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Pecnik P, Poschalko G, Just A, Fischer EM, Ott J. Association between the number of in vitro fertilization cycles and age at menopause. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2012. [DOI: 10.1016/s2305-0500(13)60070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Hershberger PE, Gallo AM, Kavanaugh K, Olshansky E, Schwartz A, Tur-Kaspa I. The decision-making process of genetically at-risk couples considering preimplantation genetic diagnosis: initial findings from a grounded theory study. Soc Sci Med 2012; 74:1536-43. [PMID: 22445765 PMCID: PMC3328546 DOI: 10.1016/j.socscimed.2012.02.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 01/30/2012] [Accepted: 02/01/2012] [Indexed: 12/31/2022]
Abstract
Exponential growth in genomics has led to public and private initiatives worldwide that have dramatically increased the number of procreative couples who are aware of their ability to transmit genetic disorders to their future children. Understanding how couples process the meaning of being genetically at-risk for their procreative life lags far behind the advances in genomic and reproductive sciences. Moreover, society, policy makers, and clinicians are not aware of the experiences and nuances involved when modern couples are faced with using Preimplantation Genetic Diagnosis (PGD). The purpose of this study was to discover the decision-making process of genetically at-risk couples as they decide whether to use PGD to prevent the transmission of known single-gene or sex-linked genetic disorders to their children. A qualitative, grounded theory design guided the study in which 22 couples (44 individual partners) from the USA, who were actively considering PGD, participated. Couples were recruited from June 2009 to May 2010 from the Internet and from a large PGD center and a patient newsletter. In-depth semi-structured interviews were completed with each individual partner within the couple dyad, separate from their respective partner. We discovered that couples move through four phases (Identify, Contemplate, Resolve, Engage) of a complex, dynamic, and iterative decision-making process where multiple, sequential decisions are made. In the Identify phase, couples acknowledge the meaning of their at-risk status. Parenthood and reproductive options are explored in the Contemplate phase, where 41% of couples remained for up to 36 months before moving into the Resolve phase. In Resolve, one of three decisions about PGD use is reached, including: Accepting, Declining, or Oscillating. Actualizing decisions occur in the Engage phase. Awareness of the decision-making process among genetically at-risk couples provides foundational work for understanding critical processes and aids in identifying important gaps for intervention and future research.
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Affiliation(s)
- Patricia E Hershberger
- Department of Women, Children, & Family Health Science, University of Illinois at Chicago, 845 S. Damen Avenue (MC802), Room 840, Chicago, IL 60612, USA.
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Silva S, Machado H. The construction of meaning by experts and would-be parents in assisted reproductive technology. SOCIOLOGY OF HEALTH & ILLNESS 2011; 33:853-868. [PMID: 21899561 DOI: 10.1111/j.1467-9566.2010.01327.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article explores the construction of meaning regarding assisted reproductive technology by legal framers, medical practitioners and would-be parents, through the concept of ecology of knowledge. It is argued that these inter-relationships between experts and lay people can be understood in terms of the formation of a social structure of ecology of knowledge, which depends on local and emotional knowledge co-produced by medical doctors, jurists and lay people in dynamic ways without compromising the autonomy of medical, legal and lay knowledge and skills. The assessment of the benefits and risks of assisted reproductive technology partially represents negotiations of knowledge between these social and professional groups, aiming to reproduce existing relations and practices, particularly the social power of medicine and technology, the dominant perceptions about women's and men's bodies and the geneticisation of genealogy. These negotiations of knowledge generate new rights, new social actors, new scientific fields and new ways of thinking and talking about individual and institutional responsibilities. Ecology of knowledge comes imbued with hope, trust, power, credibility of institutions and moralisation whereby some citizens' rights may be weakened.
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Affiliation(s)
- Susana Silva
- Institute of Public Health (ISPUP) and Cardiovascular R&D Unit, University of Porto Medical School, Portugal.
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Hershberger PE, Schoenfeld C, Tur-Kaspa I. Unraveling preimplantation genetic diagnosis for high-risk couples: implications for nurses at the front line of care. Nurs Womens Health 2011; 15:36-45. [PMID: 21332957 PMCID: PMC3408233 DOI: 10.1111/j.1751-486x.2011.01609.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Patricia E Hershberger
- University of Illinois at Chicago College of Nursing and College of Medicine, Chicago, IL, USA.
