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Siermann M, Valcke O, Vermeesch JR, Raivio T, Tšuiko O, Borry P. Limitations, concerns and potential: attitudes of healthcare professionals toward preimplantation genetic testing using polygenic risk scores. Eur J Hum Genet 2023; 31:1133-1138. [PMID: 36935419 PMCID: PMC10545753 DOI: 10.1038/s41431-023-01333-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/08/2023] [Accepted: 03/07/2023] [Indexed: 03/21/2023] Open
Abstract
Preimplantation genetic testing using polygenic risk scores (PGT-P) has recently been introduced. However, PGT-P has been met with many ethical concerns. It is therefore important to get insights into the perspectives of stakeholders regarding PGT-P. We performed a qualitative interview study on the views of healthcare professionals toward PGT-P. We conducted in-depth semi-structured interviews with 31 healthcare professionals working in the field of preimplantation genetic testing. The interviews explored the attitudes of healthcare professionals toward the technology of PGT-P, e.g., the validity, utility, limitations and potential benefits of PGT-P. We found that most healthcare professionals were concerned about the prematurity of introducing PGT-P into clinical practice. They had various ethical considerations, such as concerns related to validity and utility of PGT-P, limited embryos and options, and difficulties for prospective parents regarding comprehension and informed decision-making. Positive aspects were also identified, e.g., regarding reproductive autonomy and potential health benefits. Overall, most healthcare professionals considered that clinical implementation of PGT-P is premature. More comprehensive, longitudinal and inclusive studies are needed first, though these might not improve PGT-P enough to responsibly implement it. Healthcare professionals were also concerned that PGT-P could cause anxiety and create difficult choices for prospective parents. These perspectives and ethical considerations are crucial to consider for future guidelines and recommendations regarding PGT-P.
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Affiliation(s)
- Maria Siermann
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Ophelia Valcke
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Joris Robert Vermeesch
- Laboratory for Cytogenetics and Genome Research, Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Taneli Raivio
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Olga Tšuiko
- Laboratory for Cytogenetics and Genome Research, Department of Human Genetics, KU Leuven, Leuven, Belgium
- Reproductive Genetics Unit, Center for Human Genetics, UZ Leuven, Leuven, Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Clinical Outcome, Socioeconomic Status and Psychological Constrains of Patients Undergoing Preimplantation Genetic Testing (PGT) in Northern Greece. Medicina (B Aires) 2022; 58:medicina58101493. [PMID: 36295653 PMCID: PMC9611400 DOI: 10.3390/medicina58101493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/07/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
Background and objectives: Preimplantation genetic testing (PGT) offers patients the possibility of having a healthy baby free of chromosomal or genetic disorders. The present study focuses on the application of PGT for patients located in Northern Greece, investigating their clinical outcomes, their motives, and their overall physical and emotional experience during the treatment, in association with their socioeconomic background. Materials and Methods: Couples who underwent PGT for a monogenic condition (PGT-M, n = 19 cycles) or aneuploidy (PGT-A, n = 22 cycles) participated in the study. Fertilization, implantation, and pregnancy rates were recorded for all cycles. The couples were asked to fill in a questionnaire about the consultation they had received prior to treatment, their sociodemographic information, and the psychological impact PGT had on both the female and male partner. Results: The fertilization, implantation, and ongoing pregnancy rates for the PGT-M and PGT-A cycles were 81.3%, 70.6%, and 52.9%, and 78.2%, 64.3%, and 57.1%, respectively. Females experienced more intense physical pain than their male partners while psychological pain was encountered by both partners and occasionally in higher instances in males. No typical socioeconomic background of the patients referred for PGT in Northern Greece was noticed. Conclusion: PGT is an attractive alternative to prenatal diagnosis (PND), aiming to establisha healthy pregnancy by identifying and avoiding the transfer of chromosomally or genetically abnormal embryos to the uterus. Although the benefits of PGT were well-received by all patients undergoing the procedure, psychological pain was evident and especially prominent in patients with a previous affected child or no normal embryos for transfer. Holistic counseling is of utmost importance in order to make patients' experience during their journey to have a healthy baby less emotionally demanding and help them make the right choices for the future.
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Decision-making and experiences of preimplantation genetic diagnosis in inherited heart diseases: a qualitative study. Eur J Hum Genet 2022; 30:187-193. [PMID: 34545210 PMCID: PMC8821668 DOI: 10.1038/s41431-021-00963-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 07/15/2021] [Accepted: 09/07/2021] [Indexed: 02/03/2023] Open
Abstract
Preimplantation genetic diagnosis (PGD) ensures a disease-causing variant is not passed to the next generation, including for inherited heart diseases. PGD is known to cause significant emotional burden, but little is known about how parents experience PGD to select against inherited heart disease. We aim to understand how people with inherited heart disease, and their partners, experience and make decisions about PGD. Participants were recruited from a specialised inherited heart disease clinic. Qualitative semi-structured interviews were conducted with adult participants who had considered PGD. A semi-structured interview schedule explored overall experiences and reasons for undergoing PGD. Broad topics included experience of disease, reproductive history, psychosocial and financial considerations. Interviews were recorded, transcribed verbatim and thematically analysed using a framework method. Twenty participants were included (15 with inherited cardiomyopathy, 3 with inherited arrhythmia syndrome and 2 partners). In contemplating PGD, participants considered 3 main issues: past experience of disease e.g. sudden cardiac death, sport restrictions and clinical heterogeneity; intergenerational responsibilities; and practical considerations such as finances and maternal age. Among those who chose to undergo PGD (n = 7/18), past experience of a significant cardiac event, such as family history of sudden cardiac death, was important in the decision process. The decision to undergo PGD for inherited heart disease is complex and influenced by individual values and experience of disease. We highlight key areas where further discussion may assist in PGD decision processes.
