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Martel RA, Lee MB, Schadwell A, Siavoshi M, Kwan L, Miller J, Leonard C, Roman RA, Armstrong A, Kroener L. Aneuploidy rates and likelihood of obtaining a usable embryo for transfer among in vitro fertilization cycles using preimplantation genetic testing for monogenic disorders and aneuploidy compared with in vitro fertilization cycles using preimplantation genetic testing for aneuploidy alone. Fertil Steril 2024:S0015-0282(24)00627-7. [PMID: 39069217 DOI: 10.1016/j.fertnstert.2024.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 07/08/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To compare aneuploidy rates among in vitro fertilization (IVF) cycles using preimplantation genetic testing for monogenic disorders (PGT-M) and aneuploidy (PGT-A) compared with IVF cycles using PGT-A alone, and to determine the likelihood of obtaining at least one usable embryo in cycles using PGT-M+PGT-A compared with cycles using PGT-A alone. DESIGN Retrospective cohort study. SETTING Single genetics laboratory. PATIENT(S) All IVF cycles for patients aged 18-45 undergoing PGT-A with or without concurrent PGT-M at a single genetics laboratory from November 2019 to March 2023. INTERVENTION(S) Use of PGT-M+PGT-A vs. use of PGT-A alone. MAIN OUTCOME MEASURE(S) Per cycle aneuploidy rate stratified by age, and per cycle likelihood of obtaining at least one usable embryo stratified by age and inheritance pattern of monogenic disease. RESULT(S) A total of 72,522 IVF cycles were included; 4,255 cycles (5.9%) using PGT-M+PGT-A and 68,267 cycles (94.1%) using PGT-A alone. The PGT-M+PGT-A group was younger than the PGT-A alone group (<35 years old: 56.1% vs. 30.5%). The majority of PGT-M cycles were performed for autosomal dominant pathogenic variants (42.4%), followed by autosomal recessive (36.5%), X-linked dominant (13.3%), and X-linked recessive (7.5%). The median number of embryos biopsied was higher in PGT-A alone compared with PGT-M+PGT-A cycles for patients aged <35, but it was equivalent in all other age groups. Age stratified aneuploidy rates did not significantly differ between PGT-M+PGT-A compared with PGT-A alone cycles. The probability of having a usable embryo declined with increasing age across all inheritance patterns. Compared with PGT-A alone, PGT-M+PGT-A cycles for patients aged ≤40 across all inheritance patterns were significantly less likely to yield a usable embryo, except in cycles for autosomal recessive diseases in the 38-40 age group and X-linked recessive diseases in the 35-37 age group. There were no consistent differences seen between groups in patients over 40. Cycles for patients with autosomal dominant diseases had the lowest likelihood of yielding a usable embryo for patients aged <43. CONCLUSION(S) In vitro fertilization cycles using PGT-M+PGT-A have similar age-specific aneuploidy rates to those using PGT-A alone. Cycles for patients ≤40 using PGT-M+PGT-A are significantly less likely to yield a usable embryo compared with those using PGT-A alone.
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Affiliation(s)
- Rachel A Martel
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California.
| | - Mabel B Lee
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Alessia Schadwell
- CooperSurgical, Livingston, New Jersey; University of Kent, Kent, United Kingdom
| | - Mehrnaz Siavoshi
- Department of Urology, University of California, Los Angeles, California
| | - Lorna Kwan
- Department of Urology, University of California, Los Angeles, California
| | | | | | - Robert A Roman
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | | | - Lindsay Kroener
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
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Al Eissa MM, Almsned F, Alkharji RR, Aldossary YM, AlQurashi R, Hawsa EA, AlDosari SM, Alqahtani AS, Alotibi RS, Farzan R, Alduaiji R, Sulimani SM, Alomary SA, Assiri AM. The perception of genetic diseases and premarital screening tests in the central region of Saudi Arabia. BMC Public Health 2024; 24:1556. [PMID: 38858722 PMCID: PMC11165879 DOI: 10.1186/s12889-024-19029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/31/2024] [Indexed: 06/12/2024] Open
Abstract
The prevalence of consanguineous marriages (CMs) varies worldwide from one country to another. However, the Middle East stands out as a region with a notably high rate of CMs. CM is particularly widespread in Saudi Arabia, where the prevalence of autosomal recessive genetic diseases has increased. This study aims to identify the Saudi population's awareness of genetic diseases and premarital screening tests (PMSTs). It also seeks to understand couples' perceptions of genetic diseases before and after marriage and their attitudes towards PMSTs and genetic counselling (GC) in reducing the risk of CM. Through the administration of online questionnaires, this cross-sectional study surveyed 2,057 participants to assess their awareness of genetic diseases and their understanding of testing and preventive measures for inherited diseases. Descriptive analysis, nonparametric chi-square tests and logistic regressions were performed to assess the association of categorical responses. This study included 2,035 Saudi Arabian respondents. A significant correlation was found between positive family history and partner selection (p = 0.001), as well as between partnering within the same tribe (p = 0.000139), with a different tribe (p = 0.000138) and from another family (p = 0.000489). About 91.3% of participants expressed agreement regarding the need to enhance public awareness and knowledge concerning genetic disorders, while 87% agreed that increased government regulations are required to prevent the spread of genetic diseases in affected families. Despite increased awareness of genetic diseases and PMSTs, there appears to be a lack of understanding regarding the limitations of PMSTs. The persistently high rate of CM underscores the challenge of altering marriage customs. Further governmental efforts are required to promote awareness of alternative reproductive options, establish new regulations and expand screening programmes.