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55
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Bergmann S. Fertility Tourism: Circumventive Routes That Enable Access to Reproductive Technologies and Substances. SIGNS 2011; 36:280-88. [DOI: 10.1086/655978] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Silva S, Machado H. Heterosexual couples’ uses and meanings of ovarian stimulation: Relatedness, embodiment and emotions. Health (London) 2010; 15:620-32. [DOI: 10.1177/1363459310364161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article is about how ovarian stimulation is understood within the context of heterosexual couples’ relationships. The empirical research involves 15 semi-structured interviews with patients in Portugal who have undergone IVF programmes performed with eggs collected in stimulated cycles. We argue that the uses and meanings of ovarian stimulation expressed in the patients’ narratives represent situated values and knowledges conveyed by existing emotional resources within multiple gendered relations and identities. We discuss how empirical reconfigurations work in a mode of conversion of physical and emotional pain so that the application of subcutaneous injections to women’s bodies makes sense within IVF couples’ daily routine and in their conjugal relationship. The different practices of men’s involvement in the injection of hormones into women’s bodies are perceived as emotional moments, and men’s cooperation and/ or protection seems to be essential in this domain. The cultural assumptions underlying women’s duties regarding maternity reinforce a moral framework in which the pain and the complications associated with the ovarian stimulation are naturalized, normalized and accepted.
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Abstract
In this chapter we discuss several of the most relevant subjects related to ethics on Rare Diseases. Some general aspects are discussed such as the socio-psychological problems that confront the patients and their families that finally lead to marginalization and exclusion of patients affected by these diseases from the health programs, even in wealthy countries. Then we address problems related to diagnosis and some ethical aspects of newborn screening, prenatal, pre-implantation diagnosis and reference centers, as well as some conditions that should be met by the persons and institutions performing such tasks. Alternatives of solutions for the most critical situations are proposed. Subsequently the orphan drugs subject is discussed not only from the availability point of view, prizes, industrial practices, and purchasing power in developed and developing societies. The research related to rare disease in children and other especially vulnerable conditions, the need for informed consent, review boards or ethics comities, confidentiality of the information, biobanks and pharmacogenetics are discussed.
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Silva S, Machado H. Uncertainty, risks and ethics in unsuccessful in vitro fertilisation treatment cycles. HEALTH RISK & SOCIETY 2010. [DOI: 10.1080/13698575.2010.515734] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Harton G, Braude P, Lashwood A, Schmutzler A, Traeger-Synodinos J, Wilton L, Harper JC. ESHRE PGD consortium best practice guidelines for organization of a PGD centre for PGD/preimplantation genetic screening. Hum Reprod 2010; 26:14-24. [PMID: 20966460 DOI: 10.1093/humrep/deq229] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In 2005, the European Society for Human Reproduction and Embryology (ESHRE) PGD Consortium published a set of Guidelines for Best Practice PGD to give information, support and guidance to potential, existing and fledgling PGD programmes. Subsequent years have seen the introduction of new technologies as well as the evolution of current techniques. Additionally, in light of recent advice from ESHRE on how practice guidelines should be written/formulated, the Consortium believed it was timely to update the PGD guidelines. Rather than one document that covers all of PGD, the new guidelines are separated into four documents, including one relating to organization of the PGD centre and three relating to the methods used: DNA amplification, fluorescence in situ hybridization and biopsy/embryology. Here, we have updated the sections on organization of the PGD centre. One area that has continued to expand is Transport PGD, in which patients are treated at one IVF centre, whereas their gametes/embryos are tested elsewhere, at an independent PGD centre. Transport PGD/preimplantation genetic screening (PGS) has a unique set of challenges with respect to the nature of the sample and the rapid turn-around time required. PGS is currently controversial. Opinions of laboratory specialists and clinicians interested in PGD and PGS have been taken into account here. Current evidence suggests that PGS at cleavage stages is ineffective, but whether PGS at the blastocyst stage or on polar bodies might show improved delivery rates is still unclear. Thus, in this revision, PGS has been included. This document should assist everyone interested in PGD/PGS in developing the best laboratory and clinical practice possible.
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Affiliation(s)
- G Harton
- Reprogenetics LLC, Livingston, NJ 07039, USA.
