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Comparison of Patients’ Ethical Perspectives of Preimplantation Embryo Genetic Testing for Aneuploidy (PGT-A) vs. Monogenic Disorders (PGT-M)

Abstract

What are the ethical perspectives of preimplantation genetic testing in patients using/considering PGT-A compared to those using/considering PGT-M? A 17-item questionnaire administered online was used to assess ethical perspectives in US patients who recently used/considered PGT-A (n=80) vs. those who used/considered PGT-M (n=72). Kruskal-Wallis, Chi-square, and Fisher exact tests were conducted with STATA. Most PGT-A and PGT-M users/considerers supported using PGT to screen for diseases fatal in childhood (86–89%) and those causing lifelong disabilities (76–79%) and opposed using PGT to screen for non-medical physical (80–87%) or intellectual traits (74–86%). Both groups agreed that PGT aids in parental decision-making, although some expressed concern over its potential to lead to unforeseen consequences for society and the PGT offspring. More PGT-M than PGT-A users/considerers opposed implanting genetically abnormal embryos when requested by parents (29% PGT-A vs. 56% PGT-M, p = 0.007). For embryo disposition, more PGT-A users/considerers favored freezing (95% PGTA vs. 82% PGT-M, p = 0.018) or donating genetically normal embryos to research (73% PGT-A vs. 57% PGT-M, p = 0.044), while more PGT-M users/considerers supported donating embryos with known genetic abnormalities to research (56% PGT-A vs. 81% PGT-M, p = 0.001). Regardless of the reason for using PGT, users generally agreed on the acceptable and unacceptable uses for it, as well as the potential societal impact. PGT-M users/considerers expressed more opposition than PGT-A users/considerers to implanting embryos with a genetic alteration when requested by the parents.

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Fig. 1

Data Availability statement

All data are available upon request through Dr. Lisa Pastore.

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Acknowledgements

We thank the Reproductive Medicine Associates of New York (especially Alan Copperman, Taraneh Nazem, and Joseph A Lee) and Island Fertility for communicating our study through their clinics. We thank the National Fragile X Foundation and the Parent Project Muscular Dystrophy for communicating our study to their communities. We thank Marci Lobel, PhD, at Stony Brook University for her collaborative work on developing the study questionnaires.

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J Zhang substantially contributed to the interpretation of the results, had the lead role in writing the manuscript, drafted the tables, and revised the article. LR Rubin substantially contributed to the conception of the study and interpretation of data and drafted and revised the article for important intellectual content. H Zierhut substantially contributed to the interpretation and clinical significance of the data and revised the article for important intellectual content. LM Pastore conceived and designed this study, substantially contributed to the interpretation of results, drafted the article, and revised it for important intellectual content. All authors approved the final version.

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Correspondence to L. M. Pastore.

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Zhang, J., Rubin, L.R., Zierhut, H. et al. Comparison of Patients’ Ethical Perspectives of Preimplantation Embryo Genetic Testing for Aneuploidy (PGT-A) vs. Monogenic Disorders (PGT-M). Reprod. Sci. 28, 3272–3281 (2021). https://doi.org/10.1007/s43032-021-00644-w

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  • DOI: https://doi.org/10.1007/s43032-021-00644-w

Keywords

  • Preimplantation genetic testing
  • Ethics or ethical issues
  • Aneuploidy
  • Monogenic disorders
  • Attitudes