Registration is open for the 2024 ASRM Scientific Congress & Expo

Menu
Close Close Icon

Use of preimplantation genetic testing for monogenic defects (PGT-M) for adult-onset conditions: an Ethics Committee opinion (2018)


KEY POINTS

  • Preimplantation genetic testing for monogenic disease (PGT-M) for adult-onset conditions is ethically justifiable when the conditions are serious and when there are no known interventions for the conditions, or the available interventions are either inadequately effective or are perceived to be significantly burdensome.
  • For conditions that are less serious or of lower penetrance, PGT-M for adult-onset conditions is ethically acceptable as a matter of reproductive liberty.
  • Physicians and patients should be aware that much remains unknown about the long-term effects of embryo biopsy on a developing fetus. Though thought to be without serious side effects, PGT-M for adult-onset diseases of less serious or of variable penetrance should be considered only after patients are carefully and thoroughly counseled to weigh the risks of what is unknown about the technology and the biopsy itself against the expected benefit of its use.
  • It is important to involve the participation of a genetic counselor knowledgeable about such conditions before patients undertake PGT-M. Physician counseling should also address the patient-specific prognosis for achieving pregnancy and birth, if known, through in vitro fertilization (IVF) with PGT-M.
  • If the IVF team is not comfortable transferring embryos that would result in offspring affected by the disease in question, they are not obligated to do so. In such cases, clinics should notify patients prior to starting treatment.

In both the United States and Europe, PGT-M for adult-onset conditions has been used with increasing frequency (1). Prenatal diagnosis and pregnancy termination have also been increasingly employed for serious single-gene diseases that are manifested principally in adulthood. In 2008, the Practice Committee of ASRM recommended PGT-M with IVF as a significant advance over post-conception diagnosis and pregnancy termination in the case of single-gene (monogenic) disorders (2). This opinion concludes that PGT-M is also ethically permissible in the case of genetically transmitted conditions that are highly serious and manifest in adulthood. Comprehensive counseling by a genetic counselor knowledgeable in the field of PGT-M prior to the start of the IVF process is critical to ensure that patients are adequately counseled before determining their course of action. Prenatal diagnostic testing via chorionic villus sampling (CVS) or amniocentesis to confirm the results obtained with PGTM, or as alternative to PGT-M, should also be discussed with couples as part of their pre-IVF genetic counseling.

PGT-M was initially developed to identify IVF embryos that carried genes for serious, childhood-onset diseases. More recently, PGT-M has been used for serious single-gene diseases that do not develop until adulthood, such as Huntington disease and early-onset Alzheimer disease; for cancer predisposition genes, such as BRCA mutations; and for nonfatal but potentially serious conditions that are apparent at birth, such as focal dermal hypoplasia (3–7). The use of PGT-M for these and other conditions is growing rapidly (1).

Huntington disease is an autosomal-dominant condition that is uniformly fatal, although the age of onset varies with the mutation. However, in the cases of some other serious adult-onset conditions for which PGT-M has been used, such as breast cancer associated with BRCA mutations, the presence of the identified gene or genes does not predict with certainty that an individual will ever develop the disease. Moreover, in many cases, disease can be treated successfully and thus may not be ultimately fatal, such as breast cancer (8). The use of PGT-M for serious adult-onset conditions thus raises challenging policy and ethical questions, given what we know about the human genome, disease etiology, and embryo biopsy procedures. The complexity of these issues demands that the patient considering the procedure consult with an expert in genetic counseling knowledgeable in the field of PGT-M (9).

To the best of current knowledge, embryo biopsy is not linked to fetal malformations or other identifiable problems in offspring (10–12). IVF itself is associated with an increased risk of multiple birth, particularly if more than one embryo is transferred. In addition, there is a small risk of ovarian hyperstimulation syndrome, potential complications associated with the oocyte retrieval, and an increased risk of adverse perinatal and obstetrical outcomes (5, 13). Thus, long-term consequences for the offspring as a result of IVF and PGT-M cannot be ruled out with certainty at present. Moreover, with the available PGT-M technology, testing is available only for identified single-gene mutations (or by linkage) causing disease. As of this time, testing is not available for multifactorial diseases, and there remain risks of diagnostic error and of missing unidentified mutations (2, 10).