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Affiliation(s)
- Mariam M Al Eissa
- Molecular Genetics Department, Molecular Genetics Laboratory, Public Health Laboratory, Public Health Authority, Riyadh, Saudi Arabia.
- Medical School, AlFaisal University, Riyadh, Saudi Arabia.
- The Computational Sciences Department at the Centre for Genomic Medicine (CGM), King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
| | - Fahad Almsned
- Research Center, King Fahad Specialist Hospital in Dammam (KFSH-D), Dammam, Saudi Arabia
- Population Health Management, Eastern Health Cluster, Dammam, 32253, Saudi Arabia
- School of Systems Biology, George Mason University, Fairfax, Virginia, USA
| | - Reem R Alkharji
- Research Department, Health Sciences Research Centre, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Yousif M Aldossary
- Research Center, King Fahad Specialist Hospital in Dammam (KFSH-D), Dammam, Saudi Arabia
- Population Health Management, Eastern Health Cluster, Dammam, 32253, Saudi Arabia
| | - Raghad AlQurashi
- Molecular Genetics Department, Molecular Genetics Laboratory, Public Health Laboratory, Public Health Authority, Riyadh, Saudi Arabia
| | - Esraa A Hawsa
- Molecular Genetics Department, Molecular Genetics Laboratory, Public Health Laboratory, Public Health Authority, Riyadh, Saudi Arabia
| | - Sahar M AlDosari
- Medical Laboratory Sciences Department, Assistant Professor and Consultant of Molecular Genetics, Majmaah University, Riyadh, Saudi Arabia
| | | | - Raniah S Alotibi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Raed Farzan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
- Center of Excellence in Biotechnology Research, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
- Chair of Medical and Molecular Genetics Research, King Saud University, Riyadh, 11433, Saudi Arabia
| | | | - Suha M Sulimani
- Healthy Marriage Program, Deputyship of Public Health, Ministry of Health, Riyadh, Saudi Arabia
| | - Shaker A Alomary
- Directorate of Health Programs and Chronic Diseases, Ministry of Health, Riyadh, 11176, Saudi Arabia
| | - Abdullah M Assiri
- Assistant Deputyship of Preventive Health, Ministry of Health, Riyadh, Saudi Arabia
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3
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Patton K, Wong EK, Cirino AL, Dobson LJ, Harris S. Reproductive decision-making and the utilization of preimplantation genetic testing among individuals with inherited aortic or vascular disease. J Genet Couns 2024; 33:592-604. [PMID: 37533143 DOI: 10.1002/jgc4.1759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/15/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023]
Abstract
Preimplantation genetic testing for monogenic disorders (PGT-M) is a reproductive technology used in conjunction with in-vitro fertilization (IVF) to reduce the risk of passing on a known genetic condition from parent to child. There is limited research describing the experience and emotional impact of PGT-M among individuals with inherited aortic or vascular disease (IAVD). Our qualitative study aims to explore the factors that influence reproductive decision-making and the uptake of PGT-M within this population. Individuals diagnosed with IAVD who have considered PGT-M, and/or their reproductive partner, were recruited using internal clinical databases and advocacy organizations. Virtual semi-structured interviews were conducted using an interview guide that included questions related to participants' lived experience of their condition, risk perception, reproductive history, familiarity with PGT-M/IVF, and financial/psychosocial considerations. A total of 17 interviews were completed (13 affected individuals, 4 unaffected partners) and analyzed using thematic analysis. Emergent themes included: (1) the lived experience and perceived severity of disease; (2) need for comprehensive, balanced, and timely information; (3) and impact of personal values and circumstances. When discussing the impact of lived experience on reproductive decision-making, participants identified the physical and emotional impact of disease and variability of disease as factors influencing the uptake of PGT-M. Many described PGT-M as the only reproductive option presented to them by providers. Even so, participants expressed gaps in their understanding of PGT-M, particularly regarding cost/insurance coverage and the experience of IVF. Finally, participants recognized that the decision to pursue PGT-M primarily requires introspection and evaluation of one's values, but that cost remains a significant consideration. The findings from our study highlight the complexity of reproductive decision-making for individuals with IAVD and provide insight into their psychological and informational needs when engaging in this process. Providers can use these findings to tailor their discussions about reproductive decision-making with this patient cohort.
