Preimplantation genetic screening (PGS) still in search of a clinical application: a systematic review

Reproductive Biology and Endocrinology

David H Barad¹  Vitaly A Kushnir²  Norbert Gleicher¹ 

[1] The Foundation for Reproductive Medicine, New York, USA;The Center for Human Reproduction (CHR), New York, USA

关键词: Blastocyst stage embryo transfer;    Trophectoderm biopsy;    In vitro fertilization (IVF);    Assisted reproduction (ART);    Preimplantation genetic diagnosis (PGS);   

Others  :  804520
DOI  :  10.1186/1477-7827-12-22

 received in 2014-01-17, accepted in 2014-03-09,  发布年份 2014

【 摘 要 】

Only a few years ago the American Society of Assisted Reproductive Medicine (ASRM), the European Society for Human Reproduction and Embryology (ESHRE) and the British Fertility Society declared preimplantation genetic screening (PGS#1) ineffective in improving in vitro fertilization (IVF) pregnancy rates and in reducing miscarriage rates. A presumably upgraded form of the procedure (PGS#2) has recently been reintroduced, and is here assessed in a systematic review. PGS#2 in comparison to PGS#1 is characterized by: (i) trophectoderm biopsy on day 5/6 embryos in place of day-3 embryo biopsy; and (ii) fluorescence in-situ hybridization (FISH) of limited chromosome numbers is replaced by techniques, allowing aneuploidy assessments of all 24 chromosome pairs. Reviewing the literature, we were unable to identify properly conducted prospective clinical trials in which IVF outcomes were assessed based on “intent to treat”. Whether PGS#2 improves IVF outcomes can, therefore, not be determined. Reassessments of data, alleged to support the efficacy of PGS#2, indeed, suggest the opposite. Like with PGS#1, the introduction of PGS#2 into unrestricted IVF practice again appears premature, and threatens to repeat the PGS#1 experience, when thousands of women experienced reductions in IVF pregnancy chances, while expecting improvements. PGS#2 is an unproven and still experimental procedure, which, until evidence suggests otherwise, should only be offered under study conditions, and with appropriate informed consents.

【 授权许可】

   
2014 Gleicher et al.; licensee BioMed Central Ltd.

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