ETHICAL ANALYSIS

Overview

Arguments offered in support of PGT-M for serious adult-onset conditions include the right to reproductive choice on the part of persons who seek to bear children, the medical good of preventing the transmission of genetic disorders, the avoidance of abortion based on the revelation of a genetic disorder through prenatal testing, and potential societal benefits of reducing the overall burden of disease. Arguments advanced against the use of PGT-M include expense, the questionable value of the medical benefits obtained in light of our inability to predict medical progress over the longer term, the possibility of misdiagnosis, the unknown risks of the procedure, and the possible negative impacts on persons living with the genetic disease or predisposition for the condition.


Arguments in Favor of PGT-M for Serious Adult-Onset Conditions

The goal of preventing serious disease supports the use of PGT-M for adult-onset conditions. PGT-M is an effective intervention to identify genes that can lead to disease (2). Parents may wish to try to avoid the possibility that their offspring will become afflicted with the condition of concern. There is also the potential benefit to society to avoid of the high costs of long-term treatment of severe chronic disease (14).

In the case of adult-onset diseases, parents may have many reasons for choosing PGT-M. Reproductive liberty is an important, albeit not absolute, right. Parents may wish to avoid the lifelong concern caused by the chance that their children may develop serious adult-onset conditions. Professional organizations such as the American Academy of Pediatrics currently recommend that genetic testing of children for adult-onset conditions for which interventions are unavailable is inappropriate until children reach adulthood (15–17). This argument is based on the idea that the child has the right to an open future which is not burdened with the knowledge of a genetic condition. Families may thus experience the stress of not knowing about a possible adult-onset disease during childhood, until age 18. Critics have argued that this recommendation against testing fails to understand emerging autonomy and to appreciate the harms that may be associated with uncertainty (18), yet the recommendation was reaffirmed in 2013 (15).

Parents may also wish to avoid the stress of medical management during childhood. With some late-onset conditions, testing may be medically indicated before the child reaches adulthood. For patients who carry the familial polyposis gene (APC), for example, testing and polyp removal may be important before adulthood.

The use of PGT-M to avoid the transmission of a serious genetic disorder via discard of affected embryos can play a role in avoiding pregnancy termination based on the discovery of a genetic anomaly through prenatal testing. If individuals or couples use PGT-M to avoid giving birth to a child with the genetic marker for a serious adult-onset disorder, it is possible the patients would have aborted a fetus discovered to be affected during the pregnancy. While by no means universally held, some assert that discard of embryos via PGT-M is a more ethically acceptable choice than prenatal diagnosis followed by abortion (19).

Finally, cost reasons also support the reproductive liberty to choose PGT-M in cases of some adult-onset conditions. This is particularly relevant given the growing lifetime cost of health care for chronic medical conditions. With PGT-M, the expenses are borne at the outset; the costs of managing late-onset conditions may be significantly greater in comparison. Patients with a genetic condition must undergo repeated testing and treatment, often from early adulthood or beyond. The social costs of Huntington disease include lost wages and long-term medical treatment (20). The psychological impact of these diseases should also be considered, as many individuals who have these genes must live with the ongoing burden of fear and concern about the development of disease. An individual whose embryos are undergoing PGT-M for Huntington disease may also request that his or her own carrier status not be disclosed to him or her. It is ethically acceptable to honor such requests, but this practice is controversial around the world (21, 22).

If there are only affected embryos, it is permissible to transfer them after additional genetic counseling. If the IVF team is not comfortable transferring embryos that would result in offspring affected by the disease or predisposition in question, they are not obligated to do so (23). In such cases, clinics should alert patients to this fact prior to the start of treatment during initial PGT-M counseling.


