), while for embryos with genetic abnormalities, most respondents favored donating to research (78%) or destroying them (62%). Stratification by religious affiliation revealed several differences, such as less acceptance of PGT for diseases that occur in adulthood and have no treatment options among Protestants (p = .015) and greater willingness to donate surplus embryos to research among participants without a religious affiliation (p < .001). These results are limited by the relatively homogeneous sample of participants (mostly White, married, and predominantly college-educated). In summary, participants who considered/used PGT found PGT acceptable overall for screening for disease conditions; most opposed using PGT for trait selection. Our novel questionnaire provides a structured tool for assessing the ethical perspectives surrounding the use of PGT.
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Affiliation(s)
- Jiahui Zhang
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Lisa M Pastore
- Department of Obstetrics/Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook, NY, USA
| | - Miriam Sarwana
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Samantha Klein
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Lisa R Rubin
- Department of Psychology, The New School for Social Research, New York, NY, USA
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Hughes T, Bracewell-Milnes T, Saso S, Jones BP, Almeida PA, Maclaren K, Norman-Taylor J, Johnson M, Nikolaou D. A review on the motivations, decision-making factors, attitudes and experiences of couples using pre-implantation genetic testing for inherited conditions. Hum Reprod Update 2021; 27:944-966. [PMID: 33969393 DOI: 10.1093/humupd/dmab013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In pre-implantation genetic testing (PGT), fertile couples undergo IVF with genetic testing of embryos to avoid conceptions with a genetic condition. There is an exponentially increasing uptake with over 600 applications listed by the Human Fertilisation and Embryology Authority in the UK. The psychological aspects of the decision-making process and the experience of PGT, however, are relatively underevaluated, with the potential to leave patients unsupported in their journeys. OBJECTIVE AND RATIONALE In this review, we aim to comprehensively report on every aspect of couples' experiences of PGT. We consider what motivates users, the practical and ethical decisions involved and how couples navigate the decision-making process. Additionally, we report on the social and psychological impact on couples who are actively undergoing or have completed the PGT process. SEARCH METHODS A systematic search of English peer-reviewed journals of three computerized databases was undertaken following PRISMA guidelines. Studies that examined the motivations, attitudes, decision-making factors and experiences of patients who have been actively engaged in the PGT process were included. No restrictions were placed on study design or date of publication. Studies examining patients using PGT in a hypothetical context or solely using PGT for aneuploidy were excluded. Qualitative data were extracted using thematic analysis. OUTCOMES The main outcomes were patient motivations, deciding factors and attitudes, as well as the patient experience of coming to a decision and going through PGT.Patients were primarily motivated by the desire to have a healthy child and to avoid termination of pregnancy. Those with a sick child or previous experience of termination were more likely to use PGT. Patients also felt compelled to make use of the technology available, either from a moral responsibility to do so or to avoid feelings of guilt if not. The main factors considered when deciding to use PGT were the need for IVF and the acceptability of the technology, the financial cost of the procedure and one's ethical standpoint on the creation and manipulation of embryos. There was a general consensus that PGT should be applied to lethal or severe childhood disease but less agreement on use for adult onset or variable expression conditions. There was an agreement that it should not be used to select for aesthetic traits and a frustration with the views of PGT in society. We report that couples find it difficult to consider all of the benefits and costs of PGT, resulting in ambivalence and prolonged indecision. After deciding on PGT use, we found that patients find the process extremely impractical and psychologically demanding. WIDER IMPLICATIONS This review aimed to summarize the current knowledge on how patients decide to use and experience PGT and to make suggestions to incorporate the findings into clinical practice. We cannot stress enough the importance of holistic evaluation of patients and thorough counselling prior to and during PGT use from a multidisciplinary team that includes geneticists, IVF clinicians, psychologists and also patient support groups. Large prospective studies using a validated psychological tool at various stages of the PGT process would provide an invaluable database for professionals to better aid patients in their decision-making and to improve the patient experience.
