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The PGS/PGT-A controversy in IVF addressed as a formal conflict resolution analysis

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Abstract

Purpose

To use conflict resolution analysis on the conflict between proponents and opponents of preimplantation genetic testing for aneuploidy (PGT-A), previously called preimplantation genetic screening (PGS).

Methods

Considered in conflict analysis a case study, we reviewed the English literature based on key-word searches at www.pubmed.com and www.google.com, and interviewed professional opinion leaders and other actor-representatives. This analysis was the product of a mandated externship by L.M. at the Foundation for Reproductive Medicine (FRM), as part of the Master of Science Program in Negotiations and Conflict Resolution at Columbia University, New York, NY.

Results

Initially a typical difference of opinion, conflict evolved after proponents rejected studies that failed to confirm expected benefits, and authors felt demeaned by their criticism. Becoming “destructive,” the conflict evolved according to Glasl’s escalation model stages. Proponents became continuous attractors. Unable to produce validations for PGT-A, proponents moved goal posts through 3 stages (PGS 1.0–PGS 3.0). Ultimately concurring that pregnancy and live birth rates are unaffected, they started claiming new benefits.

Conclusions

The FRM underwrote this study as a starting tool for a conflict resolution process. A consensus building conference of stakeholders appears as of this point to represent the most promising potential intervention. The goal of such a conference should be sustainable consensus about clinical utilization of PGS/PGT-A in IVF, based on transparent and validated criteria. A potential date for such a conference is set for 2020.

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Funding

This manuscript was supported by intramural funding from The Foundation for Reproductive Medicine, New York, NY.

Author information

Authors and Affiliations

  1. Foundation for Reproductive Medicine, New York, NY, 10021, USA

    Lyka Mochizuki & Norbert Gleicher

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

    Lyka Mochizuki & Norbert Gleicher

  3. Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY, 10016, USA

    Norbert Gleicher

  4. Department of Obstetrics and Gynecology, Vienna University of Medicine, 1090, Vienna, Austria

    Norbert Gleicher

Authors
  1. Lyka Mochizuki
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  2. Norbert Gleicher
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Contributions

This analysis was the product of a mandated externship by L.M. at the Foundation for Reproductive Medicine (FRM), a not-for-profit research foundation in New York City, as part of the Master of Science Program in Negotiations and Conflict Resolution at Columbia University, New York, NY.

L.M., therefore, conducted the research and wrote the first draft of the manuscript. Both authors revised the manuscript and agreed on its final content.

Corresponding author

Correspondence to Lyka Mochizuki.

Ethics declarations

Competing interests

L.M. has no competing interests to report but has joined The CHR as a research fellow. N.G. is President of The Foundation for Reproductive Medicine in New York, NY, a not-for-profit research foundation that hosted the externship of L.M. and supported her research. N.G. is also the owner of a for-profit fertility center, The CHR in New York, NY. He is a co-inventor on several pending and already awarded US patents claiming therapeutic benefits from androgen supplementation in women with low functional ovarian reserve and relating to the FMR1 gene in diagnostic functions in female fertility. He receives royalties from Fertility Nutraceuticals, LLC, in which N.G. also holds shares. He is also a co-inventor on three pending AMH-related patent applications and in the past received research grants, travel funds, and/or speaker honoraria from Pharma and/or medical device companies, though none in any way related to hear presented materials. Neither author has commercial interests, relating to PGS/PGT-A.

Additional information

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Glossary of in this manuscript encountered conflict resolution terminology

Accelerant

Person or constellation that enhances a conflict.

Actor

Participant in a conflict. In accordance with their respective importance to the conflict, they are designated as primary, secondary, and tertiary actors.

Attractor

Attractors are constellations of conflicts that feed intractability.

Clusters

Graphic depiction of cooperating units in a conflict map.

Conflict analysis

Systematic study of causes, actors, and dynamics of a conflict.

Conflict map

Graphic depiction between actors in a conflict in relationship to problem(s).

Destructive phase of a conflict

According to Deutsch, destructive conflicts are characterized by a tendency to expand and escalate. Whether a conflict is destructive or constructive depends on the behavior of actors. Behaviors that escalate conflicts until they develop a life of their own are considered destructive (M. Deutsch. J Social Issues 1969; 25(1):11–12).

Glasl’s escalation model stages

(1) Hardening; (2) debates and polemics; (3) actions not words; (4) images and coalitions; (5) loss of face; (6) strategies of threats; (7) limited destructive blows; (8) fragmentation of the enemy; and (9) together into the abyss (Jordan T. https://www.mediate.com/articles/jordan.cfm).

Hubs and spokes

Parts of a conflict map that graphically demonstrate “how things work.”

Networks

When the number of actors in a conflict is high, it lends itself to a so-called network analysis.

Stakeholders

Individuals who may be impacted by a conflict’s outcome.

Sustainable consensus

To reach sustainable consensus it is essential for reach sustainable conflict resolution.

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Mochizuki, L., Gleicher, N. The PGS/PGT-A controversy in IVF addressed as a formal conflict resolution analysis. J Assist Reprod Genet 37, 677–687 (2020). https://doi.org/10.1007/s10815-020-01688-8

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