Arguments Against PGT-M for Serious Adult-Onset Conditions

There are ethical reasons on the other side of the argument as well. The medical benefits of PGT-M for adult-onset conditions are speculative. It is impossible to predict whether effective treatment modalities will be available before the manifestation of identified conditions by the time the offspring reach adulthood. Individuals with the genetic trait may live healthy lives for several decades before a disease may become an active concern in adulthood. Moreover, some of these genes may have variable expressivity, manifesting as a much milder form of illness than anticipated, or perhaps not even expressing as illness at all, as in the case of some mutations that increase the lifetime risk of cancer. Cancer predisposition genes such as BRCA present a unique set of challenges. The current understanding of the complex interactions between DNA and the environment is limited. A woman who carries a BRCA1 gene has an increased risk for the development of breast and ovarian cancer but may never develop cancer for reasons that are not yet understood.

Critics of PGT-M also argue that utilizing the procedure for embryo selection risks devaluing certain lives (24). They contend that PGT-M has the potential to send a negative message regarding the value of those individuals living with the disease, including those who have the mutation for the disease but have not yet developed physical manifestation of the syndrome (25). An additional criticism is that use of PGT-M may inaccurately assume that a gene leads to disease and thus inadvertently reinforce problematic views of genetic causation and responsibility. Moreover, PGT operates by preventing the birth of people with the disease, not by treating a disease in the parent. In addition, misdiagnosis remains a possibility for technical reasons, and the procedure is only available at present for conditions associated with a single gene, and not for multifactorial disorders (2, 10, 26, 27).

IVF with PGT-M also is an expensive procedure with no certainty of live birth. In addition, as mentioned previously, embryo transfer for IVF, with or without PGT-M, is associated with an increased risk of multiple pregnancy. However, other adverse obstetrical outcomes, with the exception of placenta previa, appear to be related to the underlying disease and not the process of PGT-M itself (28).


SUMMARY

After careful review and consideration, the Committee concludes, based on the arguments outlined above, that PGT-M for adult-onset conditions is ethically justified when the condition is serious and no safe, effective interventions are available. The Committee further concludes that reproductive liberty arguments ethically allow for PGT-M for adult-onset conditions of lesser severity or penetrance. In the latter cases, the application of the technology hinges on the evidence that PGT-M is a relatively low-risk procedure; this evidence may change. The complexity of the scientific, psychological, and social issues involved in this arena compels the Committee to strongly recommend that an experienced genetic counselor with knowledge about PGT-M play a major role in counseling patients considering such procedures.


Acknowledgments:

This report was developed by the Ethics Committee of the American Society for Reproductive Medicine as a service to its members and other practicing clinicians. While this document reflects the views of members of that Committee, it is not intended to be the only approved standard of practice or to dictate an exclusive course of treatment in all cases. This report was approved by the Ethics Committee of the American Society for Reproductive Medicine and the Board of Directors of the American Society for Reproductive Medicine.

This document was reviewed by ASRM members and their input was considered in the preparation of the final document. The following members of the ASRM Ethics Committee participated in the development of this document. All Committee members disclosed commercial and financial relationships with manufacturers or distributors of goods or services used to treat patients. Members of the Committee who were found to have conflicts of interest based on the relationships disclosed did not participate in the discussion or development of this document.

Judith Daar, J.D.; Jean Benward, M.S.W.; Lee Collins, J.D.; Joseph Davis, D.O.; Owen Davis, M.D.; Leslie Francis, Ph.D., J.D.; Elena Gates, M.D.; Elizabeth Ginsburg, M.D.; Susan Gitlin, Ph.D.; Sigal Klipstein, M.D.; Laurence McCullough, Ph.D.; Richard Paulson, M.D.; Richard Reindollar, M.D.; Ginny Ryan, M.D.; Mark Sauer, M.D., M.S.; Sean Tipton, M.A.; Lynn Westphal, M.D.; Julianne Zweifel, Ph.D.

