PREIMPLANTATION GENETIC SCREENING: FACTORS INFLUENCING PATIENT DECISION-MAKING
Jacqueline Isaac1,2, Emily Mounts3, Susan Puumala2, Quinn Stein2,4, Lori Williamson-Dean1, Tiffany Von Wald2,
Elizabeth Barbieri3, Jason Flanagan2.
1University of Arkansas for Medical Sciences, Little Rock, AR, 2Sanford Health, Sioux Falls SD, 3Oregon Reproductive Medicine, Portland, OR, 4Augustana University, Sioux Falls, SD
BACKGROUND: In vitro fertilization (IVF) is a common treatment for many couples and individuals experiencing infertility or recurrent pregnancy loss, with over 170,000 cycles performed in the United States in 2013. However, IVF is not always successful; the national average for cycles resulting in live births ranges from 4.5% (in women over 42 years of age) to 40.1% (in women younger than 35 years of age). A common cause of implantation failure or early pregnancy loss is aneuploidy in the transferred embryo. Preimplantation genetic screening (PGS) is a tool to identify aneuploid embryos, thereby aiming to improve IVF success rates by transferring only euploid embryos. There are now multiple studies demonstrating improved success rates in certain patient groups, and in a 10-year period, 61% of all preimplantation genetic testing involved PGS.
OBJECTIVE:We sought to explore factors influencing patients to either elect or decline PGS. A secondary aim of the study was to assess the utility of the PGS information the patients received during their genetic counseling appointments.
METHODS: Over a six month period concluding in February 2016, an anonymous prospective survey, either on-line or hardcopy, was administered to 128 patients at two IVF centers: Sanford Health in Sioux Falls, South Dakota and Oregon Reproductive Medicine in Portland, Oregon. Survey items addressed fertility history, indication for IVF, knowledge, misperceptions and opinions of PGS, the participant’s decision to elect or decline PGS, factors that influenced that decision, and participants’ experiences with genetic counseling and the information received related to PGS.
RESULTS: We performed preliminary data analysis on the first 65 completed surveys. Some of the most-cited reasons to elect PGS were: reducing the chance of miscarriage, improving pregnancy chances, and to screen for Down syndrome and other chromosome abnormalities. Financial cost was indicated as one of the primary reasons not to test the embryos, followed by lack of patient-perceived benefit. Overall, participants reported feeling more informed about the risks, limitations, and benefits of PGS after meeting with a genetic counselor.
RELEVANCE TO PRACTICE: This study expands our knowledge of patient decision-making regarding PGS and identifies the value of genetic counseling in these settings.