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Affiliation(s)
- Kaleigh Patton
- Genetic Counseling Program, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Division of Cancer Genetics & Prevention, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Eugene K Wong
- Cardiology Division, Cardiovascular Genetics Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Allison L Cirino
- Genetic Counseling Program, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lori J Dobson
- Genetic Counseling Program, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Center for Fetal Medicine and Reproductive Genetics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stephanie Harris
- Cardiology Division, Cardiovascular Genetics Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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Gunderson S, Gabriel J. Transfer of embryos with positive PGT-M results: Genetic Counselors' perspectives and ethical considerations. J Genet Couns 2024. [PMID: 38785211 DOI: 10.1002/jgc4.1923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
Increasing numbers of fertility patients use preimplantation genetic testing for monogenic conditions (PGT-M) during in vitro fertilization (IVF). While PGT-M is primarily used to avoid implanting embryos with a monogenic condition, patients can request to transfer an embryo with the monogenic condition (positive embryo transfer), especially in cases where an IVF cycle results in no unaffected embryos. Transferring embryos with known disease-causing variants raises ethical concerns. There is limited understanding about how stakeholders in the assisted reproductive technology (ART) field approach these issues. In this study, genetic counselors were sent a survey to gather insight into their views about transferring embryos with different monogenic conditions. N = 99 genetic counselors completed the survey, 22 of whom had experience with patients requesting or deciding to transfer an embryo with a monogenic condition (positive embryo transfer experience). Most participants, including those with positive embryo transfer experience, were supportive of positive embryo transfer, regardless of the genetic condition. While participating genetic counselors were largely supportive of all patient decisions, they reported increased moral uneasiness around transferring embryos with life-limiting monogenic conditions, such as Huntington's disease. Further investigation into the experiences of genetic counselors who have experienced positive embryo transfer requests in practice can help delineate the ethical questions that ART providers face in this context and clarify how genetic counselors can contribute to establishing guidelines in the ART field.
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Affiliation(s)
- Silvia Gunderson
- Division of Graduate Medical Sciences, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jazmine Gabriel
- Division of Graduate Medical Sciences, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Population Health Sciences, Research Institute, Geisinger, Danville, Pennsylvania, USA
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Taguchi S, Hayashi T, Watanabe N, Tada Y, Matsubara T, Calongos G, Yamamoto K, Fujishima R, Imoto S, Funabiki M, Nakamura Y. Genetic Counseling for an Infertile Couple With Premature Chromatid Separation (PCS) Syndrome: A Case Report. Cureus 2024; 16:e56921. [PMID: 38665733 PMCID: PMC11043054 DOI: 10.7759/cureus.56921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
We report the first case of successful genetic counseling for an infertile couple with premature chromatid separation (PCS) syndrome. After our careful genetic counseling, the couple decided to continue infertility treatment. As a result, they gave birth to a baby (girl: 2,930 g) by caesarean section in May 2018. To our knowledge, there have not been any published reports regarding genetic counseling for an infertile couple with PCS after PubMed, EMBASE, and Web of Science searches until March 2024.
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Affiliation(s)
| | | | | | | | | | | | - Kiko Yamamoto
- In Vitro Fertilization Center, Oak Clinic, Osaka, JPN
| | | | - Sayaka Imoto
- In Vitro Fertilization Center, Oak Clinic, Osaka, JPN
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Albujja MH, Al-Ghedan M, Dakshnamoorthy L, Pla Victori J. Preimplantation genetic testing for embryos predisposed to hereditary cancer: Possibilities and challenges. CANCER PATHOGENESIS AND THERAPY 2024; 2:1-14. [PMID: 38328708 PMCID: PMC10846329 DOI: 10.1016/j.cpt.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/03/2023] [Accepted: 05/14/2023] [Indexed: 02/09/2024]
Abstract
Preimplantation genetic testing (PGT), which was developed as an alternative to prenatal genetic testing, allows couples to avoid pregnancies with abnormal chromosomes and the subsequent termination of the affected fetus. Originally used for early onset monogenic conditions, PGT is now used to prevent various types of inherited cancer conditions based on the development of PGT technology, assisted reproductive techniques (ARTs), and in vitro fertilization (IVF). This review provides insights into the potential benefits and challenges associated with the application of PGT for hereditary cancer and provides an overview of the existing literature on this test, with a particular focus on the current challenges related to laws, ethics, counseling, and technology. Additionally, this review predicts the future potential applications of this method. Although PGT may be utilized to predict and prevent hereditary cancer, each case should be comprehensively evaluated. The motives of couples must be assessed to prevent the misuse of this technique for eugenic purposes, and non-pathogenic phenotypes must be carefully evaluated. Pathological cases that require this technology should also be carefully considered based on legal and ethical reasoning. PGT may be the preferred treatment for hereditary cancer cases; however, such cases require careful case-by-case evaluations. Therefore, this study concludes that multidisciplinary counseling and support for patients and their families are essential to ensure that PGT is a viable option that meets all legal and ethical concerns.
