Pre-implantation genetic screening (PGS) in donor oocyte IVF cycles: a practice survey

Abstract

To survey the practices and recommendations regarding pre-implantation genetic screening (PGS) among oocyte donation IVF programs. Voluntary one-page questionnaire survey. At an April, 2018, US third-party reproduction conference, professional attendees were offered a 1-page questionnaire on the practice recommendations for PGS, the reasons recipients choose PGS in their program, and the role of embryo sex (selection) in deciding for PGS. Descriptive and comparative statistical analyses were performed. US respondents offering PGS were nurses (79%), physicians (11%), and other/not stated (10%) from 71 practices offering oocyte-donor (OD) IVF. There was a broad geographic distribution (26 states). Only one program responding did not offer PGS and was excluded from further analysis. In 2017, respondents performed 4-900 OD-IVF cycles [median 55, interquartile range (IQR) 36-146]. PGS was generally recommended by 31% of these programs. The primary reason endorsed by programs as to why recipients choose to have PGS performed was to achieve a higher pregnancy rate (61%), followed by elective sex selection (25%) and avoidance of transmitting X-linked traits (8%). Recurrent pregnancy loss was the primary reason PGS was chosen in 3% of programs. A recommendation for PGS was negatively associated with endorsing elective sex selection as the primary reason for PGS (p=0.05). Disclosure of embryo sex was according to patient preference in 73% of programs; on the other hand, 23% stated that their program routinely disclosed embryo sex, while 4% routinely did not. PGS performed for elective sex selection was offered by 43% of programs responding. Neither practice pattern of embryo sex disclosure nor offering PGS solely for sex selection was associated with a general practice recommendation for PGS. Only 36% of programs ever preferentially choose an embryo based on its sex, rather than its quality; this policy was concordant with offering PGS solely for sex selection (p=0.0003). Recipients are afforded the opportunity to choose the sex of the embryo(s) being replaced in 74% of practices responding. In 2017, the vast majority of US programs surveyed offer PGS as an option for patients undergoing donor oocyte IVF, although the majority did not recommend its general use. While disclosure of embryo sex was responsive to recipient desires, the majority of programs did not offer PGS solely for sex selection or choose an embryo preferentially based on its sex.