Aneuploid embryo transfer: clinical policies and provider opinions at United States fertility clinics

Abstract

Objective: To describe institutional clinical policies and individual provider opinions regarding aneuploid embryo transfer (aET). Design: A survey about clinical policies was electronically sent to Society for Assisted Reproductive Technology (SART) member laboratory directors, and a separate survey about personal opinions was electronically sent to all SART members. Setting: Not applicable. Patients: Patients pursuing preimplantation genetic testing for aneuploidy (PGT-A). Intervention: Not applicable. Main Outcome Measures: Current clinical policies about aET were described. Individual provider opinions about aET in the context of specific aneuploidies and mosaicism were also described. Results: A total of 48 laboratory directors and 212 individual providers responded to their respective surveys. Twelve (25%) clinics report that they do not have a policy regarding aET, but clinics performing PGT-A in >100 cycles per year were more likely to have a policy. Half of the individual providers agree that an embryo with trisomy 21 should be available for aET, but most disagreed with aET of embryos with other aneuploidies and most were either unsure about or unwilling to transfer embryos with mosaicism. Those who worked in primarily patient-facing roles held more agreeable opinions regarding aET. Conclusion:There is no consensus regarding ideal clinical policies for aET. The wide range of current clinical practices and individual provider opinions regarding under what circumstances, if any, aET should be available to patients indicates that this is a divisive issue among ART providers, and there is a clear need for specific professional guidelines to address this issue. (Fertil Steril Ò 2020;114:110-7. Ó2020 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

Progress and Challenges in Laboratory-Based Diagnostic and Screening Approaches for Aneuploidy Detection during Pregnancy

“…98,100 Groups such as the Practice Committee of the American Society for Reproductive Medicine (ASRM), Genetic Counseling Professional Group (GCPG), Preimplantation Genetic Diagnosis International Society (PGDIS), and Society for Assisted Reproductive Technology (SART) have all worked to provide statements or reports regarding the clinical management of mosaic and aneuploidy embryo transfer to address these limitations. 101–103 There have also been alternative statements presented in response, for example, by the International Do No Harm Group in IVF (IDNHG-IVF), regarding concerns of increasing added procedures to IVF. 104 In addition to statements by groups or professional societies, continued research has been pursued regarding the safety of these embryo transfers by groups, including Grati et al, who devised an evidence-based scoring system for prioritizing mosaic aneuploid embryos for transfer.…”

Legal challenges in reproductive genetics

“…In addition, clinics increasingly use NGS rather than the less sensitive fluorescence in situ hybridization to assess the biopsied cells (37). NGS allows laboratories to assess chromosome copy number to distinguish full aneuploidy from mosaicism (38,39), which can be inferred by identifying an intermediate chromosome copy number. Because the detection of mosaicism is influenced by the stage of the embryo biopsy, the method of analysis, and the classification scheme used (40), laboratories differ considerably in their detection rates.…”

Preimplantation genetic testing for aneuploidy: the conundrum with aneuploid embryo transfers

“…This hypothesis has evolved into the clinical test known as preimplantation genetic testing for aneuploidy (PGT-A). PGT-A has become increasingly popular in the past few years, with 40% of all in vitro fertilization (IVF) cycles in the U.S. including it (1).…”

“…McGowan et al (1) sought to obtain a better understanding on the policies and opinions of a diverse group of IVF practitioners regarding the transfer of aneuploid embryos (aET). They prepared two different survey questionnaires that were sent out to laboratory directors belonging to the Society for Assisted Reproductive Technology (SART) and to other SART members.…”

“…This very low participation risks causing bias regarding this study's results and conclusions, which may therefore fail to provide an accurate insight in the clinical management of fully aneuploid or mosaic embryos. In addition, these surveys were only available to US clinics, meaning that the policies and opinions described by McGowan et al (1) may not be representative of the situation in Europe nor the rest of the world.…”