What next for preimplantation genetic screening? More randomized controlled trials needed?

The recent debate on preimplantation genetic screening (PGS) has raised questions about its routine use in clinical practice. It has been suggested that the most effective way to resolve the debate about the usefulness of PGS is to perform more well-designed and well-executed randomized controlled trials (RCTs). However, in view of the lack of evidence for the effectiveness of PGS and the accumulating evidence for its harmfulness, it is our opinion that it is unethical to perform additional RCTs for the indication advanced maternal age using cleavage stage biopsy.

[1]  C. Moutou,et al.  ESHRE PGD Consortium data collection VIII: cycles from January to December 2005 with pregnancy follow-up to October 2006. , 2008, Human reproduction.

[2]  R J Lilford,et al.  Equipoise and the ethics of randomization. , 1995, Journal of the Royal Society of Medicine.

[3]  K. Hudson,et al.  Genetic testing of embryos: practices and perspectives of US in vitro fertilization clinics. , 2008, Fertility and sterility.

[4]  K. Vesela,et al.  What next for preimplantation genetic screening? , 2008, Human reproduction.

[5]  L. Wilton Preimplantation genetic diagnosis for aneuploidy screening in early human embryos: a review , 2002, Prenatal diagnosis.

[6]  Seang Lin Tan,et al.  Chromosomal mosaicism throughout human preimplantation development in vitro: incidence, type, and relevance to embryo outcome. , 2002, Human reproduction.

[7]  Michel Camus,et al.  Comparison of blastocyst transfer with or without preimplantation genetic diagnosis for aneuploidy screening in couples with advanced maternal age: a prospective randomized controlled trial. , 2004, Human reproduction.

[8]  Y. Verlinsky,et al.  Pregnancies following pre-conception diagnosis of common aneuploidies by fluorescent in-situ hybridization. , 1995, Human reproduction.

[9]  N. Muntjewerff,et al.  ESHRE PGD Consortium data collection V: cycles from January to December 2002 with pregnancy follow-up to October 2003. , 2008, Human reproduction.

[10]  B. Urman,et al.  What next for preimplantation genetic screening? A clinician's perspective. , 2008, Human reproduction.

[11]  B. Fauser,et al.  Preimplantation genetic screening reveals a high incidence of aneuploidy and mosaicism in embryos from young women undergoing IVF. , 2006, Human reproduction.

[12]  A. V. Van Steirteghem,et al.  The analysis of one or two blastomeres for PGD using fluorescence in-situ hybridization. , 2006, Human reproduction.

[13]  L. Nilsson,et al.  Preimplantation genetic screening in women of advanced maternal age caused a decrease in clinical pregnancy rate: a randomized controlled trial. , 2008, Human reproduction.

[14]  C. Strom,et al.  Diagnosing and preventing inherited disease: Pregnancies following pre-conception diagnosis of common aneuploidies by fluorescent in-situ hybridization , 1995 .

[15]  J. Zhang,et al.  What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. , 1998, JAMA.

[16]  J. Vermeesch,et al.  Preimplantation genetic screening (PGS) for aneuploidy in embryos after in vitro fertilization (IVF) does not improve reproductive outcome in women over 35: a prospective controlled randomized study , 2007 .

[17]  R. Jansen,et al.  What next for preimplantation genetic screening (PGS)? Experience with blastocyst biopsy and testing for aneuploidy. , 2008, Human reproduction.

[18]  C. Moutou,et al.  ESHRE PGD consortium data collection VII: cycles from January to December 2004 with pregnancy follow-up to October 2005. , 2008, Human reproduction.

[19]  T C Chalmers,et al.  Cumulative meta-analysis of therapeutic trials for myocardial infarction. , 1992, The New England journal of medicine.

[20]  P. Devroey,et al.  Does PGS improve pregnancy rates in young patients with single-embryo transfer , 2007 .

[21]  F. Mosteller,et al.  A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. , 1992, JAMA.

[22]  Birgit Sikkema-Raddatz,et al.  In vitro fertilization with preimplantation genetic screening. , 2007, New England Journal of Medicine.

[23]  H. Danzer,et al.  Accuracy of FISH analysis in predicting chromosomal status in patients undergoing preimplantation genetic diagnosis. , 2008, Fertility and sterility.

[24]  D. Gardner,et al.  IS ANEUPLOIDY SCREENING FOR PATIENTS AGED 35 OR OVER BENEFICIAL? A PROSPECTIVE RANDOMIZED TRIAL , 2004 .

[25]  R. Lilford Ethics of clinical trials from a bayesian and decision analytic perspective: whose equipoise is it anyway? , 2003, BMJ : British Medical Journal.

[26]  E. Pergament,et al.  Preimplantation genetic screening to improve in vitro fertilization pregnancy rates: a prospective randomized controlled trial. , 2008, Fertility and sterility.