Is Leslie Rubin Pregant Again in 2018
J Help Reprod Genet. 2018 Sep; 35(nine): 1605–1612.
Pre-implantation genetic testing: decisional factors to accept or decline among in vitro fertilization patients
Brandy Lamb,i Erin Johnson,1 Leslie Francis,ane Melinda Fagan,one Naomi Riches,1 Isabella Canada,1 Alena Wilson,1 Amber Mathiesen,1 Maya Sabatello,2 Shawn Gurtcheff,3 Erica Johnstone,1 and Erin Rothwell 
1
Brandy Lamb
aneUniversity of Utah, ten South 2000 Due east, Salt Lake City, UT Us
Erin Johnson
1University of Utah, ten South 2000 East, Common salt Lake City, UT U.s.
Leslie Francis
1University of Utah, 10 South 2000 Due east, Salt Lake City, UT USA
Melinda Fagan
1Academy of Utah, ten South 2000 East, Salt Lake Urban center, UT USA
Naomi Riches
1University of Utah, 10 South 2000 East, Salt Lake City, UT U.s.
Isabella Canada
1Academy of Utah, 10 S 2000 East, Table salt Lake City, UT U.s.a.
Alena Wilson
1University of Utah, 10 South 2000 East, Common salt Lake City, UT U.s.
Bister Mathiesen
1University of Utah, 10 South 2000 East, Salt Lake City, UT USA
Maya Sabatello
twoColumbia University, New York, NY USA
Shawn Gurtcheff
3Utah Fertility Clinic, Pleasant Grove, UT United states
Erica Johnstone
1University of Utah, ten South 2000 East, Salt Lake City, UT USA
Erin Rothwell
oneUniversity of Utah, 10 South 2000 East, Salt Lake City, UT The states
Received 2018 April 27; Accepted 2018 Jul 24.
Abstract
Purpose
Embryo testing to improve pregnancy outcomes among individuals who are seeking assisted reproduction technologies is increasing. The purpose of this written report was to appraise decisional factors through in-depth interviews for why women would accept or reject preimplantation genetic testing for aneuploidy (PGT-A) with in vitro fertilization (IVF).
Methods
Semi-structured telephone interviews were conducted with 37 women who were offered PGT-A with IVF during the summer 2017. Interviews lasted on average xl min and were audio-recorded, transcribed, and analyzed using a content analysis.
Results
Results identified a number of decisional factors related to values about conception, inability, and pregnancy termination, past pregnancy experiences, optimism toward technology, and price. Other key bug that were identified include the use of expanded carrier screening prior to IVF, maternal historic period, and express education almost PGT-A due to the complexity about education for IVF alone.
Determination
There is a demand to develop decision support tools for the increasing choices of genetic testing options for patients seeking IVF. Including patients' values, by pregnancy experiences and attitudes toward science into the decision-making process may help promote a more informed decision.
Keywords: Preimplantation genetic testing for aneuploidy (PGT-A), Preimplantation genetic screening (PGS), In vitro fertilization (IVF), Decision making, Interviews
Introduction
Preimplantation genetic testing for aneuploidy (PGT-A) (previously termed preimplantation genetic screening (PGS)) has been available to patients undergoing the process of in vitro fertilization (IVF) to effort to meliorate their reproductive outcomes for nearly 20 years [1]. The utilization of PGT-A was established due to the frequency of aneuploidy among homo embryos, which often do not result in a successful outcome or live nascence. It has been estimated that approximately 40 to 60% of human being embryos are abnormal, and after the age of 40 for females, this number can be as loftier as 80% [two–4]. Possible impacts or results of embryos that have aneuploidy include poor embryonic development, chromosomal abnormalities, miscarriage, or IVF failure [5].
PGT-A involves a trophectoderm biopsy (removal of a few cells from the developing placenta typically on twenty-four hours five or half-dozen of embryo development) and testing those cells for the presence of too few or too many chromosomes. At that place is some evidence that improver of PGT-A to IVF aids in embryo selection and can increase the potential success of the IVF transfer cycle, or pregnancy rate per transfer [6–8]. Withal, randomized controlled trials that demonstrate conclusive benefits are still needed. Despite limited evidence surrounding the benefits of PGT-A, this applied science is routinely offered and its utilization continues to increment among assisted reproductive engineering clinics [9–11].