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Affiliation(s)
- Mohammed H. Albujja
- Department of Forensic Sciences, Naif Arab University for Security Sciences, Riyadh 11452, Saudi Arabia
| | - Maher Al-Ghedan
- Genetics Laboratory, Thuriah Medical Center, Riyadh 11523, Saudi Arabia
| | | | - Josep Pla Victori
- Department of Genetic Counselling, VI-RMA Global, Valencia 46004, Spain
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7
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Liu Y, Ren Y, Feng H, Wang Y, Yan L, Qiao J, Liu P. Development of preimplantation genetic testing for monogenic diseases in China. HUM FERTIL 2023; 26:879-886. [PMID: 38059330 DOI: 10.1080/14647273.2023.2284153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023]
Abstract
Preimplantation genetic testing for monogenic diseases (PGT-M) can effectively interrupt the transmission of genetic diseases from parents to the offspring before pregnancy. In China, there are over ten million individuals afflicted with monogenic disorders. This literature review summarizes the development of PGT-M in China for the past 24 years, covering the general steps such as the indications and contraindications, genetic and reproductive counselling, biopsy methods, detecting techniques and strategies during PGT-M application in China. The ethical considerations of PGT-M are also be emphasized, including sexual selection, transferring for mosaic embryos, the three-parent baby, and the different opinions for serious adult-onset conditions. Some key policies of the Chinese government for the application of PGT-M are also considered. Methods for regulation of this technique, as well as specific management to increase the accuracy and reliability of PGT-M, are regarded as priority issues in China. The third-generation sequencing and variants testing from RNA level, and non-invasive preimplantation genetic testing using blastocoel fluid and free DNA particles within spent blastocyst medium might be potential techniques and strategies for PGT-M in future.
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Affiliation(s)
- Yujun Liu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P. R. China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, P. R. China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, P. R. China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, P. R. China
| | - Yixin Ren
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P. R. China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, P. R. China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, P. R. China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, P. R. China
| | - Hao Feng
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P. R. China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, P. R. China
| | - Yuqian Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P. R. China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, P. R. China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, P. R. China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, P. R. China
| | - Liying Yan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P. R. China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, P. R. China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, P. R. China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, P. R. China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P. R. China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, P. R. China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, P. R. China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, P. R. China
| | - Ping Liu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P. R. China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, P. R. China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, P. R. China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, P. R. China
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Mayeur A, Benaloun E, Benguigui J, Duperier C, Hesters L, Chatzovoulou K, Monnot S, Grynberg M, Steffann J, Frydman N, Sonigo C. Preimplantation genetic testing for mitochondrial DNA mutation: ovarian response to stimulation, outcomes and follow-up. Reprod Biomed Online 2023; 47:61-69. [PMID: 37202317 DOI: 10.1016/j.rbmo.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/18/2023] [Accepted: 02/20/2023] [Indexed: 03/04/2023]
Abstract
RESEARCH QUESTION How do carriers of pathogenic mitochondrial DNA (mtDNA) respond to ovarian stimulation? DESIGN A single-centre, retrospective study conducted between January 2006 and July 2021 in France. Ovarian reserve markers and ovarian stimulation cycle outcomes were compared for couples undergoing preimplantation genetic testing (PGT) for maternally inherited mtDNA disease (n = 18) (mtDNA-PGT group) with a matched-control group of patients undergoing PGT for male indications (n = 96). The PGT outcomes for the mtDNA-PGT group and the follow-up of these patients in case of unsuccessful PGT was also reported. RESULTS For carriers of pathogenic mtDNA, parameters of ovarian response to FSH and ovarian stimulation cycle outcomes were not different from those of matched-control ovarian stimulation cycles. The carriers of pathogenic mtDNA needed a longer ovarian stimulation and higher dose of gonadotrophins. Three patients (16.7%) obtained a live birth after the PGT process, and eight patients (44.4%) achieved parenthood through alternative methods: oocyte donation (n = 4), natural conception with prenatal diagnosis (n = 2) and adoption (n = 2). CONCLUSION To the best of our knowledge, this is the first study of women carrying a mtDNA variant who have undergone a PGT for monogenic (single gene defects) procedure. It is one of the possible options to obtain a healthy baby without observing an impairment in ovarian response to stimulation.
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Affiliation(s)
- Anne Mayeur
- Service de Biologie de la Reproduction- CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, cedex, F-92140 Clamart, France.; Université Paris-Sud, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France..