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60
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Harton GL, Magli MC, Lundin K, Montag M, Lemmen J, Harper JC. ESHRE PGD Consortium/Embryology Special Interest Group--best practice guidelines for polar body and embryo biopsy for preimplantation genetic diagnosis/screening (PGD/PGS). Hum Reprod 2010; 26:41-6. [DOI: 10.1093/humrep/deq265] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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61
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Hershberger PE, Pierce PF. Conceptualizing couples' decision making in PGD: emerging cognitive, emotional, and moral dimensions. PATIENT EDUCATION AND COUNSELING 2010; 81:53-62. [PMID: 20060677 PMCID: PMC2888878 DOI: 10.1016/j.pec.2009.11.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 09/02/2009] [Accepted: 11/21/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To illuminate and synthesize what is known about the underlying decision making processes surrounding couples' preimplantation genetic diagnosis (PGD) use or disuse and to formulate an initial conceptual framework that can guide future research and practice. METHODS This systematic review targeted empirical studies published in English from 1990 to 2008 that examined the decision making process of couples or individual partners that had used, were eligible for, or had contemplated PGD. Sixteen studies met the eligibility requirements. To provide a more comprehensive review, empirical studies that examined healthcare professionals' perceptions of couples' decision making surrounding PGD use and key publications from a variety of disciplines supplemented the analysis. RESULTS The conceptual framework formulated from the review demonstrates that couples' PGD decision making is composed of three iterative and dynamic dimensions: cognitive appraisals, emotional responses, and moral judgments. CONCLUSION Couples think critically about uncertain and probabilistic information, grapple with conflicting emotions, and incorporate moral perspectives into their decision making about whether or not to use PGD. PRACTICE IMPLICATIONS The quality of care and decisional support for couples who are contemplating PGD use can be improved by incorporating focused questions and discussion from each of the dimensions into counseling sessions.
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Affiliation(s)
- Patricia E Hershberger
- University of Illinois at Chicago, College of Nursing and College of Medicine, Chicago, IL 60612, USA.
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Erez A, Plunkett K, Sutton VR, McGuire AL. The right to ignore genetic status of late onset genetic disease in the genomic era; Prenatal testing for Huntington disease as a paradigm. Am J Med Genet A 2010; 152A:1774-80. [PMID: 20583190 DOI: 10.1002/ajmg.a.33432] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
During the last decade, the field of human genome research has gone through a phase of rapid discovery that has provided scientists and physicians with a wide variety of research tools that are applicable to important medical issues. We describe a true case of familial Huntington disease (HD) in which we modified personal details to protect patient's privacy, where the proband at risk preferred not to know his disease status but wanted to know the status in his unborn child. Once we found the father to be negative, the case raised an important ethical question regarding the management of this as well as future pregnancies. This article discusses the arguments for and against the right not to know of one's carrier status, as well as professional obligations in the context of withholding unwanted information that may have direct implications not only for the patient himself but also for other family members. HD has served as a model for many other adult onset genetic diseases in terms of carrier testing guidelines. Hence, we feel it is time to revisit the issue of prenatal testing for HD and consider updating the current recommendations regarding the patient's right to "genetic ignorance", or the right not to know genetic information.
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Affiliation(s)
- A Erez
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
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63
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Bouffard C, Godin JK, Bévière B. State Intervention in Couples’ Reproductive Decisions: Socioethical Reflections Based on the Practice of Preimplantation Genetic Diagnosis in France. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/21507716.2010.505897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ehrich K, Williams C. A 'healthy baby': The double imperative of preimplantation genetic diagnosis. Health (London) 2010; 14:41-56. [PMID: 20051429 DOI: 10.1177/1363459309347477] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reports from a study exploring the social processes, meanings and institutions that frame and produce 'ethical problems' and clinical dilemmas for practitioners, scientists and others working in the specialty of preimplantation genetic diagnosis (PGD). A major topic in the data was that, in contrast to IVF, the aim of PGD is to transfer to the woman's womb only those embryos likely to be unaffected by serious genetic disorders; that is, to produce 'healthy babies'. Staff described the complex processes through which embryos in each treatment cycle must meet a double imperative: they must be judged viable by embryologists and 'unaffected' by geneticists. In this article, we focus on some of the ethical, social and occupational issues for staff ensuing from PGD's double imperative.
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Affiliation(s)
- Kathryn Ehrich
- Centre for Biomedicine & Society, King's College London, Strand, London, UK.
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65
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Caldas GH, Caldas E, Araújo ED, Bonetti TCS, Leal CB, Costa AM. Opinions concerning pre-implantation genetic diagnosis and sex selection among gynecologist-obstetricians in Brazil. Eur J Obstet Gynecol Reprod Biol 2009; 148:158-62. [PMID: 19926204 DOI: 10.1016/j.ejogrb.2009.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 09/22/2009] [Accepted: 10/19/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to assess a sample of obstetrician-gynecologists on their technical knowledge of PGD as well as their views of PGD and sex selection (SS). STUDY DESIGN Cross-sectional observational study, carried out during a Congress on Gynecology and Obstetrics. A self-report questionnaire was offered to all professionals registered to attend the Congress and answers of 723 physicians were analyzed. RESULTS Of the participants, 436 (60.3%) were female and 287 (39.7%) were male; 517 (71.5%) had children. Regarding knowledge of PGD techniques, 63.2% had heard something about PGD and/or preconception SS. Concerning SS, physicians believed that SS is always the couple's choice (36.4%), should be the couple's choice only in specific situations (42.6%), or did not agree that SS should be a couple's choice (17.4%). A majority of the respondents were in favor of PGD and believed that pre-embryos with 6-8 cells are human life in potency. CONCLUSIONS In spite of a small percentage of gynecologists-obstetricians in Brazil had knowledge of PGD techniques, many of them recognized it to be a method to prevent genetic diseases and agreed with its use. The SS appears to be highly accepted for use in specific situations.