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Siermann M, Claesen Z, Pasquier L, Raivio T, Tšuiko O, Vermeesch JR, Borry P. A systematic review of the views of healthcare professionals on the scope of preimplantation genetic testing. J Community Genet 2022; 13:1-11. [PMID: 35028914 DOI: 10.1007/s12687-021-00573-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022] Open
Abstract
Preimplantation genetic testing (PGT) involves testing embryos created through in vitro fertilization for the presence of hereditary genetic disorders and chromosome abnormalities. PGT for monogenic conditions (PGT-M) is generally performed for childhood-onset, lethal disorders, but is increasingly accepted for certain adult-onset conditions, conditions with available treatment options or conditions with lower penetrance. Furthermore, the development of PGT for polygenic conditions (PGT-P) makes ethical questions regarding PGT indications imperative. A systematic review was therefore performed to gather and analyse studies on the perspectives of healthcare professionals on the appropriate scope of PGT, with the aim of getting insights into the concerns about the scope of PGT now and in the near future. PRISMA guidelines were followed. Twelve qualitative articles were included. The main themes extracted were the scope of PGT and decision-making about PGT. Defining 'a serious genetic condition' was seen as complex, but severity, high penetrance and absence of treatability and patients' experience were seen as relevant indications to determine the appropriateness of PGT. In navigating the decision-making processes with patients, professionals experienced friction between setting limits and respecting patients' autonomy. Such friction and ethical dilemmas around seriousness, informed decision-making and preventative medicine show that while expanding the list of possible PGT indications and the development of PGT-P could augment patients' reproductive autonomy, it could also lead to an increased reproductive 'burden' for patients. These insights are crucial for establishing guidelines that help healthcare professionals navigate ethical tensions associated with PGT.
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Affiliation(s)
- Maria Siermann
- Centre for Biomedical Ethics and Law, KU Leuven, 3000, Leuven, Belgium.
| | - Zoë Claesen
- Centre for Biomedical Ethics and Law, KU Leuven, 3000, Leuven, Belgium
| | - Laurent Pasquier
- Centre for Biomedical Ethics and Law, KU Leuven, 3000, Leuven, Belgium
| | - Taneli Raivio
- Department of Physiology, University of Helsinki, 00014, Helsinki, Finland
| | - Olga Tšuiko
- Center for Human Genetics, University Hospitals Leuven, 3000, Leuven, Belgium.,Laboratory for Cytogenetics and Genome Research, KU Leuven, 3000, Leuven, Belgium
| | | | - Pascal Borry
- Centre for Biomedical Ethics and Law, KU Leuven, 3000, Leuven, Belgium
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Hughes T, Bracewell-Milnes T, Saso S, Jones BP, Almeida PA, Maclaren K, Norman-Taylor J, Johnson M, Nikolaou D. A review on the motivations, decision-making factors, attitudes and experiences of couples using pre-implantation genetic testing for inherited conditions. Hum Reprod Update 2021; 27:944-966. [PMID: 33969393 DOI: 10.1093/humupd/dmab013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In pre-implantation genetic testing (PGT), fertile couples undergo IVF with genetic testing of embryos to avoid conceptions with a genetic condition. There is an exponentially increasing uptake with over 600 applications listed by the Human Fertilisation and Embryology Authority in the UK. The psychological aspects of the decision-making process and the experience of PGT, however, are relatively underevaluated, with the potential to leave patients unsupported in their journeys. OBJECTIVE AND RATIONALE In this review, we aim to comprehensively report on every aspect of couples' experiences of PGT. We consider what motivates users, the practical and ethical decisions involved and how couples navigate the decision-making process. Additionally, we report on the social and psychological impact on couples who are actively undergoing or have completed the PGT process. SEARCH METHODS A systematic search of English peer-reviewed journals of three computerized databases was undertaken following PRISMA guidelines. Studies that examined the motivations, attitudes, decision-making factors and experiences of patients who have been actively engaged in the PGT process were included. No restrictions were placed on study design or date of publication. Studies examining patients using PGT in a hypothetical context or solely using PGT for aneuploidy were excluded. Qualitative data were extracted using thematic analysis. OUTCOMES The main outcomes were patient motivations, deciding factors and attitudes, as well as the patient experience of coming to a decision and going through PGT.Patients were primarily motivated by the desire to have a healthy child and to avoid termination of pregnancy. Those with a sick child or previous experience of termination were more likely to use PGT. Patients also felt compelled to make use of the technology available, either from a moral responsibility to do so or to avoid feelings of guilt if not. The main factors considered when deciding to use PGT were the need for IVF and the acceptability of the technology, the financial cost of the procedure and one's ethical standpoint on the creation and manipulation of embryos. There was a general consensus that PGT should be applied to lethal or severe childhood disease but less agreement on use for adult onset or variable expression conditions. There was an agreement that it should not be used to select for aesthetic traits and a frustration with the views of PGT in society. We report that couples find it difficult to consider all of the benefits and costs of PGT, resulting in ambivalence and prolonged indecision. After deciding on PGT use, we found that patients find the process extremely impractical and psychologically demanding. WIDER IMPLICATIONS This review aimed to summarize the current knowledge on how patients decide to use and experience PGT and to make suggestions to incorporate the findings into clinical practice. We cannot stress enough the importance of holistic evaluation of patients and thorough counselling prior to and during PGT use from a multidisciplinary team that includes geneticists, IVF clinicians, psychologists and also patient support groups. Large prospective studies using a validated psychological tool at various stages of the PGT process would provide an invaluable database for professionals to better aid patients in their decision-making and to improve the patient experience.
