Clinical Management of In Vitro Fertilization With Preimplantation Genetic Diagnosis

Ilan Tur-Kaspa, M.D.

Disclosures

Semin Reprod Med. 2012;30(4):309-322. 

In This Article

Clinical Expertise in IVF-PGD Treatments

Another fundamental factor in PGD success is the clinical experience and expertise of a particular ART center's staff and the quality of the IVF and PGD laboratories. Because the decision to undergo ART treatment is a very personal decision, requiring a commitment of time, effort, emotional energy, and money, couples considering an ART procedure should meet personally with an infertility specialist to discuss their specific medical situation and their likelihood of success at their center.[64]

An infertility specialist should have the experience to tailor the appropriate ovarian stimulation protocol for each patient undergoing IVF for PGD to prevent a genetic disorder, for translocation, or for HLA typing. Most ART centers offer PGD to their patients,[119] but the Centers for Disease Control and Prevention reported that in 2006 only 5 of 426 U.S. centers performed >50 cycles with PGD, and among them >10 cycles specifically for the purpose of prevention of genetic disorders.[64] Three of these centers are located in New York, one in Colorado, and one in Chicago, Illinois (IHR). The expertise of the embryologists in performing biopsies for PGD, as well as the type of procedure used to breach the zona pellucida[120] and the type (polar bodies, blastomere, and/or trophectoderm)[39] and number of cells biopsied,[30–33] may all affect embryonic survival and development.[36,37] Furthermore, the experience and the expertise of the PGD laboratory are important in providing reliable genetic results for each embryo.[11,25,33,121,122] The rate for misdiagnosis at experienced PGD laboratories has been reported to be <1.0% (0.3 to 0.6%).[18,25,54,123]

When PGD is not performed routinely at an ART center, collaboration with another more experienced institution should be established to provide optimal care for the couple. Both ESHRE and the PGD International Society (PGDIS) have recently updated their guidelines on the minimal requirement for ART and PGD centers and on the collaboration needed between those two centers.[11,13] This type of collaboration will ensure discussions on the preferred ovarian stimulation protocol and optimal location for the patient's monitoring, oocyte retrieval, and embryology work including embryo biopsy. A reliable communication system for reporting the PGD results should be established. Collaboration like this may be performed nationally or internationally as they are routinely being performed at IHR/RGI as well as at other leading centers, even if the couple resides where PGD procedures are banned.[124]

In summary, ART centers should evaluate their experience and outcome of IVF for PGD and decide whether they wish to offer it locally to patients or to collaborate with another more experienced center. Centers involved in PGD should follow the guidelines published by ESHRE and/or PGDIS. The monitoring for the stimulation may be performed locally, and the oocyte retrieval, embryology and biopsy, and PGD testing may be performed at a more experienced center. Alternatively, the IVF may be completed locally, including embryo biopsy by an experienced local or traveling embryologist, and the PGD performed at another location. Patients should be counseled on the experience and results of the center for such treatments.

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