Preimplantation genetic testing for aneuploidy: It's déjà vu all over again!

Schattman, Glenn

doi:10.1016/j.fertnstert.2019.08.102

Cited by 25 publications

(18 citation statements)

References 5 publications

(4 reference statements)

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“…The IDNHG-IVF is a consensus-body of clinicians, embryologists and basic scientists, concerned with advocation of insufficiently validated add-ons to IVF. Because of an important recently published study [7] with two accompanying commentaries [8,9], this communication appears timely.…”

Section: Introductionmentioning

confidence: 95%

“…While mounting reports [7,10], some succinct commentaries [8,9] and a restated combined American Society for Reproductive Medicine (ASRM)/Society for Assisted Reproductive Technology (SART) committee opinion [16], refute such a conclusion, this introductory statement appears clearly meant to convey that PGT-A improves implantation, pregnancy and live birth rates and reduces implantation failure. By using the denominator, "per transfer, " the statement is, didactically correct; it, however, at the same time conveys highly misleading information since, as is widely accepted, IVF outcome reporting with reference point embryo transfer excludes poorer-prognosis patients whose embryos may never reach embryo transfer, especially if, as in cases of PGT-A, embryo culture to blastocyst-stage becomes mandatory.…”

Section: Addressing the 2019 Pgdis Position Statement (Ps)mentioning

confidence: 99%

“…Schattman in a recent commentary considered the overall study outcome convincing enough to advocate limiting PGT-A to only "rarest of cases" and to research studies with appropriate informed consent [9]. In a second commentary, Paulson saw a potentially somewhat brighter future for the procedure if PGT-A could be performed non-invasively from spent media; but he also cautioned against its utilization in women with small embryo numbers (i.e., in poor prognosis patients) [8].…”

Section: Addressing the 2019 Pgdis Position Statement (Ps)mentioning

confidence: 99%

“…Without offering restrictions, the PGDIS-PS, thus, continues to support broad adoption of PGT-A in routine IVF. Results of the STAR trial [7] and of accompanying commentaries [8,9]), suggest, however, otherwise. It now appears established that PGT-A in a number of sequential incarnations, so-far, has failed to establish any validated clinical utility in association with IVF.…”

Section: How Does This Affect Aneuploidy Testing In Clinical Practice?mentioning

confidence: 99%

“…It now appears established that PGT-A in a number of sequential incarnations, so-far, has failed to establish any validated clinical utility in association with IVF. Schattman advocated that its use be curtailed to clinical trials in efforts to potentially identify subgroups who, after all, may benefit from PGT-A [9]. Paulson sounded a little less restrictive in his commentary [8] but also demanded reconsideration of PGT-A utilization in well-defined patient populations and strongly argued against continuous utilization in older women with small embryo numbers.…”

Section: How Does This Affect Aneuploidy Testing In Clinical Practice?mentioning

confidence: 99%

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The 2019 PGDIS position statement on transfer of mosaic embryos within a context of new information on PGT-A

Gleicher

Albertini

Barad

et al. 2020

Reprod Biol Endocrinol

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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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Section: Introductionmentioning

confidence: 95%

Section: Addressing the 2019 Pgdis Position Statement (Ps)mentioning

confidence: 99%

Section: Addressing the 2019 Pgdis Position Statement (Ps)mentioning

confidence: 99%

Section: How Does This Affect Aneuploidy Testing In Clinical Practice?mentioning

confidence: 99%

Section: How Does This Affect Aneuploidy Testing In Clinical Practice?mentioning

confidence: 99%

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The 2019 PGDIS position statement on transfer of mosaic embryos within a context of new information on PGT-A

Gleicher

Albertini

Barad

et al. 2020

Reprod Biol Endocrinol

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PGT‐A: The biology and hidden failures of randomized control trials

Wang

et al. 2022

Prenatal Diagnosis

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Objective Preimplantation Genetic Testing ‐ Aneuploidy (PGT‐A) for embryo selection has undergone significant advancements in the last 2 decades and yet many studies still fail to demonstrate any clinical benefits over traditional embryo morphology selection (Mo‐S). To understand this conundrum, we performed a multi‐center clinical study of PGT‐A patients, where Mo‐S and euploid selection (Eu‐S) outcomes were directly compared. Method All suitable blastocysts were biopsied and analyzed for chromosome copy number. Outcomes (positive beta hCG, implantation, ongoing pregnancy, and live birth rates) for Eu‐S were compared to Mo‐S using single embryo transfers. Results Compared to Eu‐S embryos, Mo‐S embryos resulted in significant reduction of outcomes for positive beta hCG (p = 0.0005), implantation (p = 0.0008), ongoing pregnancy (p = 0.0046), livebirth (p = 0.0112), babies per transfer (p = 0.0112), and babies per embryo transferred (p = 0.0112). Morphology selection resulted in patients of all age groups having non‐euploid embryos chosen for transfer. Post‐hoc evaluation of individual clinic performances showed variable transfer outcomes that could potentially confound the true benefits of PGT‐A. Conclusion Embryo chromosome status is central to improved embryo transfer outcomes and sole reliance on current morphology‐based selection practices, without Eu‐S, will always compromise outcomes. Often overlooked but a major effector of successful PGT‐A outcomes are individual clinic performances.

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Aneuploidiescreening in der Altersgruppe über 40 Jahre – Sinn oder Unsinn?

Schmutzler

Strowitzki

2020

Gynäkologische Endokrinologie

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Preimplantation genetic testing for aneuploidy: It's déjà vu all over again!

Cited by 25 publications

References 5 publications

The 2019 PGDIS position statement on transfer of mosaic embryos within a context of new information on PGT-A

The 2019 PGDIS position statement on transfer of mosaic embryos within a context of new information on PGT-A

PGT‐A: The biology and hidden failures of randomized control trials

Aneuploidiescreening in der Altersgruppe über 40 Jahre – Sinn oder Unsinn?

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