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Affiliation(s)
- Tara Hughes
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Timothy Bracewell-Milnes
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Srdjan Saso
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Benjamin P Jones
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Paula A Almeida
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Katherine Maclaren
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Julian Norman-Taylor
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Mark Johnson
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Dimitrios Nikolaou
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
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Zuckerman S, Gooldin S, Zeevi DA, Altarescu G. The decision-making process, experience, and perceptions of preimplantation genetic testing (PGT) users. J Assist Reprod Genet 2020; 37:1903-1912. [PMID: 32462417 PMCID: PMC7468006 DOI: 10.1007/s10815-020-01840-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/21/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE The decision to undergo preimplantation genetic testing (PGT) entails a variety of personal and societal variables. Although PGT technology is widely accepted and used, few studies have queried the motives and concerns of PGT users; moreover, in-depth qualitative data regarding the PGT experience is scant. METHODS In order to explore and analyze the experience, concerns, expectations, and attitudes toward the PGT technique and its implications, semi-structured interviews were conducted in a single tertiary medical center with 43 Israeli PGT users for HLA matching and autosomal dominant, autosomal recessive, and X-linked genetic disorders. RESULTS The primary considerations in choosing PGT were prevention of birth of a child who would suffer a terminal or chronic disease as well as abrogation of a familial genetic condition. Religion played a decisive role in accepting PGT as an antenatal option. Regarding satisfaction with the PGT experience, many interviewees highlighted the need for greater attention to be given to potential stages of failure throughout the procedure and the need for emotional support. Our clinical results regarding implantation rate and cumulative live birth rate are 38-40% and 27-30%, respectively. CONCLUSION This survey broadens understanding of the specialized needs of women, couples, and minority groups undergoing PGT and underscores the relevance of counseling services for PGT users.
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Affiliation(s)
- Shachar Zuckerman
- Shaare Zedek Medical Center- Medical Genetics Institute, Jerusalem, Israel.
- Hadassah Medical School, Hebrew University , Jerusalem, Israel.
| | - Sigal Gooldin
- Department of Sociology and Anthropology, Hebrew University, Jerusalem, Israel
| | - David A Zeevi
- Shaare Zedek Medical Center- Preimplantation Genetic Unit, Jerusalem, Israel
| | - Gheona Altarescu
- Shaare Zedek Medical Center- Medical Genetics Institute, Jerusalem, Israel
- Hadassah Medical School, Hebrew University , Jerusalem, Israel
- Shaare Zedek Medical Center- Preimplantation Genetic Unit, Jerusalem, Israel
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7
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Al-Kharusi K, Bruwer Z, Wessels TM. The experience of Preimplantation Genetic Testing (PGT) among Muslim couples in Oman in the Middle East. J Genet Couns 2020; 30:121-131. [PMID: 32578356 DOI: 10.1002/jgc4.1300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/11/2019] [Accepted: 05/05/2020] [Indexed: 11/06/2022]
Abstract
Preimplantation genetic testing (PGT) is an alternative reproductive technology integrated with in vitro fertilization (IVF). It is a well-established technique offering a reproductive option for families at a high risk of transmitting a genetic disorder, allowing them to avoid making a decision about termination of an affected pregnancy (TOP). In Arab communities and particularly in Oman, where TOP is not favored under the majority of implemented Muslim law, termination of pregnancy for fetal indications is not always possible. As these communities are in favor of consanguineous marriage, they are at increased risk of serious and lethal autosomal recessive conditions, and as a result, PGT is a feasible option as a TOP decision can be avoided. However, undergoing PGT is relatively new in the Arab Muslim countries and Omani patients have only recently had access to the service. This qualitative study utilized a phenomenological approach to explore the experience of Omani families who had selected to undergo PGT as a means of reducing the risk of having a child affected with a genetic disorder. Fourteen participants from eight families who underwent PGT were interviewed. Data collected were analyzed using thematic analysis. The research identified four main themes: Anxiously waiting 'Taraqub'; Unforeseen; Secrecy; and Me and My Partner. The findings of the research have provided insight into the PGT experiences of Omani families. Unique cultural and religious perspectives should be considered when counseling Omani Muslim couples.