The procedure of patient education for PGT-A is variable across unlike healthcare clinics with respect to who is involved in the education process and how patient agreement is assessed [12]. Some of the key components recommended for inclusion in patient didactics include (1) PGT-A cannot modify the genetic makeup of the embryo and therefore that PGT-A does non meliorate the chances of achieving a pregnancy per egg retrieval; (2) PGT-A can aid in certain populations (i.e., advanced maternal historic period, repeated implantation failure, recurrent miscarriage) increasing the rate of successful implantation (i.due east., a pregnancy) and reducing the rate of miscarriage per embryo transfer; and (3) PGT-A is non a perfect test, there are both biological and technological limitations inhibiting routine employ of PGT-A [4, 9, 13, 14].
Surprisingly, there is piffling literature regarding patients' experiences, attitudes, and understanding of PGT-A with IVF. Merely a few studies have described patient perspectives on factors in the conclusion-making procedure for the utilization of PGT-A with IVF [13, 15]. Of those factors, cost was identified as the well-nigh significant determinant for patients' decisions, followed past social support and acceptance from friends and family unit [13, 15]. Some insight can further be gleaned from research on patients' perspectives on preimplantation genetic diagnosis (PGD), which screens embryos for a unmarried, highly penetrant disease such as Huntington's disease or spinal muscular atrophy [16]. Determinants when considering PGD include seeking a healthy baby, monetary costs, time and energy, accurateness of the testing, and the logistical decisions and ethical considerations of the disposition of embryos [17]. Withal, since PGT-A includes embryo testing prior to transfer (i.e., trophectoderm biopsy) and the limited evidence of its effectiveness to improve alive birth rates, decisional factors related to why a couple using IVF would take or decline this procedure may differ. This study fills in this gap. Its aims were to explore in-depth what factors influenced the decision making procedure to add PGT-A or not, and to describe patient educational experiences of IVF and PGT-A.
Methods
The Institutional Review Board at the University of Utah granted approval for the study (IRB no. 98692). A qualitative descriptive blueprint was used to capture and assess experiences amidst patients who accepted or declined preimplantation genetic testing for aneuploidy (PGT-A) with IVF. A semi-structured interview guide was adult based on a review of literature and practiced input. Questions were designed to capture reasons for why PGT-A was important or non with IVF prior to embryo transfer and their experiences and pedagogy with the choice (see Tabular array 1 for a list of representative questions).
Table 1
Representative interview questions
| 1. To begin, can yous tell me how yous first heard nigh IVF? | |
| 2. What factors influenced your choice to pursue IVF? | |
| 3. Every bit yous remember this procedure, what type of educational activity or materials did you receive before IVF? | |
| 4. In your own words after y'all decided to pursue IVF, tin you draw the procedure until now? | |
| 5. Do you lot remember if you lot had whatsoever type of genetic testing before the embryo transfer? | |
| 6. What blazon of education did you receive virtually PGT-A (preimplantation genetic screening, or genetic testing on your embryos to run into which ones have the right number of chromosomes) during your IVF experience? Subsequently PGT-A? Did they differ? Like? Same? | |
| seven. Tin you tell me why you chose or did not choose PGT-A? | |
| 8. Earlier implantation (embryo transfer), what genetic data given dorsum about the embryo? (Or was it after information technology was implanted?) Non at all? | |
| nine. When was this genetic data communicated to y'all in the process? | |
| 10. Throughout the IVF experience, did you accept whatever surprises or unexpected outcomes? | |
| 11. What would y'all have liked to have known before commencement IVF? | |
| 12. Looking back, what was almost helpful in understanding the process of IVF? What was the least? | |
| 13. What would you have liked to have known before pursuing PGT-A with IVF? |
Recruitment and participants
A retrospective medical nautical chart review of women who were offered PGT-A with in vitro fertilization (IVF) between July 2016 and July 2017 was conducted at both an academic medical center clinic and a for profit clinic. Letters were mailed to the potential participants (n = 100, 50 at from each dispensary) including an opt-in or opt-out pre-paid postcard to return indicating their interest in participating in this study. Approximately, 30% returned postcards (two of which indicated a selection to opt out). For those who did not return a postcard, one or 2 attempts were made with a phone follow-up approximately 2 weeks later on the initial letter of the alphabet was mailed. The total response charge per unit, including the five respondents who were unable to be contacted for interviews afterward opting-in, was 42%. Participants who agreed to an interview were consented over the phone and agreed to accept the interview sound recorded. Thirty-seven interviews were conducted in total. On average, interviews lasted xl min. Each respondent who completed an interview was given a $forty gift card for her participation.
