New Hope for IVF-PGS Patients: New York Magazine Article
New York Magazine’s “The Abnormal Embryos That Aren’t” is the first article in a major publication that directly deals with the dubious promise of preimplantation genetic screening (PGS). The thoroughly researched piece by Stephen Hall ushers in a light of hope to IVF patients who thought they’d hit an insurmountable wall on their journey to parenthood after all their embryos were deemed “abnormal” by PGS. Center for Human Reproduction’s Dr. Gleicher explains.Want to Consult Dr. Gleicher?
I want to talk to you today about a beautiful piece that just appeared in the New York Magazine. A very excellent writer by the name of Steven Hall offered new hope to infertile women who have undergone PGS, pre-implantation genetic screening, which recently has also received a new name, pre-implantation genetic testing, for unemployed or PGTA. This new name is kind of meant as a new beginning for the procedure which in recent months and years has faced increasing skepticism. Especially, from us here at CHR.
CHR has probably been the leading and most vocal opposition to the increasing use of PGS/PGTA. Because we feel that both biologically and practically, clinically PGS, not only does not fulfill its promises of improving IVF outcomes, but it actually may reduce pregnancy chances for some women. Particularly, adversely affected, obviously women who produce very few embryos and therefore, cannot afford false diagnosis and even less opinionated people about PGS including the current president of the American Society for Reproductive Medicine Dr. Richard Paulson from USC in Los Angeles are in current times assessing that the false positive rate, in other words the embryos that are declared to be abnormal when in reality being normal, may be as high as 40%. Think about that. This may mean and that up to 40% of embryos, which are tested and which could be safely transferred to a woman are not transferred and often disposed of.
So because of that, we here at CHR have been quite opposed to the utilization of PGS and just a few days ago New York Magazine came out with this story here, even presented at the cover of the magazine, and what makes this story so special is not only that it is the first media presentation of the whole disapproval that PGS has been facing increasingly in the recent times. But the writer did it in a wonderful and very positive way because instead of saying look how terrible this procedure is which has resulted in the mistaken disposal of so many potentially healthy embryos. He turned the story around and he came actually out of it with a positive message and that positive message is even on the cover when the magazine says tens of thousands of women thought they couldn’t have babies, but what if they could? And what is meant by this heading is the fact that many of these embryos which until very recently were automatically disposed of now suddenly can and are being transferred.
We are very proud, here at CHR, to have been the first ones to do that. We started offering on an experimental basis of the transfer of so-called anaploid chromosomally abnormal embryos, already in 2012, five years ago. By 2013, two women had given birth to healthy babies. When a few colleagues here in New York joined us in a small informal consortium and they also started transferring such embryos and by 2015. At our annual ASRM meeting in October, I was therefore able to present already five live birth or advanced pregnancies of women who had such embryos transferred and all of these pregnancies were determined to be normal. Less than two years later, we now know that close to a hundred healthy babies have been born so far.
Very recently, actually a group of proponents of PGS, published a very important paper. This was the largest group of so-called mosaic, whereas we used to call them anaploid embryos, that was transferred. And in this quite large group roughly 140 embryos were transferred. These authors reported amazingly high clinical ongoing pregnancy rates. Indeed, in women whose embryos had either trisomies or monosomies. Those are the two most frequent chromosomal abnormalities we find in embryos. The ongoing clinical pregnancy rate was a whopping 50%. Imagine that. The testing of the words in helping to determine whether a given embryo should be discarded or can be transferred was as good as a coin flip, 50%. Head or tail, same thing.
So this paper contributed greatly to increasing skepticism over the procedure of PGS. Steven Hall, in this article in New York magazine, really very fairly described both sides of the controversy. He interviewed literally everybody who had something important to say, scientifically, all over the world. He quoted investigators from the U.S, from Europe, from Israel. He spoke to everybody who ever had published an important paper on the subject. And as already stated, he presented his conclusions in a very positive way. He did not condemn what happened. He presented it as a new opportunity and this is what increasing knowledge, in this case, really offers: patients who have been told up till now that they could not get pregnant because all of their embryos were always anapoloid chromosomally abnormal.
They should know now that this was the wrong information. There is no such thing like a woman having only abnormal embryos. There’s only one thing that could lead to those results and that is an inaccurate test. Nature doesn’t work in hundred percents or zero percents. Nature is always a gradual process and therefore, if you have a patient who has had only so-called anaploid or mosaic embryos, don’t discourage her from trying again. If you are a patient who had repeated cycles and you were told that all of your embryos were abnormal, ask if those embryos are still cryopreserved because if they are, there is a good chance that at least some of them can still be transferred safely.