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Affiliation(s)
- Khalsa Al-Kharusi
- Genetics and Developmental Medicine Clinic, Sultan Qaboos University Hospital, Muscat, Oman
| | - Zandre Bruwer
- Genetics and Developmental Medicine Clinic, Sultan Qaboos University Hospital, Muscat, Oman
| | - Tina-Marié Wessels
- Division of Human Genetics, Department of Pathology Faculty of Medicine, University of Cape Town, Cape Town, South Africa
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Poulton A, Lewis S, Hui L, Halliday JL. Prenatal and preimplantation genetic diagnosis for single gene disorders: A population-based study from 1977 to 2016. Prenat Diagn 2018; 38:904-910. [DOI: 10.1002/pd.5352] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/31/2018] [Accepted: 08/26/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Alice Poulton
- Public Health Genetics; Murdoch Children's Research Institute, Royal Children's Hospital; Parkville Victoria Australia
| | - Sharon Lewis
- Public Health Genetics; Murdoch Children's Research Institute, Royal Children's Hospital; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Parkville Victoria Australia
| | - Lisa Hui
- Public Health Genetics; Murdoch Children's Research Institute, Royal Children's Hospital; Parkville Victoria Australia
- Department of Perinatal Medicine; Mercy Hospital for Women; Heidelberg Victoria Australia
- Department of Obstetrics and Gynaecology; University of Melbourne; Parkville Victoria Australia
| | - Jane L. Halliday
- Public Health Genetics; Murdoch Children's Research Institute, Royal Children's Hospital; Parkville Victoria Australia
- Department of Paediatrics; University of Melbourne; Parkville Victoria Australia
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Järvholm S, Thurin-Kjellberg A, Broberg M. Is pre-implantation genetic diagnosis (PGD) more of a strain regarding satisfaction with marital quality for male or female partners? A three-year follow-up study. J Psychosom Obstet Gynaecol 2018; 39:182-189. [PMID: 28447499 DOI: 10.1080/0167482x.2017.1319816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Men and women with a hereditary genetic disease are faced with different options when they plan to become parents. One is pre-implantation genetic diagnosis (PGD) which is a combination of in vitro fertilization (IVF) and genetic analysis of the embryo before implantation. The present study focuses on how men and women planning for PGD experience the quality of marital satisfaction when they apply for treatment and again, three years later. METHODS The study was a prospective cohort study where all couples (n = 22) applying for PGD during 2010 and 2011 were eligible. Nineteen women and 17 men (i.e. 17 couples and two women) participated. Participants answered several questionnaires (Dyadic Adjustment Scale, Hospital Anxiety and Depression Scale and Parental Stress Questionnaire) before PGD treatment, and again three years later. RESULTS Women who underwent PGD rated the quality of their marital relationship similarly to that of first-time parents and IVF couples, whereas men rated the marital quality somewhat lower than the contrasts groups. Satisfaction with marital quality was stable over the three-year period although men were less satisfied than women on both occasions. At year three, there was a significant correlation between martial satisfaction and parental stress in men, and between martial satisfaction and anxiety and depression in women. DISCUSSION Men are equally, or more, affected by their situation than their female partners, with consequences for satisfaction with marital quality. For this reason they should be included in any counselling offered.
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Affiliation(s)
- Stina Järvholm
- a Department of Obstetrics and Gynaecology , Sahlgrenska Academy, University of Gothenburg. Sahlgrenska University Hospital , Gothenburg , Sweden.,b Department of Psychology , University of Gothenburg , Gothenburg , Sweden
| | - Ann Thurin-Kjellberg
- a Department of Obstetrics and Gynaecology , Sahlgrenska Academy, University of Gothenburg. Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Malin Broberg
- b Department of Psychology , University of Gothenburg , Gothenburg , Sweden
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Genoff Garzon MC, Rubin LR, Lobel M, Stelling J, Pastore LM. Review of patient decision-making factors and attitudes regarding preimplantation genetic diagnosis. Clin Genet 2018; 94:22-42. [PMID: 29120067 DOI: 10.1111/cge.13174] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 12/22/2022]
Abstract
The increasing technical complexity and evolving options for repro-genetic testing have direct implications for information processing and decision making, yet the research among patients considering preimplantation genetic diagnosis (PGD) is narrowly focused. This review synthesizes the literature regarding patient PGD decision-making factors, and illuminates gaps for future research and clinical translation. Twenty-five articles met the inclusion criteria for evaluating experiences and attitudes of patients directly involved in PGD as an intervention or considering using PGD. Thirteen reports were focused exclusively on a specific disease or condition. Five themes emerged: (1) patients motivated by prospects of a healthy, genetic-variant-free child, (2) PGD requires a commitment of time, money, energy and emotions, (3) patients concerned about logistics and ethics of discarding embryos, (4) some patients feel sense of responsibility to use available technologies, and (5) PGD decisions are complex for individuals and couples. Patient research on PGD decision-making processes has very infrequently used validated instruments, and the data collected through both quantitative and qualitative designs have been inconsistent. Future research for improving clinical counseling is needed to fill many gaps remaining in the literature regarding this decision-making process, and suggestions are offered.
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Affiliation(s)
- M C Genoff Garzon
- Department of Psychology, The New School for Social Research, New York, NY
| | - L R Rubin
- Department of Psychology, The New School for Social Research, New York, NY
| | - M Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY
| | - J Stelling
- Reproductive Specialists of NY, Stony Brook, NY.,Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook University, Stony Brook, NY
| | - L M Pastore
- Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook University, Stony Brook, NY
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Acceptable applications of preimplantation genetic diagnosis (PGD) among Israeli PGD users. Eur J Hum Genet 2017; 25:1113-1117. [PMID: 28905883 DOI: 10.1038/ejhg.2017.113] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 06/08/2017] [Accepted: 06/20/2017] [Indexed: 11/08/2022] Open
Abstract
The use of PGD technology to select against genetic disorders and traits is increasing. Although PGD may eliminate some of the obstacles related to conservative options of prenatal diagnosis, it can raise personal, social and moral questions. Ethical issues concerning the justified uses of PGD are a subject of ongoing debate among medical and bioethical communities. Although attitudes toward the acceptable uses of PGD were evaluated among population groups worldwide, bioethics councils were criticized for ignoring public perspectives. In the last decade PGD has been widely used in Israel. The ethical guidelines were created solely by medical-bioethics experts and, some felt, totally isolated from public opinions. Semi-structured in-depth interviews of 37 users (carriers of autosomal recessive, dominant and X-linked disorders, and HLA-matching) were performed. The interviews explored attitudes toward ethical and sociological aspects of PGD. The overall results of this study show highly favorable attitudes of Israeli PGD users toward medical applications. Furthermore, our subjects demonstrate a more permissive stand toward the controversial application of social sex selection albeit with strong objection to esthetic means of selection. PGD users are coping with both genetic disease and load of the PGD procedure. Taking into consideration their opinion is important since it reflects the gains and burdens of these procedures alongside the demand for future optional services. Their attitudes should play an important role in the professional discussion concerning the justified uses of PGD and should significantly influence the design of policy making in this field.