| | - Emmanuelle Benaloun
- Service de Biologie de la Reproduction- CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, cedex, F-92140 Clamart, France
| | - Jonas Benguigui
- Service de Médecine de la reproduction et Préservation de la Fertilité, Assistance Publique Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart 92140, France
| | - Constance Duperier
- Service de Médecine de la reproduction et Préservation de la Fertilité, Assistance Publique Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart 92140, France
| | - Laetitia Hesters
- Service de Biologie de la Reproduction- CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, cedex, F-92140 Clamart, France
| | | | - Sophie Monnot
- Université de Paris, Imagine INSERM UMR1163 et Service de Médecine Génomique des Maladies rares, Groupe Hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Michael Grynberg
- Université Paris-Sud, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France.; Service de Médecine de la reproduction et Préservation de la Fertilité, Assistance Publique Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart 92140, France
| | - Julie Steffann
- Université de Paris, Institut Imagine, INSERM UMR1163, Paris, France.; Université de Paris, Imagine INSERM UMR1163 et Service de Médecine Génomique des Maladies rares, Groupe Hospitalier Necker-Enfants Malades, AP-HP, Paris, France
| | - Nelly Frydman
- Service de Biologie de la Reproduction- CECOS, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, cedex, F-92140 Clamart, France.; Université Paris-Sud, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - Charlotte Sonigo
- Université Paris-Sud, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France.; Service de Médecine de la reproduction et Préservation de la Fertilité, Assistance Publique Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart 92140, France.; Inserm U1185, Faculté de médecine Paris Sud, France
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Zhu H, Shi L, Wang R, Cui L, Wang J, Tang M, Qian H, Wei M, Wang L, Zhou H, Xu W. Global Research Trends on Infertility and Psychology From the Past Two Decades: A Bibliometric and Visualized Study. Front Endocrinol (Lausanne) 2022; 13:889845. [PMID: 35903282 PMCID: PMC9317298 DOI: 10.3389/fendo.2022.889845] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The aim of this study was to evaluate the global scientific output of research on infertility and psychology; explore the current status and trends in this field through the cooperation of authors, countries, and institutions; shed light on the direction of clinical infertility research in the future, and provide inspiration for targeted diagnosis and treatment of infertility. Methods Research publications on infertility and psychology from the past two decades were retrieved from the Web of Science Core Collection (WoSCC). Bibliometric analyses were performed using VOSviewer software and the bibliometrix R package. Network maps were generated to evaluate the collaborations between different authors, countries, institutions, and keywords. Results A total of 151 articles related to the study of infertility and psychology were identified. We observed a gradual increase in the number of publications from 2001 to 2021, and the trend has been relatively stable in the past eight years. Human Reproduction (England), as the leading journal publishing the most papers (29 articles), was cited in the most journals (1208 times). Boivin J was the most prolific author (16 articles), with the largest number of citations (890 times) and the highest h-index (14) during the past decades. Boivin J was also the leader with the highest publication frequency and more active cooperation with other top authors. The United Kingdom (34 papers) and Cardiff University (25 articles) contributed the most publications and were the leading contributors in this field. Active cooperation between countries and between institutions was observed, and analyses of articles and references were also shown. The main hot topics included matters related to women (39 times), in-vitro salt (31 times), infertility (30 times), couples (25 times), and impact (24 times). Conclusion Our study results provide a comprehensive overview of the development of scientific literature, allowing relevant authors and research teams to recognize the current research status in this field. At the same time, infertility and psychology may soon become hotspots and should be closely monitored.
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Affiliation(s)
- Hongkun Zhu
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Lingli Shi
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Rong Wang
- Department of Laboratory Medicine, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Lijuan Cui
- Department of Pathology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Jiahui Wang
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Mengyu Tang
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Haiqing Qian
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Minggang Wei
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Lihong Wang
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Huifang Zhou
- Department of Gynaecology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenting Xu
- Nanjing University of Chinese Medicine, Nanjing, China
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
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10
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Vriesen N, Carmany EP, Natoli JL. Clinical outcomes of preimplantation genetic testing for hereditary cancer syndromes: A systematic review. Prenat Diagn 2022; 42:201-211. [PMID: 34981540 DOI: 10.1002/pd.6084] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/09/2021] [Accepted: 12/29/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To conduct a systematic review of the published literature on clinical outcomes following preimplantation genetic testing for monogenic disorders (PGT-M) for hereditary cancer syndromes (HCS). METHODS Three electronic databases (PubMed, Cochrane, and EMBASE) were searched for publications related to PGT-M for HCS. When appropriate, weighted means were used to calculate clinical and live birth rates. RESULTS We identified 22 publications that reported on clinical and/or psychosocial outcomes of PGT-M for HCS. The weighted mean clinical pregnancy rate (CPR) per embryo was 33.5% (11 studies, 95% CI: 29.1%, 38.2%), and the CPR per cycle with embryonic transfer was 40.1% (14 studies, 95% CI: 36.1%, 44.3%). The weighted mean live birth rate (LBR) per embryo was 28.9% (11 studies, 95% CI: 24.7%, 33.4%) and the LBR per cycle with embryonic transfer was 33.2% (13 studies, 95% CI: 29.2%, 37.4%). The limited literature regarding the psychosocial outcomes of PGT-M for HCS suggests reproductive decision-making is difficult and additional support may be desired. CONCLUSION These findings suggest that CPR and LBR following PGT-M for HCS are comparable to other monogenic disorders. Heterogeneity across studies suggests the overall CPR and LBR found may not be applicable to all HCS indications and PGT-M methodologies.