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Affiliation(s)
- George H Caldas
- Medicine Center of Sergipe-Fertility Clinic, CEMISE-CLIFERT, Aracaju, SE, Brazil.
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66
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Karatas JC, Strong KA, Barlow-Stewart K, McMahon C, Meiser B, Roberts C. Psychological impact of preimplantation genetic diagnosis: a review of the literature. Reprod Biomed Online 2009; 20:83-91. [PMID: 20158992 DOI: 10.1016/j.rbmo.2009.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 05/11/2009] [Accepted: 09/15/2009] [Indexed: 11/26/2022]
Abstract
Preimplantation genetic diagnosis (PGD) was first reported as successful in humans in the early 1990s and nearly two decades later the psychological impact of PGD has not yet been clearly defined. As PGD requires the use of IVF, this paper provides a brief summary of literature related to the various psychological aspects of IVF followed by a review of the literature related to the psychological and broader psychosocial impact of PGD. The current literature includes attitudinal studies of couples for whom PGD may be beneficial and results suggest that those with traumatic reproductive and genetic histories are more likely to find PGD an acceptable treatment option. A small number of studies have used samples of women and couples who have used PGD. Due to a general lack of homogeneity in scope, method and results, these studies have not provided a uniform understanding of the PGD experience. Promisingly, however, two studies on parents of children born after PGD that explored parental stress show no differences between PGD, IVF and natural conception couples. The paper concludes that the missing link in the literature is a prospective study of PGD using validated psychological scales. Suggestions for future research are provided.
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Affiliation(s)
- J C Karatas
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia.
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68
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Bouffard C, Viville S, Knoppers BM. Genetic diagnosis of embryos: clear explanation, not rhetoric, is needed. CMAJ 2009; 181:387-91. [PMID: 19687106 DOI: 10.1503/cmaj.080658] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Chantal Bouffard
- Division of Genetics, Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada.
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69
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Stuppia L, Gatta V, Antonucci I, Giuliani R, Scioletti AP, Palka G. Genetic testing in couples undergoing assisted reproduction technique protocols. ACTA ACUST UNITED AC 2009; 3:571-83. [DOI: 10.1517/17530050902970986] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Checa MA, Alonso-Coello P, Solà I, Robles A, Carreras R, Balasch J. IVF/ICSI with or without preimplantation genetic screening for aneuploidy in couples without genetic disorders: a systematic review and meta-analysis. J Assist Reprod Genet 2009; 26:273-83. [PMID: 19629673 DOI: 10.1007/s10815-009-9328-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 07/10/2009] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To assess the efficacy of preimplantation genetic screening to increase ongoing pregnancy rates in couples without known genetic disorders. METHODS Systematic review and meta-analysis of randomized controlled trials. Two reviewers independently determined study eligibility and extracted data. RESULTS Ten randomized trials (1,512 women) were included. The quality of evidence was moderate. Meta-analyses using a random-effects model suggest that PGS has a lower rate of ongoing pregnancies (risk ratio=0.73, 95% confidence interval 0.62-0.87) and a lower rate of live births (risk ratio=0.76, 95% confidence interval 0.64-0.91) than standard in vitro fertilization/intracytoplasmic sperm injection. CONCLUSIONS In women with poor prognosis or in general in vitro fertilization program, in vitro fertilization/intracytoplasmic sperm injection with preimplantation genetic screening for aneuploidy does not increase but instead was associated with lower rates of ongoing pregnancies and live births. The use of preimplantation genetic screening in daily practice does not appear to be justified.
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Affiliation(s)
- Miguel A Checa
- Department of Obstetrics and Gynecology, Hospital Universitari del Mar, Autonomous University of Barcelona, Passeig Marítim 25-29, Barcelona 08003, Spain.
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71
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Affiliation(s)
- A Nakash
- Department of Obstetrics and Gynaecology, Homerton Hospital, London, UK.