Coding and data analysis
All of the telephone interviews were sound recorded, transcribed past a professional person transcription company and verified for accuracy past one of the researchers. A content assay was used to clarify the transcript data. The data was uploaded into a qualitative software program called Dedoose [18]. A coding template was created based on the interview questions and reading of the first 5 transcripts. The codes were and so systematically applied to the transcripts by one of the researchers (BL), with the ability to use open coding to capture information that may have been missed with the initial evolution of the codebook [19, twenty]. The transcripts and coded data were blinded and then that it was unknown who accustomed or declined PGT-A. Codes were reviewed and verified independently by another researcher (ER). Once coding was complete, the coded data was separated using the query tool in Dedoose by written report group (accepted or declined PGT-A), and so the codes were linked together based on similarity and summarized to identify the about frequently reported codes beyond and within each of the interviews for both groups of accepters and decliners.
Results
Assay of the transcript codes revealed a number of factors impacting patients' decision whether to accept or turn down PGT-A with IVF. These include patients' values and attitudes toward science, formulation, disability, and pregnancy termination as well equally experience with past pregnancies, maternal age, and costs. These themes are presented below. At the time the interviews were completed, PGS was the terminology used inside the clinics and then all information that used the term PGS was changed to PGT-A for consistency throughout this paper.
Demographics
Out of the 37 people interviewed, 21 chose to undergo PGT-A and 16 declined PGT-A. The average historic period of the participant was 37 years onetime with an historic period range of 27 to 44 years old. The majority of participants (97%) had health insurance, almost were college educated (86%), and a bulk (64%) reported household income over $75,000. Only 4 participants were currently living exterior of Utah and four were not married. There were no significant differences between the two groups in demographics. The remaining demographic information, including race/ethnicity, and outcomes of their most contempo IVF cycle for all participants are provided in Table 2.
Tabular array two
Demographic information (due north = 36) (1 missing)
| Historic period (mean) | 36.86 years | |
|---|---|---|
| Race/ethnicity | Caucasian | 32 (88.89%) |
| Chinese | 1 (2.78%) | |
| Hispanic | 1 (2.78%) | |
| Mixed/other | two (5.56%) | |
| Marital status | Married | 32 (88.89%) |
| Divorced | 2 (5.56%) | |
| Single | ii (5.56%) | |
| State of residence | Utah | 32 (88.89%) |
| Idaho | ii (5.56%) | |
| Oregon | 1 (ii.78%) | |
| New Jersey | 1 (2.78%) | |
| Highest level of education | High school diploma | ii (5.56%) |
| Some college | 1 (2.78%) | |
| Associate's degree | 2 (5.56%) | |
| Bachelor's degree | 16 (44.44%) | |
| Graduate degree | 13 (36.ane%) | |
| PhD | 2 (5.56%) | |
| Household income | $100,000 or college | 17 (47.22%) |
| $75,000 to $100,000 | 6 (16.67%) | |
| $50,000 to $75,000 | eight (22.22%) | |
| $25,000 to $50,000 | 3 (viii.33%) | |
| Less than $25,000 | ane (2.78%) | |
| Laissez passer | 1 (2.78%) | |
| Health insurance | Yeah | 35 (97.22%) |
| No | 1 (2.78%) | |
| Outcome of almost contempo IVF cycle | Live birth | fourteen (38.89%) |
| Currently meaning | 7 (19.44%) | |
| Waiting for embryo transfer | 2 (5.56%) | |
| Not pregnant or failed cycle | 12 (33.33%) | |
| Not pregnant (waiting for surrogate) | 1 (ii.78%) |
Values about conception, disability, and pregnancy termination
Responses to the questions about why one did or did not elect to undergo PGT-A were strongly related to individual values about conception, disability, and pregnancy termination. Many participants stated that they elected for PGT-A because they did not want to stop a pregnancy if the fetus was later found to have a chromosomal abnormality. Other participants wanted to avoid having a child with a disability. Three representative quotes capture these oft expressed views:
We did non desire to exist in difficult position to decide if nosotros needed to terminate a pregnancy if there was a risk to the embryo of a severe genetic defect
This is going to sound horrible, but we knew that nosotros actually wanted to have a salubrious baby and that we didn't wanna bargain with whatsoever Down syndrome or genetic issues. And [if] we didn't practice it and so we got stuck in a state of affairs where we had to brand a decision almost keeping a child or non—we didn't want to be put in that spot.
I might sound shallow, but I wanted to have a salubrious babe. I know people that accept Down's syndrome children and stuff and it'due south hard. I wasn't a hundred percent sure that I was up for the challenge if that was the case.
All the same, other participants wanted to avert miscarriages and the emotional consequences of an unsuccessful embryo transfer. For example: "It was bad but following a miscarriage—if my embryos were gonna exist abnormal, and then I may not want to utilize them. Just then I don't keep miscarrying and having that disappointment."; and "Nosotros figured that if we knew that the embryos tested genetically normal, we would have a smaller chance of having to go through another loss."
