PGS no more; Long live PGT-A!

Nothing happens by accident, not even changes in how procedures in IVF are referred to. It now appears time to say good-bye to a term we have been using since the late 1990s, when European colleagues first coined it: Preimplantation genetic screening (PGS), then considered a small sub-category of preimplantation genetic diagnosis (PGD) that described chromosomal testing of human embryos prior to transfers. At least, American Society for Reproductive Medicine (ASRM) and Fertility & Sterility (F&S), the official journal of the ASRM, no longer considers PGS the appropriate term to describe a chromosomal analysis of human embryos.

Instead, the May issue of F&S, largely dedicated to the procedure, suddenly, and without further explanation, was instead referring to the procedure as preimplantation genetic testing for aneuploidy (PGT-A). And for those who considered that a coincidence, the recent preliminary draft of a Practice Committee Opinion of ASRM and Society for Assisted Reproduction (SART) had as its short tile, PGT-A for “aneuploidy.”

Since such drafts of Practice Committee Opinions are preliminary, and ASRM members are requested to keep them confidential until official publication, we will not further comment on the opinion itself here. The sudden name change is, however, peculiar enough to comment on because it surprises not only in its suddenness but also in its obvious coordination by the ASRM.

In this month’s lead article of the VOICE, we make the point that the renaming of the procedure gives the impression of a typical rebranding marketing effort, which under the name PGS has failed twice and, in the process, has not only wasted incredible resources, added significant undue financial burden to IVF and, in many cases, has actually reduced patients’ IVF pregnancy rates and live birth chances, while leading to the mistaken discarding of large numbers of perfectly normal human embryos.

We are hesitant about being so cynical but, despite maximal efforts by everybody here at CHR, we, simply, could not come up with another explanation for the sudden name change which, of course, follows just a few short months the equally sudden radical revamp of how the procedure is viewed by “experts,” analyzed and reported by the industry, in more detail discussed in this month’s lead article.

While we truly hope that our cynicism will be refuted by another, better explanation, should the name change really be primarily only a marketing ploy, then shame is, of course, on the PGS/PGT-A industry. But even bigger condemnation would have to be directed at the ASRM and its primary medical journal, F&S, for supporting such a charade.

The most important take-home lesson from this column is, however, that should anybody try in the future to promote something, either called PGS or PGT-A to improve your IVF experience, run, just run! We then suggest you use a tiny fraction of the money you saved from avoiding the procedure to buy a celebratory drink for having avoided to fall for version 3.0 of the same old ruse.

This is a part of the July 2017 CHR VOICE.

Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned reproductive endocrinologist, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.