2019 年 PGDIS 关于在 PGT-A 新信息背景下转移嵌合体胚胎的立场声明。
The 2019 PGDIS position statement on transfer of mosaic embryos within a context of new information on PGT-A.
机构信息
Center for Human Reproduction, 21 East 69th Street, New York, N.Y, 10021, USA.
The Foundation for Reproductive Medicine, New York, N.Y, USA.
出版信息
Reprod Biol Endocrinol. 2020 May 29;18(1):57. doi: 10.1186/s12958-020-00616-w.
BACKGROUND
A recently published Position Statement (PS) by the Preimplantation Genetics Diagnosis International Society (PGDIS) regarding utilization of preimplantation genetic testing for aneuploidy (PGT-A) in association with in vitro fertilization (IVF) contained inaccuracies and misrepresentations. Because opinions issued by the PGDIS have since 2016 determined worldwide IVF practice, corrections appear of importance.
METHODS
The International Do No Harm Group in IVF (IDNHG-IVF) is a spontaneously coalesced body of international investigators, concerned with increasing utilization of add-ons to IVF. It is responsible for the presented consensus statement, which as a final document was reached after review of the pertinent literature and again revised after the recent publication of the STAR trial and related commentaries.
RESULTS
In contrast to the PGDIA-PS, we recommend restrictions to the increasing, and by IVF centers now often even mandated, utilization of PGT-A in IVF cycles. While PGT-A has been proposed as a tool for achieving enhanced singleton livebirth outcomes through embryo selection, continued false-positive rates and increasing evidence for embryonic self-correction downstream from the testing stage, has led IDNHG-IVF to conclude that currently available data are insufficient to impose overreaching recommendations for PGT-A utilization.
DISCUSSION
Here presented consensus offers an alternative to the 2019 PGDIS position statement regarding utilization of preimplantation genetic testing for aneuploidy (PGT-A) in association with in vitro fertilization (IVF). Mindful of what appears to offer best outcomes for patients, and in full consideration of patient autonomy, here presented opinion is based on best available evidence, with the goal of improving safety and efficacy of IVF and minimizing wastage of embryos with potential for healthy births.
CONCLUSIONS
As the PGDIS never suggested restrictions on clinical utilization of PGT-A in IVF, here presented rebuttal represents an act of self-regulation by parts of the IVF community in attempts to control increasing utilization of different unproven recent add-ons to IVF.
背景
最近，植入前遗传学诊断国际协会（PGDIS）发布的一份关于体外受精（IVF）中使用胚胎植入前遗传学检测非整倍体（PGT-A）的立场声明（PS）存在不准确和误导性陈述。由于自 2016 年以来，PGDIS 发布的意见决定了全球范围内的 IVF 实践，因此进行纠正显得尤为重要。
方法
国际 IVF 无害组织（IDNHG-IVF）是一个自发形成的国际研究人员团体，关注于增加对 IVF 的附加使用。它负责提出本共识声明，该声明作为最终文件，在审查相关文献后达成，并在最近发布的 STAR 试验和相关评论后再次修订。
结果
与 PGDIS-PS 相反，我们建议限制越来越多的——现在甚至是许多 IVF 中心强制的——PGT-A 在 IVF 周期中的使用。虽然 PGT-A 被提议作为通过胚胎选择提高单胎活产率的工具，但其持续的假阳性率和从检测阶段下游胚胎自我纠正的证据不断增加，导致 IDNHG-IVF 得出结论，目前可用的数据不足以对 PGT-A 的使用提出过度的建议。
讨论
这里提出的共识为 2019 年 PGDIS 关于体外受精（IVF）中使用胚胎植入前遗传学检测非整倍体（PGT-A）的立场声明提供了另一种选择。考虑到似乎为患者提供最佳结果的因素，并充分考虑患者的自主权，这里提出的意见是基于最佳现有证据，旨在提高 IVF 的安全性和有效性，并最大限度地减少具有健康生育潜力的胚胎的浪费。
结论
由于 PGDIS 从未建议限制 PGT-A 在 IVF 中的临床应用，因此这里提出的反驳代表了 IVF 社区的一部分试图控制对不同未经证实的 IVF 新附加物的日益增加的使用而进行的自我监管行为。
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