Several participants who declined PGT-A said they did so for religious reasons ("We felt similar it all conflicted with our religious views."). Others stated that the genetic testing information was not necessary because they would not end a pregnancy. For case "Because we were fine with Down syndrome. We were fine with whatever came about. We just had five embryos to piece of work with, and and so we but wanted to give them all a shot."; and "Simply because I guess nosotros look at information technology as whatever is gonna happen happens." One person stated that she thought PGT-A harmed the embryo and she did non want to impairment them. Finally, some participants expressed preferences for a more "natural" formulation with IVF. PGT-A, in contrast, added more "medicalization" to the procedure such as freezing the embryos and/or intracytoplasmic sperm injection (ICSI). Representative quotes included: "We tried naturally for a couple of years and hadn't had success. Nosotros did a couple rounds IUI because it was more natural and so jumped to IVF as last resort."; and "We did not want ICSI [ER, i.e., a procedure that forces the sperm into the egg] instead of actual IVF."
Optimism in science to improve embryo selection
One of the primary differences between those who declined or elected to undergo PGT-A was their opinions well-nigh science. Those who chose PGT-A had a more than optimistic view of the ability of technological advancements in science to improve their chances of a successful pregnancy. For case, a few quotes included: "Well, yous don't have to do it. We really wouldn't suggest information technology." I said, "Okay, well, then I'll do information technology[laughter]."; "My husband said the merely manner he would do IVF is if nosotros did it [PGT-A]. PGT-A was 100 percent worth it to make sure you are transferring a normal embryo. It was peace of heed for him."; and "Increment your odds. Specially if you can but transfer 1."
Participants who accepted PGT-A stated that this technology was not only useful for ensuring a healthy baby only likewise for choosing the sex activity of the embryo. Although none of the participants stated that she utilized PGT-A for sex selection, almost all participants who accepted PGT-A stated that this was a positive addition to decision-making process. Two representative quotes that captured this attitude included: "So the added bonus was we thought it would be cool that we could choose the gender."; and "We had unlike reasons. My hubby wanted to know the gender and I wanted to select the best embryo with the healthiest outcome."
Of those who declined, many questioned the technology, did not desire to do whatever straight testing on the embryo, or were willing to move forward without the information PGT-A provided. Some quotes that capture these perspectives are: "I read that there's some controversy on whether or non it is dangerous for the embryos, or if information technology damages the embryo quality, so we decided non to do that."; "Nosotros were willing to have the gamble to transfer without genetic testing."; and "None [genetic testing] on the embryos, just testing on u.s.a.."
Boosted genetic screening of embryos and parents
Another decisional factor that was identified in the interviews was the high use of other types of genetic screening, specifically expanded carrier screening with IVF. It is standard do to conduct expanded carrier screening with IVF, but some participants appeared to misunderstand the purpose of this testing and used information technology to make decisions about embryo testing. Of those who declined PGT-A, some participants stated they already did genetic testing and did not need to do boosted testing. For example, one participant who declined PGT-A stated "My husband, he did some genetic testing with the lab work to see if he was a carrier of certain things before. That was all we did."; and "They told us it would just screen for all screenable genetic disorders that nosotros were carriers for, whatever y'all could catch." Conversely, participants who opted for PGT-A stated that they wanted more assurance well-nigh the wellness of the embryo. A representative quote included: "Because my husband and I had obviously each had our testing done to see if we had anything that matched upward. We didn't take anything—It made sense to follow this other testing option." Finally, several participants who used gamete donation reported that genetic testing was conducted on the donor. For example, "I had genetic testing of me and the donor we were using and they did some genetic testing for carriers. That combination, it seemed reasonable to not do genetic testing [PGT-A] with IVF."
Pregnancy history and maternal age
Many of the individuals who opted for PGT-A stated that they had failed previous transfers and wanted more than explanation of why they were miscarrying. For example, "I knew that because of my age, I wanted to brand sure the quality of the embryos were there."; "I'd had ii miscarriages. The second miscarriage, they genetically tested. They wanted to know why I was miscarrying."; and "I ended up having a miscarriage. He said information technology was probably an abnormal embryo. With our side by side IVF cycle, nosotros decided to have those embryos tested only to keep from miscarrying." Others stated that because of their age and that they had not been significant before, they opted for PGT-A to ensure everything was chromosomally normal. "Yeah. It very much seemed like it was a protocol. Similar, you lot are this age, you're at this level, we should practice this. I was similar, okay. I guess we're doing it."; and "I guess since for me I think I'1000 already older, so it's safer to do the examination than just having IVF with no checking." For those who declined, some of the reasons included that even though they were older, they did not have a previous miscarriage history, a family history of genetic conditions, or were unwilling to discard an embryo based on the result. Some quotes included: "It seemed reasonable to not exercise genetic testing on the first fourth dimension with IVF."; "We didn't feel like there were any huge risk factors that we knew about."; "I had no problems getting pregnant with them before. We just didn't feel similar it was a necessity." and "I just felt like that I wasn't in a place where I could only throw my embryos away if there was something incorrect with them."
