Chromosomal Preimplantation Genetic Diagnosis: 25 Years and Counting

From Public Eugenics to Private Eugenics: What Does the Future Hold?

Traditional public eugenics, which was ordered by the State, has been replaced by a kind of private eugenics conducted by parents using reproductive techniques, genetic testing and, eventually in the future, genetic engineering. While traditional eugenics strived to improve the species, the new model aims to satisfy parents' reproductive aspirations. The association between public and private eugenics is an ongoing issue, mostly due to its relation to nazi eugenics. This paper will state that both are eugenics; however, with different characteristics, and thus worthy of different legal and ethical assessments. The paper will contextualize private eugenics in the framework of reproductive rights (legal and ethical perspective) and in the development of genetics and reproductive techniques (scientific perspective). Finally, it will analyze some of the legal consequences of a broader acceptance of private eugenics, namely in terms of liability and tort law. Throughout the paper, the different legal solutions in place in Europe will contextualize its considerations.

Analysis of IVF live birth outcomes with and without preimplantation genetic testing for aneuploidy (PGT-A): UK Human Fertilisation and Embryology Authority data collection 2016-2018

Purpose

To examine the live birth and other outcomes reported with and without preimplantation genetic testing for aneuploidy (PGT-A) in the United Kingdom (UK) Human Embryology and Fertilization Authority (HFEA) data collection.

Methods

A retrospective cohort analysis was conducted following freedom of information (FoI) requests to the HFEA for the PGT-A and non-PGT-A cycle outcomes for 2016–2018. Statistical analysis of differences between PGT-A and non-PGT-A cycles was performed. Other than grouping by maternal age, no further confounders were controlled for; fresh and frozen transfers were included.

Results

Outcomes collected between 2016 and 2018 included total number of cycles, cycles with no embryo transfer, total number of embryos transferred, live birth rate (LBR) per embryo transferred and live birth rate per treatment cycle. Data was available for 2464 PGT-A out of a total 190,010 cycles. LBR per embryo transferred and LBR per treatment cycle (including cycles with no transfer) were significantly higher for all PGT-A vs non-PGT-A age groups (including under 35), with nearly all single embryo transfers (SET) after PGT-A (significantly more in non-PGT-A) and a reduced number of transfers per live birth particularly for cycles with maternal age over 40 years.

Conclusion

The retrospective study provides strong evidence for the benefits of PGT-A in terms of live births per embryo transferred and per cycle started but is limited in terms of matching PGT-A and non-PGT-A cohorts (e.g. in future studies, other confounders could be controlled for). This data challenges the HFEA “red traffic light” guidance that states there is “no evidence that PGT-A is effective or safe” and hence suggests the statement be revisited in the light of this and other new data.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10815-021-02349-0.

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

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.