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Experiences of Pre-Implantation Genetic Diagnosis (PGD) in Sweden: a Three-Year Follow-Up of Men and Women. J Genet Couns 2017; 26:1008-1016. [PMID: 28191608 PMCID: PMC5582074 DOI: 10.1007/s10897-017-0078-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/30/2017] [Indexed: 11/03/2022]
Abstract
Men and women with a hereditary genetic disease are faced with different options when they wish to become parents. One is pre-implantation genetic diagnosis (PGD) which is a combination of in vitro fertilization (IVF) and genetic analysis of the embryo before implantation. The present study focused on men and women's psychological experiences of PGD three years after applying for PGD. Nineteen women and seventeen men (i.e. seventeen couples and two women) participated. The interviews were analysed by thematic method. It is better to have tried was identified as a master theme, under which came three underlying sub-themes, which had the following headings: Practical experience of PGD, Psychological experience of PGD and Goals of PGD. The results show that men and women three years after PGD are still psychologically affected by their experience. The men and women raised concerns that their relationship had been affected, both positively and negatively, and feelings of anxiety and depression still remained. Healthcare services should recognize the heterogeneous nature of the group being studied and therefore the need for counselling can arise at different times and in relation to different areas, regardless of the outcome of the PGD.
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13
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The endometrial preparation for frozen-thawed euploid blastocyst transfer: a prospective randomized trial comparing clinical results from natural modified cycle and exogenous hormone stimulation with GnRH agonist. J Assist Reprod Genet 2016; 33:873-84. [PMID: 27221477 DOI: 10.1007/s10815-016-0736-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/13/2016] [Indexed: 01/22/2023] Open
Abstract
PURPOSE The aim of the study was to evaluate two methods of endometrial preparation for frozen-thawed single euploid blastocyst transfer: modified natural and artificial cycle with GnRH-agonist pituitary suppression. METHODS In this prospective, controlled randomized trial, a total of 236 patients undergoing infertility treatment were randomized in 1:1 ratio; 118 received a frozen-thawed single euploid blastocyst transfer in a modified natural cycle and 118 in an artificial cycle with GnRH-agonist pituitary suppression. In the artificial protocol, GnRH-agonist combined with estradiol valerate was administered. In the natural protocol, only final oocyte maturation was induced using human chorionic gonadotropin administration. The primary end-points were the clinical pregnancy and implantation rates; the secondary end-points were the cost-benefit in terms of drug cost and the number of visits and the woman psychological distress caused by the treatment. RESULTS No significant differences were found in clinical pregnancy, implantation, and miscarriage rates between protocols. The number of clinical and ultrasound controls and the number of laboratory dosages and venous samplings were similar in both study groups. No significant differences were found between the groups in the anxiety and depression values before the start of treatment, on the days of progesterone administration, the blastocyst transfer, and pregnancy test. CONCLUSIONS The findings of this study evidence that in case of frozen-thawed single euploid blastocyst transfer, both protocols are equally effective in terms of clinical outcomes, cost-benefit, and patient compliance. The choice of endometrial preparation protocol should be based on women menstrual and ovulatory characteristics or otherwise on patient need for cycle planning. TRIAL REGISTRATION www.clinicaltrials.gov with number NCT02378584.
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Winter C, Van Acker F, Bonduelle M, Van Berkel K, Belva F, Liebaers I, Nekkebroeck J. Depression, pregnancy-related anxiety and parental-antenatal attachment in couples using preimplantation genetic diagnosis. Hum Reprod 2016; 31:1288-99. [DOI: 10.1093/humrep/dew074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 03/14/2016] [Indexed: 11/13/2022] Open
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Gameiro S, Boivin J, Dancet E, de Klerk C, Emery M, Lewis-Jones C, Thorn P, Van den Broeck U, Venetis C, Verhaak CM, Wischmann T, Vermeulen N. ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction-a guide for fertility staff. Hum Reprod 2015; 30:2476-85. [PMID: 26345684 DOI: 10.1093/humrep/dev177] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/11/2015] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Based on the best available evidence in the literature, what is the optimal management of routine psychosocial care at infertility and medically assisted reproduction (MAR) clinics? SUMMARY ANSWER Using the structured methodology of the Manual for the European Society of Human Reproduction and Embryology (ESHRE) Guideline Development, 120 recommendations were formulated that answered the 12 key questions on optimal management of routine psychosocial care by all fertility staff. WHAT IS ALREADY KNOWN The 2002 ESHRE Guidelines for counselling in infertility has been a reference point for best psychosocial care in infertility for years, but this guideline needed updating and did not focus on routine psychosocial care that can be delivered by all fertility staff. STUDY, DESIGN, SIZE, DURATION This guideline was produced by a group of experts in the field according to the 12-step process described in the ESHRE Manual for Guideline Development. After scoping the guideline and listing a set of 12 key questions in PICO (Patient, Intervention, Comparison and Outcome) format, thorough systematic searches of the literature were conducted; evidence from papers published until April 2014 was collected, evaluated for quality and analysed. A summary of evidence was written in a reply to each of the key questions and used as the basis for recommendations, which were defined by consensus within the guideline development group (GDG). Patient and additional clinical input was collected during the scoping and the review phase of the guideline development. PARTICIPANTS/MATERIALS, SETTING, METHODS The guideline group, comprising psychologists, two medical doctors, a midwife, a patient representative and a methodological expert, met three times to discuss evidence and reach consensus on the recommendations. MAIN RESULTS AND THE ROLE OF CHANCE THE GUIDELINE PROVIDES 120 recommendations