Costs
All participants stated that financial burden of IVF and PGT-A was a meaning decisional factor in the choice. In general, those who declined PGT-A stated that they did not want to pay the additional costs. For those that opted for PGT-A, many stated cost-effective calculations relating to pay and possible success of the procedure. For case: "Non willing to pay for IVF without knowing if it was a feasible embryo."; "Lets pick the best one if [we're] paying this much already."; and "So the cost of PGT-A testing was instead of transferring all those normal embryos—or those day 5 embryos that all made it—those ix of them—they PGT-A test them and it obviously played out in our favor." The boosted toll of PGT-A as well allowed some participants to choose the sex of the embryo. "Allow'south pay some other v grand more than to make sure that our embryos are good, and equally a signing bonus, I mean we're paying this much money, allow's pick the sexual activity that we want." Finally, for a few participants, the costs were 1 of the reasons IVF was their last option. ("Merely the extra price." [reason for declining]; "Information technology was a lot of extra money to have it done."; and "It was just more costly and didn't know if that would change our mind nearly transferring them.")
Didactics about PGT-A
Questions were asked about the type of pedagogy received about PGT-A. The rationale for asking about education in relation to the conclusion making procedure for PGT-A is that it gives more than context to how this was offered and how information technology may or may not influence choices. In full general, most of the participants stated that education was provided verbally, (merely a few mentioned a brochure to follow-up the verbal advice) and in conjunction with all other data provided prior to IVF. For example: "We were just told that it was to brand sure that all the chromosomes were in that location."; "They talked most that a little bit, but that wasn't a huge thing they talked about. In that location was just a niggling fleck of information given."; and "Basically just talking about it'southward like chromosome testing. There's not much details. It's similar telling us to get read out the booklet more." Other representative quotes included:
Perchance just a few sentences. I don't think it was much. I think what I understood was that this helps u.s. not to become through potential miscarriages, but it identifies which embryo has the biggest chances of surviving. That's all I needed to know actually.
Never heard about it till really nosotros were working on the IVF treatments. The doctors and the nurses kinda suggested information technology just, over again, because of my historic period, the risk for having abnormalities were a little bit higher. We were told that the chances of getting meaning and continuing on with pregnancy was higher if nosotros exam those embryos to make sure they all had 46 chromosomes.
Discussion
This is 1 of the few studies to conduct an in-depth, descriptive assessment through interviews among both patients who accepted or declined PGT-A. Understanding the factors that contribute to the controlling procedure of patients tin can assistance providers to incorporate this information and improve the didactics provided and the shared conclusion making procedure. In turn, patient experience and satisfaction may increase as a event of more than informed controlling. This study identified several determinants in the decision-making process of why a patient accepted or declined PGT-A with IVF. These included personal values toward conception, disability and pregnancy termination, trust in science, employ of other genetic testing, pregnancy history and maternal age, and costs.
In a previous study, Gebhart et al. (2016) identified toll, social support, and partner and provider influences as determinants for the inclusion of PGT-A past surveying patients online [15]. This report plant cost as an influential cistron, thus reinforcing earlier findings. Social back up was also a factor, but this was not discussed often in these interviews. Even so, this report also identified additional novel factors that many participants discussed, specifically, how personal values influenced the selection virtually whether or not to add together PGT-A to IVF. For example, the most common reasons expressed by the participants who elected PGT-A with IVF was to avoid a miscarriage and the need to avoid time to come decisions about pregnancy termination also as desire to avoid or decrease the likelihood to have a child with disabilities. Interestingly, well-nigh all participants who elected PGT-A also mentioned sex pick. In contrast, participants in the online written report of factors influencing decisions for PGT-A, 89% reported that gender identification was not important and did not influence the decision making process [15].
