Findings sparked controversy
This trial generated controversy within the genetics and reproductive endocrinology specialties because it challenged the intuitive view that screening of embryos before transfer into the uterus should be beneficial—or, at least, harmless. Some now argue that the benefits of PGS, if any, cannot be intuitively assumed and assert that the burden of proof of those benefits rests with proponents of PGS.
The practice committees of the Society for Assisted Reproductive Technology (SART) and ASRM found insufficient evidence to support the use of PGS to improve the live birth rate in women of advanced age or in those who have had implantation failure or recurrent pregnancy loss (TABLE). Many physicians believe, however, that technologies under development will soon bring verifiable benefits of PGS to patients.
SART and ASRM weigh in on use of preimplantation genetic testing
| TEST | RECOMMENDATION |
|---|---|
| Pre-implantation genetic diagnosis | |
| Pre- implantation genetic screening | |
| SOURCE: Society for Assisted Reproductive Technology and American Society for Reproductive Medicine | |
Advise your patients that oocyte cryopreservation is “a long shot”
Practice Committee of the Society for Assisted Reproductive Technology and Practice Committee of the American Society for Reproductive Medicine. Essential elements of informed consent for elective oocyte cryopreservation: a practice committee opinion. Fertil Steril. 2007;88:1495–1496.
Oocyte cryopreservation is an experimental procedure that should not be offered or marketed as a means to defer reproductive aging, primarily because data on clinical outcomes are limited. That is the conclusion of this guideline from SART and ASRM. Consequently, women who may be considering the procedure should be fully informed about the process and likely outcomes and counseled by a qualified mental health professional.
Counseling is crucial
According to the SART and ASRM guideline, pretreatment counseling should include comprehensive information on a range of topics (see the box below). In addition, women considering oocyte cryopreservation should be counseled thoroughly about reproductive aging and life planning.7,8
Few alternatives for some women
Women who have cancer should receive the same counseling. Unlike healthy women, however, they may have no other options, and cryopreservation may be more appropriate for them despite experimental status.
Be forthright about oocyte cryopreservation
Patients considering this procedure need comprehensive information about:
- Ovarian stimulation and oocyte retrieval
- Methods of oocyte cryopreservation
- Storage fees
- The expected thaw survival rate
- The requirement for intracytoplasmic sperm injection
- Clinic-specific data and outcomes or, in their absence, literature estimates of a 2% overall live birth rate per oocyte thawed using slow-freeze methods and 4% for vitrification, compared with age-related probabilities of success per IVF cycle using fresh nondonor oocytes
- The relatively low likelihood that a woman who cryopreserves her eggs before age 35 will ever need or use them
- State and federal screening laws for potential donation of cryopreserved oocytes
- Potential risks of basing important life decisions and expectations on a limited number of cryopreserved oocytes
- The possibility that the facility may cease operation, necessitating transfer of cryopreserved oocytes to another facility
- The possibility that cryopreserved oocytes might be lost or damaged as a result of laboratory error or other events beyond control.