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Preimplantation

Genetic Testing (PGS): It Should be Used Selectively,


NOT Routinely.
by Dr. Geoffrey Sher
The introduction of preimplantation genetic sampling (PGS) to karyotyping of embryos for selective
transfer of the most competent embryos, requires in most cases that the tested blastocysts be frozen by
vitrification and banked (vitribanked) while awaiting test results and then transferred to the uterus at a
later date. Many IVF programs have advocated the routine use of PGS in IVF purported to improve IVF
outcome. But PGS should in my opinion should only be used selectively. I do not believe that it is needed
for all women undergoing IVF. First, there is the significant additional cost involved and second it will
not benefit everyone undergoing IVF, in my opinion.
While PGS is a good approach for older women and those with diminished ovarian reserve (DOR) and
also for woman who experience recurrent pregnancy loss (RPL) or unexplained recurrent IVF failure
recent data suggests that it will not improve IVF Clinic success rates in women under 36Y who have
normal ovarian reserve, who represent the majority of women seeking IVF treatment, nor is it needed in
women (regardless of their age) undergoing IVF with eggs donated by a younger donor. This is because in
such women, about 1:2/3 of their eggs/embryos are usually chromosomally normal, and in most cases will
upon fertilization produce multiple blastocysts per IVF attempt. Thus, in such cases the transfer of 2
blastocysts will likely yield the same outcome regardless of whether the embryos had been subjected to
PGS or not.
Women who have diminished ovarian reserve (DOR) and/or contemplating embryo banking and for
women with unexplained recurrent IVF failure, recurrent pregnancy loss and women with alloimmune
implantation dysfunction who regardless of their age or ovarian reserve require PGS for diagnostic
reasons.
Embryo Banking: Some IVF centers are doing embryo banking cycles with Preimplantation Genetic
Screening (PGS). With Embryo Banking several IVF cycles are performed sequentially (usually about 2
months apart), up to the egg retrieval stage. The eggs are fertilized and the resulting advanced embryos
are biopsied. The biopsy specimens are held over until enough 4-8 blastocysts have been vitribanked,
thus providing a reasonable likelihood that one or more will turn out to be PGS-normal. At this point the
biopsy specimens (derived all banking cycles) are sent for PGS testing at one time (a significant costsaver), the chromosomally normal blastocysts are identified and the women are scheduled for timed FET
procedures.. with a good prospect of a markedly improved chance of success as well as a reduced risk
of miscarriage.

To Summarize: PGS is an important addition to the IVF Pregnancy diagnostic and


therapeutic armamentarium. However, it should not be done as a routine. Rather, it
should be used selectively to diagnose the cause ofunexplained IVF failure, recurrent
pregnancy loss (RPL) and therapeutically in cases where embryo banking is done in of
older women, women with diminished ovarian reserve (DOR) and women with
alloimmune implantation dysfunction.