The results of this study also expand the quantitative findings of Gebhart et al. (2016) past identifying why those who declined adding PGT-A would not add information technology to IVF. The primary reason was that additional genetic information would not impact decisions to continue a pregnancy and that they were concerned that genetically testing the embryos would risk the success of the transfer, thus, once more highlighting the importance of values toward pregnancy and disability as significant influences. Similar research on determination making effectually pre-implantation genetic diagnosis (PGD) stated that couples made decisions about PGD with IVF through 4 active phases of dynamic determination-making in which couples frequently revert dorsum and forth [21]. Notwithstanding, unlike PGT-A, most couples in PGD are aware of their genetic risk status and contemplation about the decision to undergo PGD involved reflections on values toward parenthood, not necessarily pregnancy outcomes. The couples during the contemplation stage of decision making for PGD reported request themselves if whether they desire to become parents or non as why they would add PGD. In this study, all of the participants expressed the need to become parents. As such, providers who are offering PGT-A may be faced with different decisional factors than couples contemplating PGD and promoting accurate instruction about PGT-A should be taking into consideration for this context.
Our findings point that patients may not accurately understand PGT-A and its limits, and that there is a need to amend the educational activity process regarding PGT-A with IVF. For case, a common response among women who declined PGT-A with their IVF treatment was that previous genetic testing of the parents had eliminated their risk for sure genetic conditions and/or that PGT-A was not needed or would not provide any additional information. This may suggest patients' misunderstanding because an increased risk of aneuploidy is often not "carried" by a parent and each pregnancy carries a certain corporeality a gamble to have aneuploidy occur by chance, relative to a adult female'south age. Similarly, participants who elected PGT-A had highly positive views toward technology and science for improving IVF outcomes. Thus, educating patients about the limitations of this engineering are needed to prevent positive views of applied science inhibiting understanding of the real benefits of PGT-A. PGT-A is not a perfect test, and there are both biological and technological limitations that inhibit PGT-A from being diagnostic. For example, PGT-A removes cells from the trophectoderm (where the placenta would develop) and non from the inner mass cells (where the fetus would develop), and thus, information technology is an estimate of the likelihood that the embryo would have mosicasim. Additionally, sure deletions/duplications of chromosome material or other genetic changes, that tin bear upon wellness outcomes, cannot be identified with this applied science.
Current recommendations from national fertility societies still question the value of PGT-A as a universal screening exam for all IVF patients [9]. Until more conclusive show is generated through randomized controlled trials, thorough education and counseling must be provided to accost limitations, risks of errors, and lack of evidence that information technology improves live-nascence rates [22]. This report also highlights the importance of this pre-test education in that in near participants, there were some misconceptions and gaps in knowledge almost PGT-A and how it differs from other genetic testing offered with IVF.
Several reasons may account for this educational gap. Although many of the participants stated that PGT-A was discussed verbally in the context of other general information with IVF, information technology can exist difficult for patients to understand the complexities of genetic testing, particularly given the emotional impacts of the IVF process [23]. Moreover, although clinicians may be providing authentic education nearly PGT-A, highly optimistic views toward science in full general may cause barriers to adequate patient comprehension about the risks and benefits of this genetic testing [24]. Finally, information technology is possible that how participants sympathise information about PGT-A is closely continued with their values and other beliefs near gamble estimates and probabilities for success. None of the participants reported how such issues were discussed, or considered, although these are often used in decision back up tools when dealing with multiple choices for healthcare utilization such as PGT-A [25]. Indeed, private'south previous experiences and values are unique and influence the determination-making process as are individual's knowledge and bodily gamble estimates for embryo transfers. Thus, to address this educational gap, a decision assist to support patient informed conclusion may exist warranted. In improver, for individuals considering calculation PGT-A to their IVF handling, at that place is a need to explore, consider, and place the emotional impacts that information from PGT-A can arm-twist prior determining whether to add together PGT-A to IVF.
Written report limitations
This study is limited by the relatively small sample size and use of only two IVF healthcare centers. Because only female participants were identified and offered to participate in the written report, the feel of male partners using PGT-A was not explored. Additionally, this was a qualitative descriptive research study with self-selected participants. The views of those who declined to participate in the interview are non represented. The majority of women who participated had education beyond an acquaintance's degree, identified as Caucasian, higher socioeconomic condition, and insured. This population may have better access to IVF treatments and the views of other populations may have non been captured. Farther, participants self-selected to participate in interviews, and as such, this sample may accept more experience and knowledge about genetics and, equally such, chose to participate. It is unknown the demographics of those that choose not to participate. Futurity research will demand to include more various samples to assess if more than patients remember the offer of PGT-A.