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Affiliation(s)
- Tara Hughes
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Timothy Bracewell-Milnes
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Srdjan Saso
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Benjamin P Jones
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Paula A Almeida
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Katherine Maclaren
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Julian Norman-Taylor
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Mark Johnson
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Dimitrios Nikolaou
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
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Rothwell E, Lamb B, Johnson E, Gurtcheff S, Riches N, Fagan M, Sabatello M, Johnstone E. Patient perspectives and experiences with in vitro fertilization and genetic testing options. Ther Adv Reprod Health 2020; 14:2633494119899942. [PMID: 32518912 PMCID: PMC7254585 DOI: 10.1177/2633494119899942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 12/31/2022] Open
Abstract
Objective: Decision-making and patient experiences with embryo selection during in vitro fertilization often include genetic testing options. The purpose of this study was to gain insight about the experiences and perspectives of women using in vitro fertilization and genetic technologies. Methods: Interviews (n = 37) were conducted among female patients who had undergone in vitro fertilization, underwent expanded carrier screening, and were offered pre-implantation genetic testing for aneuploidy between July 2016 and July 2017. The interviews were transcribed and a content analysis was conducted on the transcripts. Results: Categories that emerged from the data analysis included unexpected outcomes, uncertainty, unanticipated emotional consequences, too much emphasis on the woman’s contributions and questions about embryo viability. Patient experiences with genetic technologies during in vitro fertilization played a significant role within these results. Conclusion: The emotional and psychological impacts of infertility during in vitro fertilization were the primary concerns discussed by participants. Future research is needed to identify ways to help manage unexpected outcomes and continuous uncertainty, including the increasing use of genetic technologies, to not add to the psychological burden of infertility. There is a need to explore more support options or counseling services for patients struggling with infertility during in vitro fertilization treatment.
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Affiliation(s)
- Erin Rothwell
- Associate Vice President for Research, Integrity and Compliance, The University of Utah, 75 South 2000 East, Salt Lake City, UT 84112, USA
| | - Brandy Lamb
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT, USA
| | - Erin Johnson
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT, USA
| | | | - Naomi Riches
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT, USA
| | - Melinda Fagan
- Department of Philosophy, The University of Utah, Salt Lake City, UT, USA
| | - Maya Sabatello
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Erica Johnstone
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT, USA
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Yeager S, Mehta S, Sodhi M, Shah B. Can preimplantation genetic diagnosis be used for monogenic endocrine diseases? J Pediatr Endocrinol Metab 2019; 32:1305-1310. [PMID: 31490775 DOI: 10.1515/jpem-2019-0184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/22/2019] [Indexed: 11/15/2022]
Abstract
Context Preimplantation genetic diagnosis (PGD) is currently used for over 400 monogenic diseases. Some endocrine conditions that occur due to monogenic defects are either life-threatening or can cause severe morbidities; thus, PGD may be an option to avoid the occurrence of such diseases. Evidence acquisition An initial search in PubMed/Medline search was done to identify monogenic endocrine conditions using appropriate search terms. Eleven articles (1999-2018) reported 15 cases using PGD for monogenic endocrine diseases performed at major reproductive centers. Clinical and outcome data of these cases were reviewed with respect to the number of PGD cycles, successful pregnancy rates, live births and their genetic status. Evidence synthesis Fifteen couples underwent 32 PGD cycles (one to nine per couple), of which 17 resulted in a pregnancy. Seven couples underwent a single PGD cycle. Four couples had successful pregnancies each resulting in live births, one couple had an unsuccessful pregnancy, one needed medical termination of pregnancy and the outcome data were not reported in one. The remaining eight couples underwent multiple PGD cycles (two to nine per couple) and all had successful pregnancies in at least one cycle resulting in 16 live births. Of the total live births, 60% were genetically unaffected and 40% were carriers of the autosomal recessive gene mutation. Conclusions PGD may be a potential tool for preventing the inheritance of severe monogenic endocrine diseases in future generations. Currently, the use of PGD in endocrine disorders is rare but provides a promising option on a case-by-case basis, provided the optimal resources are available.