that aim at guiding fertility clinic staff in providing optimal evidence-based routine psychosocial care to patients dealing with infertility and MAR. The guideline is written in two sections. The first section describes patients' preferences regarding the psychosocial care they would like to receive at clinics and how this care is associated with their well-being. The second section of the guideline provides information about the psychosocial needs patients experience across their treatment pathway (before, during and after treatment) and how fertility clinic staff can detect and address these. Needs refer to conditions assumed necessary for patients to have a healthy experience of the fertility treatment. Needs can be behavioural (lifestyle, exercise, nutrition and compliance), relational (relationship with partner if there is one, family friends and larger network, and work), emotional (well-being, e.g. anxiety, depression and quality of life) and cognitive (treatment concerns and knowledge). LIMITATIONS, REASONS FOR CAUTION We identified many areas in care for which robust evidence was lacking. Gaps in evidence were addressed by formulating good practice points, based on the expert opinion of the GDG, but it is critical for such recommendations to be empirically validated. WIDER IMPLICATIONS OF THE FINDINGS The evidence presented in this guideline shows that providing routine psychosocial care is associated with or has potential to reduce stress and concerns about medical procedures and improve lifestyle outcomes, fertility-related knowledge, patient well-being and compliance with treatment. As only 45 (36.0%) of the 125 recommendations were based on high-quality evidence, the guideline group formulated recommendations to guide future research with the aim of increasing the body of evidence.
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Affiliation(s)
- S Gameiro
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, CF10 3AT Cardiff, UK
| | - J Boivin
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, CF10 3AT Cardiff, UK
| | - E Dancet
- Leuven University Fertility Centre, University Hospitals Leuven, 3000 Leuven, Belgium Center for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - C de Klerk
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam 3000 CA, The Netherlands
| | - M Emery
- Centre for Medically Assisted Procreation-CPMA, CH-1003 Lausanne, Switzerland
| | | | - P Thorn
- Practice for Couple and Family Therapy, 64546 Moerfelden, Germany
| | - U Van den Broeck
- Leuven University Fertility Centre, University Hospitals Leuven, 3000 Leuven, Belgium
| | - C Venetis
- Women's and Children's Health, St George Hospital, University of New South Wales, NSW 2217 Sydney, Australia
| | - C M Verhaak
- Department of Psychology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - T Wischmann
- Institute of Medical Psychology, Centre for Psychosocial Medicine, Heidelberg University Hospital, 69115 Heidelberg, Germany
| | - N Vermeulen
- European Society for Human Reproduction and Embryology, 1852 Grimbergen, Belgium
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Winter C, Van Acker F, Bonduelle M, Desmyttere S, Nekkebroeck J. Psychosocial development of full term singletons, born after preimplantation genetic diagnosis (PGD) at preschool age and family functioning: a prospective case-controlled study and multi-informant approach. Hum Reprod 2015; 30:1122-36. [DOI: 10.1093/humrep/dev036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 02/06/2015] [Indexed: 11/13/2022] Open
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Quinn GP, Knapp C, Sehovic I, Ung D, Bowman M, Gonzalez L, Vadaparampil ST. Knowledge and Educational Needs about Pre-Implantation Genetic Diagnosis (PGD) among Oncology Nurses. J Clin Med 2014; 3:632-45. [PMID: 26237394 PMCID: PMC4449683 DOI: 10.3390/jcm3020632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/20/2014] [Accepted: 05/22/2014] [Indexed: 12/28/2022] Open
Abstract
Preimplantation genetic diagnosis (PGD), a form of assisted reproductive technology, is a new technology with limited awareness among health care professionals and hereditary cancer families. Nurses play a key role in the care of patients and are often in an ideal position to discuss and refer patients on sensitive quality of life issues, such as PGD. Two hundred and one nurses at Moffitt Cancer Center (MCC) responded to an online survey assessing knowledge and educational needs regarding PGD and families with hereditary cancer. The majority of respondents were female (n = 188), white (n = 175), had an RN/BSN degree (n = 83), and provided outpatient care at the cancer center (n = 102). More than half of respondents (78%) were unfamiliar with PGD prior to the survey and respondents who had heard of PGD had limited knowledge. More than half of the participants reported PGD was an acceptable option for families with hereditary cancer syndromes and thought individuals with a strong family or personal history should be provided with information about PGD. This study indicates that oncology nurses may benefit from and desire education about PGD. With advances in reproductive technology and options, further PGD education is needed among healthcare professionals. An examination of current oncology nursing curriculum and competencies regarding genetic education may identify need for future revisions and updates.
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Affiliation(s)
- Gwendolyn P Quinn
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd #11, Tampa, FL 33612, USA.
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center and Research Institute, Moffitt Cancer Center, MRC CANCONT, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | - Caprice Knapp
- Department of Health Outcomes and Policy, University of Florida, 1329 SW 16th St., Gainesville, FL 32608, USA.
| | - Ivana Sehovic
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center and Research Institute, Moffitt Cancer Center, MRC CANCONT, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | - Danielle Ung
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center and Research Institute, Moffitt Cancer Center, MRC CANCONT, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | - Meghan Bowman
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center and Research Institute, Moffitt Cancer Center, MRC CANCONT, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | - Luis Gonzalez
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center and Research Institute, Moffitt Cancer Center, MRC CANCONT, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | - Susan T Vadaparampil
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd #11, Tampa, FL 33612, USA.