Conclusion
More and more women are electing to pursue IVF and genetic testing, including PGT-A [26]. Identifying ways to inform and educate patients well-nigh the purpose, benefits, limitations, and impacts of PGT-A is essential. Information technology will exist important that patients' healthcare providers help in facilitating the decision-making procedure for IVF and the consideration of the improver of genetic testing. Evolution of a decision-making tool to use in addition to provider'south data may further help address these concerns and potentially allow patients to better consider genetic testing options with IVF treatments. For example, discussing patients' values about for conception, pregnancy, and inability may help promote more than informed decision-making. Time to come studies could develop or evaluate a decision-making tool to assist patients to reverberate on personal values while navigating genetic testing with IVF handling every bit well every bit inclusion of more diverse groups.
Acknowledgements
The authors would like to thank the Academy of Utah Graduate Programme in Genetic Counseling and the Artistic Research Grant program for their support for this research. We would like to thank the Utah Eye in Excellence in Ethical, Legal and Social Implications (HG009037) and the Center for Clinical and Translational Science program (1UL1TR001067) for their partial back up.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
References
ane. Rubio C, Rodrigo L, Mir P, Mateu E, Peinado V, Milán M, Al-Asmar N, Campos-Galindo I, Garcia S, Simón C. Employ of array comparative genomic hybridization (array-CGH) for embryo assessment: clinical results. Fertil Steril. 2013;99(4):1044–1048. doi: ten.1016/j.fertnstert.2013.01.094. [PubMed] [CrossRef] [Google Scholar]
2. Fragouli E, Wells D, Whalley KM, Mills JA, Faed MJW, Delhanty JDA. Increased susceptibility to maternal aneuploidy demonstrated by comparative genomic hybridization analysis of human being MII oocytes and start polar bodies. Cytogenet Genome Res. 2006;114(1):30–38. doi: ten.1159/000091925. [PubMed] [CrossRef] [Google Scholar]
3. Bielanska M, Tan SL, Ao A. High rate of mixoploidy among human blastocysts cultured in vitro. Fertil Steril. 2002;78(6):1248–1253. doi: ten.1016/S0015-0282(02)04393-five. [PubMed] [CrossRef] [Google Scholar]
iv. Dahdouh EM, Balayla J, Audibert F, Genetics Committee. Wilson RD, Audibert F, Brock JA, Campagnolo C, Carroll J, Chong 1000, Gagnon A, Johnson JA, MacDonald W, Okun N, Pastuck Thousand, Vallée-Pouliot K. Technical Update: Preimplantation Genetic Diagnosis and Screening. J Obstet Gynaecol Tin. 2015;37(five):451–463. doi: 10.1016/S1701-2163(fifteen)30261-9. [PubMed] [CrossRef] [Google Scholar]
5. Scott RT, Jr, Ferry Yard, Su J, Tao Ten, Scott K, Treff NR. Comprehensive chromosome screening is highly predictive of the reproductive potential of human embryos: a prospective, blinded, nonselection study. Fertil Steril. 2012;97(4):870–875. doi: 10.1016/j.fertnstert.2012.01.104. [PubMed] [CrossRef] [Google Scholar]
6. Brezina PR, et al. Evaluation of 571 <em>in vitro</em> fertilization (IVF) Cycels and 4,873 embryos using 23-chromosome single nucleotide polymorphism (SNP) microarray preimplantation genetic screening (PGS) Fertil Steril. 2012;97(3):S23–S24. [Google Scholar]
vii. Forman EJ, Tao 10, Ferry KM, Taylor D, Treff NR, Scott RT. Single embryo transfer with comprehensive chromosome screening results in improved ongoing pregnancy rates and decreased miscarriage rates. Hum Reprod. 2012;27(4):1217–1222. doi: ten.1093/humrep/des020. [PMC gratuitous article] [PubMed] [CrossRef] [Google Scholar]
8. Besser AG, Mounts EL. Counselling considerations for chromosomal mosaicism detected past preimplantation genetic screening. Reprod BioMed Online. 2017;34(iv):369–374. doi: ten.1016/j.rbmo.2017.01.003. [PubMed] [CrossRef] [Google Scholar]
9. Penzias A et al. The use of preimplantation genetic testing for aneuploidy (PGT-A): a committee opinion. Fertil Steril. 2018;109(3):429–436. 10.1016/j.fertnstert.2018.01.002. [PubMed]