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Affiliation(s)
| | - Shilpa Mehta
- Division of Pediatric Endocrinology, Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Misha Sodhi
- Division of Pediatric Endocrinology, Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Bina Shah
- Division of Pediatric Endocrinology, Department of Pediatrics, New York University School of Medicine, New York, NY, USA, Phone: +212-562-3793
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Pastore LM, Cordeiro Mitchell CN, Rubin LR, Nicoloro-SantaBarbara J, Genoff Garzon MC, Lobel M. Patients' preimplantation genetic testing decision-making experience: an opinion on related psychological frameworks. Hum Reprod Open 2019; 2019:hoz019. [PMID: 31598567 PMCID: PMC6777985 DOI: 10.1093/hropen/hoz019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 12/18/2022] Open
Abstract
The process of deciding whether to pursue preimplantation genetic testing (PGT) of an embryo is highly stressful for individuals and couples and has adverse emotional consequences (e.g. distress and uncertainty). PGT influences patients’ lives in both positive and negative ways and is experienced at an individual level, as a dyadic unit, as a family member and as part of the society. Here, we argue that providing a conceptual framework with which to understand the `experience of decision making’ about PGT for monogenic disease (PGT-M) testing specifically, as well as the factors contributing to `decisional distress’ and `uncertainty’ that patients endure as a result—apart from what decision they make—is crucial to optimizing patient counseling, satisfaction and outcomes in the field of ART. Derived from psychological theory, the framework proposed here identifies three categories of contributing factors to decisional distress and uncertainty in considering PGT-M; namely, ‘intraindividual’, ‘interpersonal’ and ‘situational’ factors. We reviewed evidence from the PGT literature to inform our framework. Well-accepted theories of stress and health decision making were also reviewed for their relevance to PGT-M decision making, focusing on potential distress and uncertainty. Our novel conceptual framework can be used to inform clinical practice, to advance research and to aid the development of interventions for individuals and couples who are deciding whether or not to use PGT-M. Alleviating emotional distress and uncertainty can improve patients’ well-being during their reproductive journey.
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Affiliation(s)
- L M Pastore
- Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook, NY, USA
| | - C N Cordeiro Mitchell
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L R Rubin
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | | | - M C Genoff Garzon
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | - M Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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Goldman KN, Blakemore J, Kramer Y, McCulloh DH, Lawson A, Grifo JA. Beyond the biopsy: predictors of decision regret and anxiety following preimplantation genetic testing for aneuploidy. Hum Reprod 2019; 34:1260-1269. [DOI: 10.1093/humrep/dez080] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 04/01/2019] [Accepted: 04/30/2019] [Indexed: 01/25/2023] Open
Abstract
Abstract
STUDY QUESTION
What factors are associated with decision regret and anxiety following preimplantation genetic testing for aneuploidy (PGT-A)?
SUMMARY ANSWER
The majority of patients viewed PGT-A favourably regardless of their outcome; although patients with negative outcomes expressed greater decision regret and anxiety.
WHAT IS KNOWN ALREADY
PGT-A is increasingly utilized in in vitro fertilization (IVF) cycles to aid in embryo selection. Despite the increasing use of PGT-A technology, little is known about patients’ experiences and the possible unintended consequences of decision regret and anxiety related to PGT-A outcome.
STUDY DESIGN, SIZE, DURATION
Anonymous surveys were distributed to 395 patients who underwent their first cycle of autologous PGT-A between January 2014 and March 2015.
PARTICIPANTS/MATERIALS, SETTING, METHODS
There were 69 respondents who underwent PGT-A at a university-affiliated fertility centre, completed the survey and met inclusion criteria. Respondents completed three validated questionnaires including the Brehaut Decision Regret (DR) Scale, short-form State-Trait Anxiety Inventory (STAI-6) and a health literacy scale. The surveys also assessed demographics, fertility history, IVF and frozen embryo transfer cycle data.