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Affiliation(s)
- Natalie Vriesen
- Division of Medical Genetics, Henry Ford Health System, Detroit, Michigan, USA.,Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Erin P Carmany
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jaime L Natoli
- Department of Clinical Analysis, Evidence-Based Medicine Services, Southern California Permanente Medical Group, Kaiser Permanente, Pasadena, California, USA
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11
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Fine E, Knoll MA, Maslow BSL. Fertility Considerations for Reproductive-Aged Carriers of Deleterious BRCA Mutations: A Call for Early Intervention. JCO Oncol Pract 2021; 18:165-168. [PMID: 34606330 DOI: 10.1200/op.21.00389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Eliana Fine
- Jewish Orthodox Women's Medical Association (JOWMA), New York, NY.,Department of OBGYN, Renaissance School of Medicine at Stonybrook University, Stonybrook, NY
| | - Miriam A Knoll
- Jewish Orthodox Women's Medical Association (JOWMA), New York, NY.,Department of Radiation Oncology, Montefiore Nyack Hospital, Nyack, NY
| | - Bat-Sheva L Maslow
- Jewish Orthodox Women's Medical Association (JOWMA), New York, NY.,Extend Fertility Medical Practice, New York, NY
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12
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Zhang J, Pastore LM, Sarwana M, Klein S, Lobel M, Rubin LR. Ethical and moral perspectives of individuals who considered/used preimplantation (embryo) genetic testing. J Genet Couns 2021; 31:176-187. [PMID: 34279057 DOI: 10.1002/jgc4.1471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/05/2022]
Abstract
This study examined perspectives on the ethical implications of preimplantation genetic testing (PGT) among individuals who actually (not hypothetically) used or considered using PGT. Most of the prior patient-centered research on PGT ethics used qualitative designs (9 out of the 11 articles) and focused only on single gene testing. This cross-sectional study used an anonymous online questionnaire; 15 items assessed potential ethical concerns involved in PGT decision-making, including clinical indications for PGT, the greater implications of PGT for society, and unused embryo disposition. N = 207 individuals (mean female/male age 35.7/38.9 years, 21% Hispanic or non-White) who had recently used or considered using PGT for single gene (60%) or for chromosomal testing (40%) completed the questionnaire. Most respondents supported PGT screening for disease conditions with childhood or adult onset that are untreatable (64%-85% across items); most opposed PGT for trait selection (76%-81%). Most respondents agreed that PGT aids in parental decision-making (66%-67%), although some expressed concern over potential unforeseen consequences (25%-30%). Regarding disposition of embryos without known genetic abnormalities, most respondents favored freezing indefinitely (86%) or donating to another family (69%), while for embryos with genetic abnormalities, most respondents favored donating to research (78%) or destroying them (62%). Stratification by religious affiliation revealed several differences, such as less acceptance of PGT for diseases that occur in adulthood and have no treatment options among Protestants (p = .015) and greater willingness to donate surplus embryos to research among participants without a religious affiliation (p < .001). These results are limited by the relatively homogeneous sample of participants (mostly White, married, and predominantly college-educated). In summary, participants who considered/used PGT found PGT acceptable overall for screening for disease conditions; most opposed using PGT for trait selection. Our novel questionnaire provides a structured tool for assessing the ethical perspectives surrounding the use of PGT.
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Affiliation(s)
- Jiahui Zhang
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Lisa M Pastore
- Department of Obstetrics/Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook, NY, USA
| | - Miriam Sarwana
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Samantha Klein
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Lisa R Rubin
- Department of Psychology, The New School for Social Research, New York, NY, USA
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13
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Comparison of Patients' Ethical Perspectives of Preimplantation Embryo Genetic Testing for Aneuploidy (PGT-A) vs. Monogenic Disorders (PGT-M). Reprod Sci 2021; 28:3272-3281. [PMID: 34131887 DOI: 10.1007/s43032-021-00644-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
What are the ethical perspectives of preimplantation genetic testing in patients using/considering PGT-A compared to those using/considering PGT-M? A 17-item questionnaire administered online was used to assess ethical perspectives in US patients who recently used/considered PGT-A (n=80) vs. those who used/considered PGT-M (n=72). Kruskal-Wallis, Chi-square, and Fisher exact tests were conducted with STATA. Most PGT-A and PGT-M users/considerers supported using PGT to screen for diseases fatal in childhood (86-89%) and those causing lifelong disabilities (76-79%) and opposed using PGT to screen for non-medical physical (80-87%) or intellectual traits (74-86%). Both groups agreed that PGT aids in parental decision-making, although some expressed concern over its potential to lead to unforeseen consequences for society and the PGT offspring. More PGT-M than PGT-A users/considerers opposed implanting genetically abnormal embryos when requested by parents (29% PGT-A vs. 56% PGT-M, p = 0.007). For embryo disposition, more PGT-A users/considerers favored freezing (95% PGTA vs. 82% PGT-M, p = 0.018) or donating genetically normal embryos to research (73% PGT-A vs. 57% PGT-M, p = 0.044), while more PGT-M users/considerers supported donating embryos with known genetic abnormalities to research (56% PGT-A vs. 81% PGT-M, p = 0.001). Regardless of the reason for using PGT, users generally agreed on the acceptable and unacceptable uses for it, as well as the potential societal impact. PGT-M users/considerers expressed more opposition than PGT-A users/considerers to implanting embryos with a genetic alteration when requested by the parents.