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72
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Basille C, Frydman R, Aly AE, Hesters L, Fanchin R, Tachdjian G, Steffann J, LeLorc’h M, Achour-Frydman N. Preimplantation genetic diagnosis: State of the art. Eur J Obstet Gynecol Reprod Biol 2009; 145:9-13. [DOI: 10.1016/j.ejogrb.2009.04.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 02/10/2009] [Accepted: 04/01/2009] [Indexed: 10/20/2022]
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Alonso Cerezo C, Carmen Cañadas Gálvez M, de la Fuente Hernández LA, García-Ochoa C, Sagredo JMG, Villafáñez VG, González MM, Virgili RO, Clemente MO. Recomendaciones para el estudio genético de la pareja con alteraciones en la reproducción. Rev Int Androl 2009. [DOI: 10.1016/s1698-031x(09)72572-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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74
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Krahn T. Preimplantation genetic diagnosis: does age of onset matter (anymore)? MEDICINE, HEALTH CARE, AND PHILOSOPHY 2009; 12:187-202. [PMID: 18979183 DOI: 10.1007/s11019-008-9171-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Accepted: 10/03/2008] [Indexed: 05/27/2023]
Abstract
The identification and avoidance of disease susceptibility in embryos is the most common goal of preimplantation genetic diagnosis (PGD). Most jurisdictions that accept but regulate the availability of PGD restrict it to what are characterized as 'serious' conditions. Line-drawing around seriousness is not determined solely by the identification of a genetic mutation. Other factors seen to be relevant include: impact on health or severity of symptoms; degree of penetrance (probability of genotype being expressed as a genetic disorder); potential for therapy; rate of progression; heritability; and age of onset. In the original applications of PGD, most, if not all of these factors were seen as necessary but none was seen as sufficient for determining whether a genetic condition was labelled 'serious'. This, however, is changing as impact on health or severity of symptoms is coming to eclipse the other considerations. This paper investigates how age of onset (primarily in the context of the United Kingdom (UK)) has become considerably less significant as a criterion for determining ethically acceptable applications of PGD. Having moved off the threshold of permitting PGD testing for only fatal (or seriously debilitating), early-onset diseases, I will investigate reasons for why age of onset will not do any work to discriminate between which adult-onset diseases should be considered serious or not. First I will explain the rationale underpinning age of onset as a factor to be weighed in making determinations of seriousness. Next I will challenge the view that later-onset conditions are less serious for being later than earlier-onset conditions. The final section of the paper will discuss some of the broader disability concerns at stake in limiting access to PGD based upon determinations of the 'seriousness' of genetic conditions. Instead of advocating a return to limiting PGD to only early-onset conditions, I conclude that the whole enterprise of trying to draw lines of what is to count as a 'serious' condition is itself problematic and in certain ways morally misleading.
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Affiliation(s)
- Timothy Krahn
- Novel Tech Ethics, Bioethics Department, Dalhousie University, Intellectual Commons, 1234 LeMarchant St., Halifax, Nova Scotia, Canada.
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75
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Quality management system in PGD/PGS: now is the time. J Assist Reprod Genet 2009; 26:197-204. [PMID: 19266277 DOI: 10.1007/s10815-009-9307-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Accepted: 02/19/2009] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Governments and international authorities require an accreditation of the PGD/PGS laboratories in order to ensure the safety and reproducibility of these analytical procedures. The implementation of a Quality Management System is the first mandatory step prior to accreditation. Our aim is to offer a detailed guidance to the PGD/PGS community that would like to implement this system in the future. METHODS The certification was based on the norm ISO 9001:2000 and requires the identification of procedures, definition of the flowchart, documentation of the processes, recognition of the critical control points, establishment of quality controls, performance of validation and audit system. RESULTS The achievement of ISO certification with the specific scope of "preimplantation genetic diagnosis". CONCLUSION Certification of PGD/PGS allows to achieve evaluation of the efficiency to ensure the sensitivity and a continuous improvement of the genetic diagnosis of embryonic single cells.
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76
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Delatycki MB. Population screening for reproductive risk for single gene disorders in Australia: now and the future. Twin Res Hum Genet 2009; 11:422-30. [PMID: 18637742 DOI: 10.1375/twin.11.4.422] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract As the results of the Human Genome Project are realized, it has become technically possible to identify carriers of numerous autosomal and X-linked recessive disorders. Couples at risk of having a child with one of these conditions have a number of reproductive options to avoid having a child with the condition should they wish. In Australia the haemoglobinopathies are the only group of conditions for which population screening is widely offered and which is government funded. In some Australian states there are also population screening programs for cystic fibrosis and autosomal recessive conditions more common in Ashkenazi Jewish individuals which are generally offered on a user pays basis. It is predicted that as consumer demand increases and testing becomes cheaper, that many people planning or in the early stages of pregnancy will have carrier screening for multiple genetic conditions. This will have significant implications for genetic counseling, laboratory and prenatal testing resources. In addition such screening raises a number of ethical issues including the value of lives of those born with genetic conditions for which screening is available.