MAIN RESULTS AND THE ROLE OF CHANCE
The majority of respondents were Caucasian, >35 years of age and educated beyond an undergraduate degree. The majority utilized PGT-A on their first IVF cycle, most commonly to ‘maximize the efficiency of IVF’ or reduce per-transfer miscarriage risk. The overall median DR score was low, but 39% of respondents expressed some degree of regret. Multiple regression confirmed a relationship between embryo ploidy and decision regret, with a lower number of euploid embryos associated with a greater degree of regret. Patients who conceived following euploid transfer reported less regret than those who miscarried or failed to conceive (P < 0.005). Decision regret was inversely associated with number of living children but not associated with age, education, race, insurance coverage, religion, marital status or indication for IVF/PGT-A. Anxiety was greater following a negative pregnancy test or miscarriage compared to successful conception (P < 0.0001). Anxiety was negatively associated with age, time since oocyte retrieval and number of living children, and a relationship was observed between anxiety and religious affiliation. Overall, decision regret was low, and 94% of all respondents reported satisfaction with their decision to pursue PGT-A; however, patients with a negative outcome were more likely to express decision regret and anxiety.
LIMITATIONS, REASON FOR CAUTION
This survey was performed at a single centre with a relatively homogenous population, and the findings may not be generalizable. Reasons for caution include the possibility of response bias and unmeasured differences among those who did and did not respond to the survey, as well as the possibility of recall bias given the retrospective nature of the survey. Few studies have examined patient perceptions of PGT-A, and our findings should be interpreted with caution.
WIDER IMPLICATIONS OF THE FINDINGS
Overall decision regret was low following PGT-A, and the vast majority deemed the information gained valuable for reproductive planning regardless of outcome. However, more than one-third of the respondents expressed some degree of regret. Respondents with no euploid embryos were more likely to express regret, and those with a negative outcome following euploid embryo transfer expressed both higher regret and anxiety. These data identify unanticipated consequences of PGT-A and suggest opportunities for additional counselling and support surrounding IVF with PGT-A.
STUDY FUNDING/COMPETING INTEREST(S)
No external funding was obtained for this study. D.H.M. reports personal fees, honorarium, and travel expenses from Ferring Pharmaceuticals, personal fees and travel expenses from Granata Bio, and personal fees from Biogenetics Corporation, The Sperm and Embryo Bank of New York, and ReproART: Georgian American Center for Reproductive Medicine. All conflicts are outside the submitted work.
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Affiliation(s)
- Kara N Goldman
- New York University Langone Fertility Center, 660 First Avenue, Fifth Floor, New York, NY, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street Suite 2310, Chicago, IL, USA
| | - Jennifer Blakemore
- New York University Langone Fertility Center, 660 First Avenue, Fifth Floor, New York, NY, USA
| | - Yael Kramer
- New York University Langone Fertility Center, 660 First Avenue, Fifth Floor, New York, NY, USA
| | - David H McCulloh
- New York University Langone Fertility Center, 660 First Avenue, Fifth Floor, New York, NY, USA
| | - Angela Lawson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street Suite 2310, Chicago, IL, USA
| | - Jamie A Grifo
- New York University Langone Fertility Center, 660 First Avenue, Fifth Floor, New York, NY, USA
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Mor P, Brennenstuhl S, Metcalfe KA. Uptake of Preimplantation Genetic Diagnosis in Female BRCA1 and BRCA2 Mutation Carriers. J Genet Couns 2018; 27:1386-1394. [DOI: 10.1007/s10897-018-0264-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 05/22/2018] [Indexed: 01/26/2023]
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Klitzman R. Challenges, Dilemmas and Factors Involved in PGD Decision-Making: Providers’ and Patients’ Views, Experiences and Decisions. J Genet Couns 2017; 27:909-919. [DOI: 10.1007/s10897-017-0173-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 11/06/2017] [Indexed: 12/29/2022]
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