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Gleicher N, Albertini DF, Barad DH, Homer H, Modi D, Murtinger M, Patrizio P, Orvieto R, Takahashi S, Weghofer A, Ziebe S, Noyes N. The 2019 PGDIS position statement on transfer of mosaic embryos within a context of new information on PGT-A. Reprod Biol Endocrinol 2020; 18:57. [PMID: 32471441 PMCID: PMC7257212 DOI: 10.1186/s12958-020-00616-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/20/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND A recently published Position Statement (PS) by the Preimplantation Genetics Diagnosis International Society (PGDIS) regarding utilization of preimplantation genetic testing for aneuploidy (PGT-A) in association with in vitro fertilization (IVF) contained inaccuracies and misrepresentations. Because opinions issued by the PGDIS have since 2016 determined worldwide IVF practice, corrections appear of importance. METHODS The International Do No Harm Group in IVF (IDNHG-IVF) is a spontaneously coalesced body of international investigators, concerned with increasing utilization of add-ons to IVF. It is responsible for the presented consensus statement, which as a final document was reached after review of the pertinent literature and again revised after the recent publication of the STAR trial and related commentaries. RESULTS In contrast to the PGDIA-PS, we recommend restrictions to the increasing, and by IVF centers now often even mandated, utilization of PGT-A in IVF cycles. While PGT-A has been proposed as a tool for achieving enhanced singleton livebirth outcomes through embryo selection, continued false-positive rates and increasing evidence for embryonic self-correction downstream from the testing stage, has led IDNHG-IVF to conclude that currently available data are insufficient to impose overreaching recommendations for PGT-A utilization. DISCUSSION Here presented consensus offers an alternative to the 2019 PGDIS position statement regarding utilization of preimplantation genetic testing for aneuploidy (PGT-A) in association with in vitro fertilization (IVF). Mindful of what appears to offer best outcomes for patients, and in full consideration of patient autonomy, here presented opinion is based on best available evidence, with the goal of improving safety and efficacy of IVF and minimizing wastage of embryos with potential for healthy births. CONCLUSIONS As the PGDIS never suggested restrictions on clinical utilization of PGT-A in IVF, here presented rebuttal represents an act of self-regulation by parts of the IVF community in attempts to control increasing utilization of different unproven recent add-ons to IVF.
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Affiliation(s)
- N Gleicher
- Center for Human Reproduction, 21 East 69th Street, New York, N.Y, 10021, USA.
- The Foundation for Reproductive Medicine, New York, N.Y, USA.
- Stem Cell Biology and Molecular Embryology Laboratory, Rockefeller University, New York, N.Y, USA.
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090, Vienna, Austria.
| | - D F Albertini
- Center for Human Reproduction, 21 East 69th Street, New York, N.Y, 10021, USA
- Stem Cell Biology and Molecular Embryology Laboratory, Rockefeller University, New York, N.Y, USA
| | - D H Barad
- Center for Human Reproduction, 21 East 69th Street, New York, N.Y, 10021, USA
- The Foundation for Reproductive Medicine, New York, N.Y, USA
| | - H Homer
- Queensland Fertility Group, Watkins Medical Center, Springhill, Queensland, Australia
| | - D Modi
- Molecular and Cellular Biology Laboratory, ICMR - National Institute for Research in Reproductive Health, Mumbai, India
| | - M Murtinger
- Nextclinic, IVF Zentren Prof. Zech, 6900, Bregenz, Austria
| | - P Patrizio
- Department of Obstetrics and Gynecology and Reproductive Sciences, Division of Reproductive Endocrinology and Infertility, Yale University, New Haven, CT, USA
| | - R Orvieto
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - S Takahashi
- Department of Biomedical Ethics and Department of Obstetrics and Gynecology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - A Weghofer
- Center for Human Reproduction, 21 East 69th Street, New York, N.Y, 10021, USA
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090, Vienna, Austria
| | - S Ziebe
- Ringhospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | - N Noyes
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, and Northwell Health's System, New York, N.Y, USA
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