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Affiliation(s)
- Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Childrens Research Institute, Australia.
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77
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Engels H, Eggermann T, Caliebe A, Jelska A, Schubert R, Schüler HM, Panasiuk B, Zaremba J, Latos-Bieleńska A, Jakubowski L, Zerres KP, Schwanitz G, Midro AT. Genetic counseling in Robertsonian translocations der(13;14): frequencies of reproductive outcomes and infertility in 101 pedigrees. Am J Med Genet A 2008; 146A:2611-6. [PMID: 18798317 DOI: 10.1002/ajmg.a.32500] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Robertsonian translocations 13/14 are the most common chromosome rearrangements in humans. However, most studies aimed at determining risk figures are more than 20 years old. Their results are often contradictory regarding important topics in genetic counseling such as infertility and unfavorable pregnancy outcomes. Here, we present a study on a sample of 101 previously unreported pedigrees of der(13;14)(q10;q10). In order to minimize problems of partial ascertainment, we included families with a wide range of reasons of ascertainment such as birth of a child with congenital anomalies, prenatal diagnosis due to maternal age, fertility problems and recurrent pregnancy loss. No evidence of increased infertility rates of female and male carriers was found. The detected miscarriage frequency of female carriers was higher than previously reported (27.6 +/- 4.0% of all spontaneous pregnancies). This may be explained by an over-correction of earlier studies, which excluded all unkaryotyped miscarriages. In three out of 42 amniocenteses, translocation trisomies 13 were diagnosed (7.1 +/- 4.0% of all amniocenteses). The frequency of stillbirths was 3.3 +/- 1.6% for female carriers and 1.4 +/- 1.4% for male carriers. A low risk for the live birth of translocation trisomy 13 children was confirmed since no live born children with trisomy 13 or Pätau syndrome were detected in the ascertainment-corrected sample.
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78
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Ziebe S, Devroey P. Assisted reproductive technologies are an integrated part of national strategies addressing demographic and reproductive challenges. Hum Reprod Update 2008; 14:583-92. [DOI: 10.1093/humupd/dmn038] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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79
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Reichenbach J, Van de Velde H, De Rycke M, Staessen C, Platteau P, Baetens P, Güngör T, Ozsahin H, Scherer F, Siler U, Seger RA, Liebaers I. First successful bone marrow transplantation for X-linked chronic granulomatous disease by using preimplantation female gender typing and HLA matching. Pediatrics 2008; 122:e778-82. [PMID: 18762514 DOI: 10.1542/peds.2008-0123] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation from an human leukocyte antigen (HLA)-identical donor is currently the only proven curative treatment for chronic granulomatous disease. Hematopoietic stem cell transplantation with alternative donors is associated with higher morbidity and mortality. Therefore, we performed in vitro fertilization and preimplantation HLA matching combined with female sexing for hematopoietic stem cell transplantation in chronic granulomatous disease. Ethical and psychological issues were considered carefully. We used in vitro fertilization with X-enriched spermatozoa followed by preimplantation genetic diagnosis to identify female HLA-genoidentical embryos in a family in need of a suitable donor for their boy affected with severe X-linked chronic granulomatous disease. Two preimplantation genetic diagnosis cycles were performed in the family. In the second cycle, 2 HLA-genoidentical female embryos were transferred and a singleton pregnancy was obtained, resulting in the birth of an unaffected girl at term. Because of insufficient cell numbers in the cord-blood source, conventional hematopoietic stem cell transplantation had to be performed at 12 months of age of the donor and 5 years of age of the recipient and resulted in complete stable donor chimerism and immunologic reconstitution up to 25 months post-hematopoietic stem cell transplantation. Hematopoietic stem cell transplantation after in vitro fertilization and combined female sexing and HLA matching offers a new and relatively rapid therapeutic option for patients with X-linked primary immunodeficiency such as chronic granulomatous disease who need hematopoietic stem cell transplantation but lack an HLA-genoidentical donor.
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Affiliation(s)
- Janine Reichenbach
- University Children's Hospital Zurich, Division of Immunology/Hematology/BMT, Steinwiesstrasse 75, CH-8032 Zürich, Switzerland.
