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评论最近发表的两项关于胚胎植入前遗传学检测(PGT-A)后“镶嵌”胚胎处理的正式指南。

Commentary on two recently published formal guidelines on management of "mosaic" embryos after preimplantation genetic testing for aneuploidy (PGT-A).

机构信息

The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.

The Foundation for Reproductive Medicine, New York, NY, USA.

出版信息

Reprod Biol Endocrinol. 2021 Feb 18;19(1):23. doi: 10.1186/s12958-021-00716-1.

Abstract

Two professional societies recently published opinions on the clinical management of "mosaic" results from preimplantation genetic testing for aneuploidy (PGT-A) in human blastocyst-stage embryos in associations with in vitro fertilization (IVF). We here point out three principal shortcomings: (i) Though a most recent societal opinion states that it should not be understood as an endorsement of the use of PGT-A, any discussion of how PGT-A should be clinically interpreted for all practical purposes does offer such an endorsement. (ii) The same guideline derived much of its opinion from a preceding guidance in favor of utilization of PGT-A that did not follow even minimal professional requirements for establishment of practice guidelines. (iii) Published guidelines on so-called "mosaic" embryos from both societies contradict basic biological characteristics of human preimplantation-stage embryos. They, furthermore, are clinically unvalidated and interpret results of a test, increasingly seen as harmful to IVF outcomes for many infertile women. Qualified professional organizations, therefore, should finally offer transparent guidelines about the utilization of PGT-A in association with IVF in general.

摘要

两个专业学会最近发表了关于体外受精(IVF)中人类囊胚期胚胎中胚胎植入前遗传学检测(PGT-A)“镶嵌”结果的临床管理的意见。我们在这里指出三个主要的缺点:(i)尽管最近的学会意见表示,不应将其理解为对 PGT-A 使用的认可,但任何关于如何在所有实际目的下对 PGT-A 进行临床解释的讨论实际上都提供了这种认可。(ii)该指南的同一部分意见主要来自于之前有利于使用 PGT-A 的指导意见,而该指导意见甚至没有遵循确立实践指南的最基本的专业要求。(iii)两个学会发表的关于所谓“镶嵌”胚胎的指南与人类胚胎植入前阶段胚胎的基本生物学特征相矛盾。此外,它们在临床上未经证实,并且对测试结果进行解释,越来越多地被认为对许多不孕妇女的 IVF 结果有害。因此,合格的专业组织最终应该提供关于一般情况下与 IVF 相关的 PGT-A 使用的透明指南。

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