REFERENCES

  1. Chang J, Boulet SL, Jeng G, Flowers L, Kissin DM. Outcomes of in vitro fertilization with preimplantation genetic diagnosis: an analysis of the United States Assisted Reproductive Technology Surveillance Data, 2011-2012. Fertil Steril 2016;105:394–400.
  2. Practice Committee of the American Society for Reproductive Medicine. Preimplantation genetic testing: a practice committee opinion. Fertil Steril 2008;90:S136–44.
  3. BBC News. Embryos to be screened for squint. Available at: http://news.bbc.co.uk/2/hi/health/6634015.stm. Last accessed November 23, 2016.
  4. Wang C. Ethical, legal and social implications of prenatal and preimplantation genetic testing for cancer susceptibility. Reprod Biomed Online 2009;19(Suppl 2):23–33.
  5. Human Fertilisation & Embryology Authority (UK). Authority decision on PGT-M policy, 10 May 2006. Available at: http://www.hfea.gov.uk/hfea/rss/622.html. Last accessed November 23, 2016.
  6. Gigarel N, Frydman N, Burlet P, Kerbrat V, Tachdjian G, Fanchin R, et al. Preimplantation genetic diagnosis for autosomal recessive polycystic kidney disease. Reprod Biomed Online 2008;16:152–8.
  7. Bostwick B, Van den Veyver IB, Sutton VR. Focal dermal hypoplasia. In: Pagon RA, Adam MP, Ardinger HH, Wallace SE, Amemiya A, Bean LJH, et al., editors. GeneReviews® [Internet]. Seattle: University of Washington, Seattle; May 15, 2008:1993–2016 (updated July 21, 2016). Available at: http://www.ncbi.nlm.nih.gov/books/NBK1543/; May 15, 2008.
  8. Metcalfe K, Lynch HT, Foulkes WD, Tung N, Kim-Sing C, Olopade OI, et al. Effect of Oophorectomy on survival after breast cancer in BRCA1 and BRCA2 mutation carriers. JAMA Oncol 2015;1:306–13.
  9. Arpino G, Pensabene M, Condello C, Ruocco R, Cerillo I, Lauria R, et al. Tumor characteristics and prognosis in familial breast cancer. BMC Cancer 2016;16:924.
  10. De Rycke M, Belva F, Goossens V, Moutou C, SenGupta SB, Traeger- Synodinos J, et al. ESHRE PGT-M Consortium data collection XIII: cycles from January to December 2010 with pregnancy follow-up to October 2011. Hum Reprod 2015;30:1763–89.
  11. Desmyttere S, Bonduelle M, Nekkebroeck J, Roelants M, Liebaers I, De Schepper J. Growth and health outcome of 102 2-year-old children conceived after preimplantation genetic diagnosis or screening. Early Hum Dev 2009;85:755–9.
  12. Basille C, Frydman R, El Aly A, Hesters L, Fanchin R, Tachdjian G, et al. Preimplantation genetic diagnosis: state of the art. Eur J Obstet Gynecol Reprod Biol 2009;145:9–13.
  13. Pandey S, Shetty A, Hamilton M, Bhattacharya S, Maheshwari A. Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis. Hum Reprod Update 2012;18:485–503.
  14. Chevreul K, Michel M, Brigham KB, López-Bastida J, Linertová R, Oliva-Moreno J, et al. Social/economic costs and health-related quality of life in patients with cystic fibrosis in Europe. Eur J Health Econ 2016;17(Suppl 1):7–18.
  15. American Academy of Pediatrics, Committee on Bioethics, Committee on Genetics, and American College of Medical Genetics and Genomics Social, Ethical and Legal Issues Committee Ethical and policy issues in genetic testing and screening of children. Pediatrics 2013;131:620–2.
  16. Kopelman L. Using the best interest standard to assess whether to test children for untreatable, late-onset genetic disease. J Med Philos 2007;32:375–94.
  17. New York State Task Force on Life and the Law. Genetic testing and screening in the age of genomic medicine. Available at: www.health.state.ny.us/nysdoh/taskfce/screening.htm. Last accessed February 26, 2013.
  18. Rhodes R. Genetic testing: is there a right not to know? MCN Am J Matern Child Nurs 2006;31:145.
  19. Cameron C, Williamson R. Is there an ethical difference between preimplantation genetic diagnosis and abortion? J Med Ethics 2003;29:90–2.
  20. Cavazza M, Kodra Y, Armeni P, De Santis M, López-Bastida J, Linertová R, et al. Social/economic costs and quality of life in patients with haemophilia in Europe. Eur J Health Econ 2016;17:53–65.
  21. Braude PR, De Wert GM, Evers-Kiebooms G, Pettigrew RA, Geraedts JP. Non-disclosure preimplantation genetic diagnosis for Huntington's disease: practical and ethical dilemmas. Prenat Diagn 1998;18:1422–6.
  22. Asscher E, Koops BJ. The right not to know and preimplantation genetic diagnosis for Huntington's disease. J Med Ethics 2010;36:30–3.
  23. Ethics Committee of the American Society for Reproductive Medicine. Transferring embryos with genetic anomalies detected in preimplantation testing: an Ethics Committee Opinion. Fertil Steril 2017;107:1130–5.
  24. Will GF. Golly, what did John do? Newsweek 2007;72.
  25. President’s Council on Bioethics, Eugenics and Inequality. Reproduction and responsibility: the regulation of new biotechnologies. Available at: http://bioethics.georgetown.edu/pcbe/reports/reproductionandresponsibility/chapter3.html. Last accessed August 15, 2017.
  26. Grace J, El-Toukhy T, Scriven P, Ogilvie C, Pickering S, Lashwood A, et al. Three hundred and thirty cycles of preimplantation genetic diagnosis for serious genetic disease: clinical considerations affecting outcome. BJOG 2006;113:1393–401.
  27. Fiorentino F, Biricik A, Nuccitelli A, De Palma R, Kahraman S, Iacobelli M, et al. Strategies and clinical outcome of 250 cycles of Preimplantation Genetic Diagnosis for single gene disorders. Hum Reprod 2005;21:670–84.
  28. Bay B, Ingerslev HJ, Lemmen JG, Degn B, Rasmussen IA, Kesmodel US. Preimplantation genetic diagnosis: a national multicenter obstetric and neonatal follow-up study. Fertil Steril 2016;106:1363–9.e1.