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80
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Yakin K, Urman B. What next for preimplantation genetic screening? A clinician's perspective. Hum Reprod 2008; 23:1686-90. [DOI: 10.1093/humrep/den241] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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81
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Nelen WLDM, van der Pluijm RW, Hermens RPMG, Bergh C, de Sutter P, Nygren KG, Wetzels AMM, Grol RPTM, Kremer JAM. The methodological quality of clinical guidelines of the European Society of Human Reproduction and Embryology (ESHRE). Hum Reprod 2008; 23:1786-92. [PMID: 18480089 DOI: 10.1093/humrep/den120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Clinical practice guidelines bridge the gap between the evidence from literature and clinical practice, and they may provide guidance in ethical, legal and societal dilemmas. To explore the potentials for future international guideline development within the field of human reproduction and embryology, we assessed the quality of existing guidelines produced by the European Society of Human Reproduction and Embryology (ESHRE). METHODS We systematically searched for the ESHRE guidelines produced after 1996 in electronic databases and on the Internet. Subsequently, we assessed the methodological quality of these guidelines using the validated Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. RESULTS The overall methodological quality of most of the 11 selected ESHRE guidelines was poor. Most of the guidelines scored <30% in the domains of 'stakeholder involvement', 'rigour of development', 'applicability' and 'editorial independence'. Only one guideline was rated 'strongly recommended'. CONCLUSIONS The methodological quality of the guidelines produced under the auspices of ESHRE can be improved. We suggest a systematic, up-to-date methodology, investment in guideline development specialists, systematic quality control and the incorporation of indicator development. Furthermore, attention should be paid to the document nomenclature, and an ESHRE guidelines' summary on a special part of the ESHRE website would be a good initiative.
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Affiliation(s)
- W L D M Nelen
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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82
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Knoppers BM, Bordet S, Isasi RM. Preimplantation genetic diagnosis: an overview of socio-ethical and legal considerations. Annu Rev Genomics Hum Genet 2008; 7:201-21. [PMID: 16724879 DOI: 10.1146/annurev.genom.7.080505.115753] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Preimplantation genetic diagnosis (PGD) permits the selection of embryos of a particular genotype prior to implantation. As a reproductive technology involving embryo selection, PGD has become associated with considerable controversy. This review examines some of the ethical, legal, and social issues raised by PGD. Relevant ethical considerations include the status of the embryo and the interests and duties of the parents. On a social policy level, considerations of access as well as the impact of this technology on families, women, and physician's duties also warrant consideration. An analysis of these issues in the context of using PGD for selecting embryos unaffected by a serious disorder and for sex selection is presented. We also present a brief survey of PGD-related regulatory schemes in several countries, including the United Kingdom and the United States.
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Affiliation(s)
- Bartha M Knoppers
- Centre de recherche en droit public (CRDP), Université de Montréal, Montréal, Québec, Canada.
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83
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Preimplantation genetic screening: "established" and ready for prime time? Fertil Steril 2008; 89:780-8. [PMID: 18353323 DOI: 10.1016/j.fertnstert.2008.01.072] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 01/17/2008] [Accepted: 01/18/2008] [Indexed: 11/24/2022]
Abstract
Unless attempts to improve pregnancy rates and/or diminish miscarriage rates through preimplantation genetic screening (PGS) are applied to only carefully selected patients, they will fail. Because specific PGS indications have remained undefined, PGS should be considered an experimental procedure.
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84
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Victoria Hurtado de Mendoza M, González-Utor AL, Díaz R, Cascales O, Alonso J, Fernández S, Gutiérrez P. Niños nacidos de técnicas de reproducción asistida con espermatozoides no procedentes de eyaculado. Rev Int Androl 2008. [DOI: 10.1016/s1698-031x(08)72564-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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85
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Provision and quality assurance of preimplantation genetic diagnosis in Europe. Eur J Hum Genet 2007; 16:290-9. [DOI: 10.1038/sj.ejhg.5201976] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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86
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Bredenoord A, Pennings G, Smeets H, de Wert G. Dealing with uncertainties: ethics of prenatal diagnosis and preimplantation genetic diagnosis to prevent mitochondrial disorders. Hum Reprod Update 2007; 14:83-94. [DOI: 10.1093/humupd/dmm037] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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87
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Genetische Beratung in der Reproduktionsmedizin. GYNAKOLOGISCHE ENDOKRINOLOGIE 2007. [DOI: 10.1007/s10304-006-0173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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88
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Castaldo G, D'Argenio V, Nardiello P, Zarrilli F, Sanna V, Rocino A, Coppola A, Di Minno G, Salvatore F. Haemophilia A: molecular insights. Clin Chem Lab Med 2007; 45:450-61. [PMID: 17439320 DOI: 10.1515/cclm.2007.093] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractHaemophilia A is the most common inherited bleeding disorder caused by defects in theClin Chem Lab Med 2007;45:450–61.