10. Harper JC, Wilton L, Traeger-Synodinos J, Goossens V, Moutou C, SenGupta SB, Pehlivan Budak T, Renwick P, de Rycke K, Geraedts JPM, Harton Grand. The ESHRE PGD consortium: 10 years of data drove. Hum Reprod Update. 2012;18(3):234–247. doi: 10.1093/humupd/dmr052. [PubMed] [CrossRef] [Google Scholar]
xi. Brezina PR, Ke RW, Kutteh WH. Preimplantation genetic screening: a practical guide. Clin Med Insights Reprod Health. 2013;7:37–42. [PMC free article] [PubMed] [Google Scholar]
12. McGowan ML, Burant CJ, Moran R, Farrell R. Patient teaching and informed consent for preimplantation genetic diagnosis: health literacy for genetics and assisted reproductive engineering science. Genet Med. 2009;11(9):640–645. doi: 10.1097/GIM.0b013e3181ac6b52. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
xiii. Brezina PR, Kutteh WH, Bailey AP, Ke RW. Preimplantation genetic screening (PGS) is an excellent tool, simply not perfect: a guide to counseling patients considering PGS. Fertil Steril. 2016;105(i):49–50. doi: 10.1016/j.fertnstert.2015.09.042. [PubMed] [CrossRef] [Google Scholar]
14. Committee, E.P.C.South ESHRE preimplantation genetic diagnosis consortium: data collection Iii (may 2001) Hum Reprod. 2002;17(one):233–246. doi: 10.1093/humrep/17.1.233. [PubMed] [CrossRef] [Google Scholar]
15. Gebhart MB, Hines RS, Penman A, The netherlands Air-conditioning. How exercise patient perceived determinants influence the decision-making process to accept or turn down preimplantation genetic screening? Fertil Steril. 2016;105(1):188–193. doi: 10.1016/j.fertnstert.2015.09.022. [PubMed] [CrossRef] [Google Scholar]
xvi. Chang J, Boulet SL, Jeng Chiliad, Flowers 50, Kissin DM. Outcomes of in vitro fertilization with preimplantation genetic diagnosis: an analysis of the United States assisted reproductive technology surveillance data, 2011–2012. Fertil Steril. 2016;105(2):394–400. doi: ten.1016/j.fertnstert.2015.10.018. [PMC complimentary commodity] [PubMed] [CrossRef] [Google Scholar]
17. Genoff Garzon MC, Rubin LR, Lobel M, Stelling J, Pastore LM. Review of Patient Conclusion-Making Factors and Attitudes Regarding Preimplantation Genetic Diagnosis. Clin Genet. 2017; ten.1111/cge.13174. [PubMed]
xviii. Dedoose . Dedoose Version 7.0.23: Web awarding for managing, analyzing, and presenting qualitative and misxed method reearch data. Los Angelos: SocioCultural research Consutlants, LLC; 2016. [Google Scholar]
19. Miles 1000, Huberman AM, Saldana J. Qualitative data analysis: A methods sourcebook. three. Los Angeles: Sage; 2014. [Google Scholar]
20. Rothwell, E., et al. Experiences amidst women with positive prenatal expanded carrier screening results. J Genet Couns, 2016. [PMC free article] [PubMed]
21. Hershberger PE, Gallo AM, Kavanaugh K, Olshansky E, Schwartz A, Tur-Kaspa I. The decision-making process of genetically at-risk couples because preimplantation genetic diagnosis: Initial findings from a grounded theory report. Soc Sci Med. 2012;74(10):1536–1543.x.1016/j.socscimed.2012.02.003. [PMC free commodity] [PubMed]
22. Practice Commission of Society for Assisted Reproductive Technology, Practice Commission of American Society for Reproductive Medicine. Preimplantation genetic testing: a exercise commission opinion. Fertil Steril. 2008;90(5 Suppl):S136–43. 10.1016/j.fertnstert.2008.08.062. [PubMed]
23. Ying L, Wu LH, Loke AY. The effects of psychosocial interventions on the mental health, pregnancy rates, and marital office of infertile couples undergoing in vitro fertilization: a systematic review. J Aid Reprod Genet. 2016;33(6):689–701. 10.1007/s10815-016-0690-8. [PMC complimentary article] [PubMed]
24. Garrett N, Sharot T. Optimistic update bias holds firm: three tests of robustness following Shah et al. Conscious Cogn. 2017;50:12–22. doi: 10.1016/j.concog.2016.ten.013. [PMC costless article] [PubMed] [CrossRef] [Google Scholar]
25. Stacey, D., et al. Decision aids for people facing health handling or screening decisions. In Cochrane Database Syst Rev. 2011. [PubMed]
26. Collins SC, Xu X, Mak W. Price-effectiveness of preimplantation genetic screening for women older than 37 undergoing in vitro fertilization. J Assist Reprod Genet. 2017;34:1515. 10.1007/s10815-017-1001-eight. [PMC costless article] [PubMed]
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133803/
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