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14
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Herrera KM, Milone G, Davis JA, Persad MD, Dinglas C, Heiselman C, Buckley A, Garretto D, Pastore LM. Psychological measures of patient's decision-making for prenatal genetic testing. J Matern Fetal Neonatal Med 2020; 35:4130-4136. [PMID: 33207999 DOI: 10.1080/14767058.2020.1847074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To use a questionnaire to determine the levels of maternal decision-related distress, clarity of the pros and cons, and certainty when considering prenatal genetic diagnostic testing; and to assess the relationship between these constructs and patient characteristics. METHOD Cross-sectional study. Voluntary, anonymous questionnaires distributed 2017-2019 to women referred for invasive prenatal genetic testing. Excluded: English or Spanish illiterate. Maternal characteristics were collected. Questions evaluated distress, decisional certainty, and decisional clarity on a 5-point Likert scale (range: 0 = low/uncertain/unclear to 4 = high/certain/clear). Analysis: non-parametric Kruskal-Wallis, correlation statistics, and ANOVA. RESULTS Forty-four female patients completed it. Most were married, white, Catholic, and multiparous. 58% had already made a testing decision. Patients expressed low distress levels (mean 1.18 ± 0.80) and expressed high decisional certainty (mean 3.28 ± 0.76) and clarity (mean 3.30 ± 0.99). Decisional certainty and clarity were positively correlated (r = 0.47, p < .01), whereas distress was negatively correlated with decisional certainty (r = -0.8136, p < .0005) and decisional clarity (r = -0.49, p = .007). No significant differences by religion or parity. Greater distress (p < .05) and less decisional clarity (p = .07) occurred between those still debating testing vs those who had decided. CONCLUSIONS Higher maternal distress scores were associated with lower decisional certainty and decisional clarity in women considering prenatal genetic testing.
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Affiliation(s)
- Kimberly M Herrera
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine Stony Brook University, Stony Brook, NY, USA
| | - Gina Milone
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine Stony Brook University, Stony Brook, NY, USA
| | - Jay A Davis
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine Stony Brook University, Stony Brook, NY, USA
| | - Malini D Persad
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine Stony Brook University, Stony Brook, NY, USA
| | - Cheryl Dinglas
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine Stony Brook University, Stony Brook, NY, USA
| | - Cassandra Heiselman
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine Stony Brook University, Stony Brook, NY, USA
| | - Ayisha Buckley
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine Stony Brook University, Stony Brook, NY, USA
| | - Diana Garretto
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine Stony Brook University, Stony Brook, NY, USA
| | - Lisa M Pastore
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine Stony Brook University, Stony Brook, NY, USA
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15
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Pastore LM, Rubin LR, SantaBarbara JN, Stelling J, Lobel M. Initial psychometric analysis of novel instruments to assess decisional distress and decisional uncertainty in women who have considered using preimplantation genetic testing. Prenat Diagn 2020; 40:1220-1227. [PMID: 32367519 PMCID: PMC10041134 DOI: 10.1002/pd.5730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/05/2020] [Accepted: 04/28/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To analyze psychometric properties of two novel instruments assessing decisional distress and uncertainty experienced by individuals considering preimplantation genetic testing (PGT). METHODS The new PGT Decisional Distress instrument (22 items) assesses negative/positive emotions. The new PGT Decisional Uncertainty instrument assesses Clarity about test benefits/disadvantages (5 items) and Certainty of having adequate information/support to make a good decision (7 items). Scales ranged from 0 to 4. Psychometrics (central tendencies, internal consistency reliability, and discriminant validity) were evaluated. Stratified analysis by decision stage was conducted. All participants had considered or used PGT in the previous 6 months. RESULTS N = 106 females (mean age 36.5 ± 4.8 years; 16% non-Caucasian; 9% Hispanic) across 16 US states completed an online anonymous questionnaire. On average, respondents reported minimal distress (mean 0.96), high clarity (mean 3.26), and high certainty (mean 3.06), particularly those who had already decided compared to undecided women (P ≤ .02). Instruments had excellent internal consistency (Cronbach's α's 0.92-0.94) and displayed sufficient inter-individual variability (SD's 0.75-0.89). Correlations confirmed expected patterns of association between instruments (P's < .01), indicating discriminant validity. CONCLUSION We document initial reliability and validity of new instruments to measure emotional distress and uncertainty in female patients who have recently considered PGT for single-gene or chromosomal disorders.