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center and Research Institute, Moffitt Cancer Center, MRC CANCONT, 12902 Magnolia Drive, Tampa, FL 33612, USA.
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Tur-Kaspa I, Jeelani R, Doraiswamy PM. Preimplantation genetic diagnosis for inherited neurological disorders. Nat Rev Neurol 2014; 10:417-24. [PMID: 24866878 DOI: 10.1038/nrneurol.2014.84] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Preimplantation genetic diagnosis (PGD) is an option for couples at risk of having offspring with an inherited debilitating or fatal neurological disorder who wish to conceive a healthy child. PGD has been carried out for conditions with various modes of inheritance, including spinal muscular atrophy, Huntington disease, fragile X syndrome, and chromosomal or mitochondrial disorders, and for susceptibility genes for cancers with nervous system involvement. Most couples at risk of transmitting a genetic mutation would opt for PGD over prenatal testing and possible termination of a pregnancy. The aim of this Perspectives article is to assist neurologists in counselling and treating patients who wish to explore the option of PGD to enable conception of an unaffected child. PGD can be accomplished for most disorders in which the genetic basis is known, and we argue that it is time for clinicians and neurological societies to consider the evidence and to formulate guidelines for the responsible integration of PGD into modern preventative neurology.
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Affiliation(s)
- Ilan Tur-Kaspa
- Institute for Human Reproduction, 409 West Huron Street, Suite 500, Chicago, IL 60654, USA, and Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL 60637, USA
| | - Roohi Jeelani
- Department of Obstetrics and Gynecology, Wayne State University, 3390 John R. Street, Detroit, MI 48201, USA
| | - P Murali Doraiswamy
- Departments of Psychiatry and Medicine, and the Duke Institute for Brain Sciences, DUMC-3018 Duke Medical Center, 1000 Trent Drive, Suite 3550, Durham, NC 27710, USA
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Drazba KT, Kelley MA, Hershberger PE. A qualitative inquiry of the financial concerns of couples opting to use preimplantation genetic diagnosis to prevent the transmission of known genetic disorders. J Genet Couns 2014; 23:202-11. [PMID: 23949612 PMCID: PMC3925761 DOI: 10.1007/s10897-013-9638-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 07/30/2013] [Indexed: 11/27/2022]
Abstract
Preimplantation genetic diagnosis (PGD) is an innovative prenatal testing option because the determination of whether a genetic disorder or chromosomal abnormality is evident occurs prior to pregnancy. However, PGD is not covered financially under the majority of private and public health insurance institutions in the United States, leaving couples to decide whether PGD is financially feasible. The aim of this qualitative study was to understand the role of finances in the decision-making process among couples who were actively considering PGD. In-depth, semi-structured interviews were completed with 18 genetic high-risk couples (36 individual partners). Grounded theory guided the analysis, whereby three themes emerged: 1) Cost is salient, 2) Emotions surrounding affordability, and 3) Financial burden and sacrifice. Ultimately, couples determined that the opportunity to avoid passing on a genetic disorder to a future child was paramount to the cost of PGD, but expressed financial concerns and recognized financial access as a major barrier to PGD utilization.
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Affiliation(s)
- Kathryn T Drazba
- Population Science, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA,
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Collins SC. Preimplantation genetic diagnosis: technical advances and expanding applications. Curr Opin Obstet Gynecol 2013; 25:201-6. [PMID: 23429571 DOI: 10.1097/gco.0b013e32835faafe] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To review the foundations, recent technical advances, and increasing number of applications for in-vitro fertilization with preimplantation genetic diagnosis (PGD). RECENT FINDINGS PGD is an important technique for reducing the burden of genetic disease. Studies have shown that the diagnostic accuracy and subsequent live-birth rate after PGD are impacted by the developmental stage at the time of biopsy, as well as the biopsy protocol used. Also essential for accurate diagnosis are refined mutation detection protocols which avoid the common problem of allele drop-out. As the technique has improved, there has been a concomitant increase in the popularity and breadth of application of PGD. A recently published 10-year dataset of worldwide PGD reveals the increasing frequency of its use and the growing number of indications for which PGD is offered. SUMMARY Technical advances from biopsy to detection of mutations have led to improved diagnostic accuracy and an increased frequency and breadth of use for PGD.
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Affiliation(s)
- Stephen C Collins
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA.
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21
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Gianaroli L, Crivello AM, Stanghellini I, Ferraretti AP, Tabanelli C, Magli MC. Reiterative changes in the Italian regulation on IVF: the effect on PGD patients' reproductive decisions. Reprod Biomed Online 2013; 28:125-32. [PMID: 24268726 DOI: 10.1016/j.rbmo.2013.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 08/05/2013] [Accepted: 08/13/2013] [Indexed: 11/29/2022]
Abstract
National legislations represent one of the main factors influencing access to assisted reproduction treatment. The Italian situation in the last decade is an example of how the treatment of patients for preimplantation genetic diagnosis (PGD) was more dependent on regulators than on medical choices. This report analysed how the changes in Italian regulation affected the number of PGD referrals to this study centre, as well as their decision to opt for cross-border reproductive care (CBRC). The analysis showed that during the period in which PGD was actually not performed because of the restriction imposed by the Italian law on IVF (from 24 February 2004 to 7 May 2009) there was a significant decrease in the number of referrals asking for PGD (2.5% of total referrals) compared with the previous years (3.3%; P < 0.025) and following years when PGD was legalized (5.1%; P < 0.001). The number of couples opting for CBRC had an opposite trend, reaching a maximum when PGD was banned from Italian centres (55 couples), whereas after the readmission of PGD, only eight couples went abroad for treatment. Concomitantly, since May 2009, the proportion of couples performing a PGD cycle in this centre has constantly increased.