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Affiliation(s)
- Giuseppe Castaldo
- Dipartimento di Biochimica e Biotecnologie Mediche, Università di Napoli Federico II, CEINGE-Biotecnologie avanzate and SEMM, Naples, Italy.
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89
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Sermon KD, Michiels A, Harton G, Moutou C, Repping S, Scriven PN, SenGupta S, Traeger-Synodinos J, Vesela K, Viville S, Wilton L, Harper JC. ESHRE PGD Consortium data collection VI: cycles from January to December 2003 with pregnancy follow-up to October 2004. Hum Reprod 2006; 22:323-36. [PMID: 17132677 DOI: 10.1093/humrep/del402] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The sixth report of the ESHRE PGD Consortium is presented, relating to cycles collected for the calendar year 2003 and follow-up of the pregnancies and babies born up to October 2004. Since the beginning of the data collections, there has been a steady rise in the number of cycles, pregnancies and babies reported. For this report, 50 centres participated, reporting on 2984 cycles, 501 pregnancies and 373 babies born. Five hundred and twenty-nine cycles were reported for chromosomal abnormalities, 516 cycles were reported for monogenic diseases, 137 cycles were reported for sexing for X-linked diseases, 1722 cycles were reported for preimplantation genetic screening (PGS) and 80 cycles were reported for social sexing. Data VI is compared to the cumulative data for data collections I-V.
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Affiliation(s)
- K D Sermon
- Centre for Medical Genetics, University Hospital and Medical School of the Dutch-speaking Brussels Free University, Brussels, Belgium.
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90
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Wittenberger MD, Hagerman RJ, Sherman SL, McConkie-Rosell A, Welt CK, Rebar RW, Corrigan EC, Simpson JL, Nelson LM. The FMR1 premutation and reproduction. Fertil Steril 2006; 87:456-65. [PMID: 17074338 DOI: 10.1016/j.fertnstert.2006.09.004] [Citation(s) in RCA: 262] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 08/04/2006] [Accepted: 08/04/2006] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To update clinicians on the reproductive implications of premutations in FMR1 (fragile X mental retardation 1). Fragile X syndrome, a cause of mental retardation and autism, is due to a full mutation (>200 CGG repeats). Initially, individuals who carried the premutation (defined as more than 55 but less than 200 CGG repeats) were not considered at risk for any clinical disorders. It is now recognized that this was incorrect, specifically with respect to female reproduction. DESIGN AND SETTING Literature review and consensus building at two multidisciplinary scientific workshops. CONCLUSION(S) Convincing evidence now relates the FMR1 premutation to altered ovarian function and loss of fertility. An FMR1 mRNA gain-of-function toxicity may underlie this altered ovarian function. There are major gaps in knowledge regarding the natural history of the altered ovarian function in women who carry the FMR1 premutation, making counseling about reproductive plans a challenge. Women with premature ovarian failure are at increased risk of having an FMR1 premutation and should be informed of the availability of fragile X testing. Specialists in reproductive medicine can provide a supportive environment in which to explain the implications of FMR1 premutation testing, facilitate access to testing, and make appropriate referral to genetic counselors.
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Affiliation(s)
- Michael D Wittenberger
- Intramural Research Program, Section on Women's Health Research, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-1103, USA
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91
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Schmidtke J. [Genetic diagnosis in medicine. An overview of basic concepts and applications]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2006; 49:982-8. [PMID: 17013778 DOI: 10.1007/s00103-006-0043-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Currently, more than half of all known monogenic diseases are characterized at the molecular (DNA) level. This opens the possibility to verify clinically suspected disease at the molecular level, to predict future (late-onset) disorders, to diagnose many diseases prenatally, and to screen the population for genetic traits. Genetic tests that can be performed in Germany, Austria and Switzerland are listed in a database maintained by the German Board of Human Genetics. As of May 2006, 678 different diseases were amenable to DNA-based testing, and 147 institutions offered such tests. The actual genetic test utilisation cannot be determined accurately, but can be deduced from the database of the "Zentralinstitut der Kassenärztlichen Bundesvereinigung". Data have been calculated for the years 1996- 2002. In this time interval, the number of individuals undergoing genetic testing doubled approximately every three years. The total number in 2002 can be estimated at 220,000.
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Affiliation(s)
- J Schmidtke
- Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, BRD.
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92
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The need for interaction between assisted reproduction technology and genetics. Recommendations of the European Societies of Human Genetics and Human Reproduction and Embryology. Eur J Hum Genet 2006; 14:509-11. [PMID: 16636691 DOI: 10.1038/sj.ejhg.5201600] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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93
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