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Affiliation(s)
- Lisa M. Pastore
- Department of Obstetrics/Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook, New York
| | - Lisa R. Rubin
- Department of Psychology, The New School for Social Research, New York, New York
| | | | - James Stelling
- Department of Obstetrics/Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook, New York
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, New York
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16
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Bracewell-Milnes T, Saso S, Jones B, Cato S, Parikh R, Thum MY, Johnson M, Almeida P, Norman-Taylor J, Nikolaou D. A systematic review exploring the patient decision-making factors and attitudes towards pre-implantation genetic testing for aneuploidy and gender selection. Acta Obstet Gynecol Scand 2020; 100:17-29. [PMID: 32862440 DOI: 10.1111/aogs.13973] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Pre-implantation genetic testing for aneuploidy (PGT-A) is in high demand worldwide, with ongoing debate among medical societies as to which patient groups it should be offered. The psychological aspects for patients regarding its use, lag behind the genomic technological advances, leaving couples with limited decision-making support. The development of this technology also leads to the possibility for its utilization in gender selection. Despite the controversy surrounding these issues, very few studies have investigated the psychological aspects of patients using PGT-A. MATERIAL AND METHODS This systematic review provides an up-to-date analysis of the psychosocial aspects surrounding PGT for aneuploidy and sex selection, as well as decision-making factors. A systematic search of English peer-reviewed journals of three computerized databases were undertaken following PRISMA guidelines. The qualitative data were extracted using thematic analysis. PROSPERO Registration number: CRD42019126439. RESULTS The main outcome measures were patients' motivations, decision-making factors, attitudes and experiences surrounding the use of PGT for aneuploidy and sex selection. Ten studies were included, four for PGT-A and six for sex selection. Attitudes towards PGT-A were positive, with the main motivating factors being decreasing miscarriage rate, reducing the risk of termination of pregnancy and reducing the time to pregnancy. Consistently raised concerns regarding PGT-A were the financial burden and moral beliefs. The vast majority of patients felt sufficiently knowledgeable to make the decision; however, studies did reveal that a minority mis-interpreted certain potential benefits of PGT-A. Studies investigating PGT for sex selection predominantly reported the main motivation was to achieve gender balance within the family dynamic, with most studies finding no difference between couples using PGT for gender selection to have male or female offspring. CONCLUSIONS Although this systematic review was limited by the small number of studies investigating this topic, a significant minority of patients appeared to misunderstand certain benefits and limitations of PGT-A. Fertility clinics must ensure they provide adequate counseling to all patients using PGT-A. With the use of PGT-A on the rise globally, there is a need to develop decision support tools for couples who have an increasing number of genetic testing options becoming available to them.
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Affiliation(s)
| | - Srdjan Saso
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Benjamin Jones
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | | | - Riya Parikh
- Biomedical Sciences, St George's, University of London, London, UK
| | | | - Mark Johnson
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Paula Almeida
- Assisted Conception Unit, Chelsea and Westminster Hospital, London, UK
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17
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De Krom G, Severijns Y, Vlieg WL, Arens YHJM, Van Golde RJT, De Die-Smulders CEM, Van Osch LADM. Motives and considerations regarding PGT in couples carrying a structural chromosomal abnormality: a qualitative exploration. J Assist Reprod Genet 2020; 37:1719-1727. [PMID: 32418135 PMCID: PMC7376769 DOI: 10.1007/s10815-020-01810-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/06/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose This study aims to describe the motives and considerations of couples carrying a structural chromosomal abnormality deciding on preimplantation genetic testing (PGT). Methods A qualitative exploratory study was conducted using semi-structured dyadic interviews with 13 couples (N = 26) carrying a structural chromosomal abnormality. All couples had an informative consultation in our PGT centre in the Netherlands. Results Almost all couples considered PGT or natural conception combined with prenatal diagnosis (PND) as the only two reproductive options. Among several considerations mentioned, the majority indicated that the wish to increase the chance of a successful pregnancy was the most important motive to opt for PGT. All couples who opted for PGT had first tried to conceive spontaneously and entered the PGT programme because of their adverse experiences during these attempts (infertility, recurrent miscarriage, termination of pregnancy, birth of an affected child). Couples that refrained from PGT were of advanced maternal age and expressed the long trajectory of PGT as the main reason to refrain. If conceiving spontaneously would not lead to an ongoing pregnancy, these couples also indicated that they would use PGT. Conclusion This study shows that couples carrying a structural chromosomal abnormality consider PGT and spontaneous conception with PND as relevant reproductive options. They are looking for the option that is in their opinion the fastest way to establish a successful pregnancy. Information on the perceived pros and cons of PGT or spontaneous conception in these couples can help to optimize counselling and psychological support during the decision-making process.
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Affiliation(s)
- G De Krom
- Department of Obstetrics & Gynaecology, Maastricht University Medical Centre +, Maastricht, The Netherlands.,School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands
| | - Y Severijns
- Department of Health Promotion/CAPHRI, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands.
| | - W L Vlieg
- Department of Health Promotion/CAPHRI, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - Y H J M Arens
- School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - R J T Van Golde
- Department of Obstetrics & Gynaecology, Maastricht University Medical Centre +, Maastricht, The Netherlands.,School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands
| | - C E M De Die-Smulders
- School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - L A D M Van Osch
- Department of Health Promotion/CAPHRI, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
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