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Affiliation(s)
- Luca Gianaroli
- S.I.S.Me.R., Reproductive Medicine Unit, V. Mazzini 12, 40138 Bologna, Italy.
| | - Anna Maria Crivello
- S.I.S.Me.R., Reproductive Medicine Unit, V. Mazzini 12, 40138 Bologna, Italy
| | - Ilaria Stanghellini
- S.I.S.Me.R., Reproductive Medicine Unit, V. Mazzini 12, 40138 Bologna, Italy
| | - Anna Pia Ferraretti
- S.I.S.Me.R., Reproductive Medicine Unit, V. Mazzini 12, 40138 Bologna, Italy
| | - Carla Tabanelli
- S.I.S.Me.R., Reproductive Medicine Unit, V. Mazzini 12, 40138 Bologna, Italy
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Drazba KT, Kelley MA, Hershberger PE. A qualitative inquiry of the financial concerns of couples opting to use preimplantation genetic diagnosis to prevent the transmission of known genetic disorders. J Genet Couns 2013. [PMID: 23949612 DOI: 10.1007/s10897-013-9638-7.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Preimplantation genetic diagnosis (PGD) is an innovative prenatal testing option because the determination of whether a genetic disorder or chromosomal abnormality is evident occurs prior to pregnancy. However, PGD is not covered financially under the majority of private and public health insurance institutions in the United States, leaving couples to decide whether PGD is financially feasible. The aim of this qualitative study was to understand the role of finances in the decision-making process among couples who were actively considering PGD. In-depth, semi-structured interviews were completed with 18 genetic high-risk couples (36 individual partners). Grounded theory guided the analysis, whereby three themes emerged: 1) Cost is salient, 2) Emotions surrounding affordability, and 3) Financial burden and sacrifice. Ultimately, couples determined that the opportunity to avoid passing on a genetic disorder to a future child was paramount to the cost of PGD, but expressed financial concerns and recognized financial access as a major barrier to PGD utilization.
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Affiliation(s)
- Kathryn T Drazba
- Population Science, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA,
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23
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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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Karatas JC, Barlow-Stewart K, Strong KA, Meiser B, McMahon C, Roberts C. Women's experience of pre-implantation genetic diagnosis: a qualitative study. Prenat Diagn 2010; 30:771-7. [PMID: 20661891 DOI: 10.1002/pd.2542] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To provide an in-depth account of the experience of pre-implantation genetic diagnosis (PGD). METHOD Exploratory qualitative interview study. Participants were recruited from one major in vitro fertilization (IVF) clinic in Sydney, Australia. Data were collected through 14 in-depth interviews with women at different stages of PGD, utilized a thematic approach and facilitated by NVivo software. RESULTS Women reported using PGD as empowering and led them to feel in control of their reproductive futures. Health professionals who did not tell women about PGD were seen as a barrier to accessing treatment. The ability to select embryos free from the genetic condition (for which it was at risk) alleviated stress. Despite this, stress experienced with PGD was significant for women, and often related to past experiences of reproductive trauma and grief. The outcome of embryos was also the cause of stress for women. CONCLUSION Women undergoing PGD have a diverse range of reproductive and genetic histories, psychosocial circumstances and world views that all interact and impact their experience of PGD. Successful support and care of these women should address all of these factors and tailor the support provided for women using this physically and emotionally complex form of reproductive technology.
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Affiliation(s)
- J C Karatas
- Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.
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Karatas JC, Barlow-Stewart K, Meiser B, McMahon C, Strong KA, Hill W, Roberts C, Kelly PJ. A prospective study assessing anxiety, depression and maternal-fetal attachment in women using PGD. Hum Reprod 2010; 26:148-56. [PMID: 20959384 DOI: 10.1093/humrep/deq281] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND PGD has been described in previous cross-sectional and retrospective studies as a stressful experience. No prospective studies of the psychological impact of PGD are currently available. METHODS Using a prospective study design, validated measures exploring anxiety and depression were used to assess women using PGD prior to treatment, following embryo transfer, following the pregnancy test result and at 24 weeks of pregnancy. Maternal-fetal attachment was also assessed during pregnancy. RESULTS The prospective design revealed the cyclical pathway through PGD for many women, often comprising repeated cycles of ovarian stimulations and IVF and frozen embryo transfers. As predicted, there were significant fluctuations in women's anxiety scores, with increases observed following embryo transfer and pregnancy testing. Women's anxiety scores returned to baseline levels during pregnancy as assessed at 24 weeks gestation. Depression scores did not significantly fluctuate during PGD. Maternal-fetal attachment scores in this sample did not differ from the normative Australian data. CONCLUSIONS For some women, the PGD pathway is convoluted and requires multiple IVF cycles and embryo transfers to achieve pregnancy. A subset of women experience significant emotional burden during PGD treatment, and it is these women who require closer attention and support. In this sample, emotional adjustment in pregnancy following PGD appears to be sound.
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Affiliation(s)
- J C Karatas
- Sydney Medical School, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.
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Karatas JC, Barlow-Stewart K, Meiser B, McMahon C, Strong KA, Hill W, Roberts C, Kelly P. Psychological adjustment, knowledge and unmet information needs in women undergoing PGD. Hum Reprod 2010; 25:1481-9. [DOI: 10.1093/humrep/deq086] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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