The hypothesis that elimination of aneuploid embryos prior to transfer into the uterus will improve in vitro fertilization (IVF) cycle outcomes has permeated IVF under various synonyms since the 1990s. Under most recent terminology called preimplantation genetic testing (PGT-A), the procedure, though never able to prove its clinical utility, has in the U.S. in many IVF centers become a routine add-on to IVF over the last 4-5 years. Meant to determine whether human embryos are to be transferred or disposed of, PGT-A was never validated and/or approved by a regulatory body, including the U.S. Food and Drug Administration (FDA), or found effective in improving IVF outcomes by an authoritative professional organization like the American Society for Reproductive Medicine (ASRM) or the European Society for Reproductive Medicine and Embryology (ESHRE). We here argue that PGT-A, as currently clinically applied, does not improve IVF outcomes and, indeed, may have the opposite effect in selected patient subpopulations. Though standard ethical clinical practice mandates prior validation studies before clinical introduction of new diagnostic tests and/or treatments, the responsibility to assess PGT-A, paradoxically, has primary fallen on the basic science community, which in recent years convincingly demonstrated that the PGT-A hypothesis for biological, mathematical and technical reasons, simply, cannot work. We, therefore, conclude that PGT-A should not be offered to patients except within experimental study frameworks and should be considered contraindicated in women with small embryo numbers, including older women and younger women with low functional ovarian reserve.
Published in the Journal of Assisted Reproduction and Genetics https://pubmed.ncbi.nlm.nih.gov/32008181/
Citation Page #: 2020; 37(3):669-672.
Journal: Journal of Assisted Reproduction and Genetics
Author Publication: Orvieto R, Gleicher N.
Publication Link: https://pubmed.ncbi.nlm.nih.gov/32008181/
Date: 2020
Norbert Gleicher, MD, FACOG, FACS
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, 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.