Topic Resources

View more on legal/ethical issues
Document Icon

Family members as gamete donors or gestational carriers: an Ethics Committee opinion (2024)

The use of adult intrafamilial gamete donors and gestational surrogates is ethically acceptable when all participants are fully informed and counseled. View the Committee Document
Document Icon

Planned oocyte cryopreservation to preserve future reproductive potential: an Ethics Committee opinion (2023)

Planned oocyte cryopreservation is an ethically permissible procedure that may help individuals avoid future infertility. View the Committee Opinion
Document Icon

Ethical considerations for telemedical delivery of fertility care: an Ethics Committee opinion (2024)

Telemedicine has the potential to increase access to and decrease the cost of care. View the Committee Opinion
Podcast Icon

ASRM Today: Policy Matters: Policy Roundup

On this episode of Policy Matters the ASRM Government Affairs Office brings us up to date on the past year of policy news and advocacy. Listen to the Episode
Document Icon

Interests, obligations, and rights in gamete and embryo donation: an Ethics Committee opinion (2019)

This Ethics Committee report outlines the interests, obligations, and rights of all parties involved in gamete and embryo donation: both males and females who choose to provide gametes or embryos for use by others, recipients of donated gametes and embryos, individuals born as a result of gamete or embryo donation, and the programs that provide donated gametes and embryos to patients. View the Committee Opinion
Legal Icon

The Supreme Court Overturns Right to Abortion, Raising Questions and Uncertainties for ART Patients and Providers

A summary of the U.S. Supreme Court’s ruling and various opinions in Dobbs v. Jackson Mississippi Women’s Health. View the Column
Document Icon

Provision of fertility services for women at increased risk of complications during fertility treatment or pregnancy: an Ethics Committee opinion (2022)

Providers may conclude that the medical risks of fertility treatment for a given patient are too high, in which case it is ethical for them to decline to provide treatment. View the Committee Opinion
Document Icon

Access to fertility services by transgender and nonbinary persons: an Ethics Committee opinion (2021)

The provision of fertility services to transgender individuals and the denial of access to fertility services is not justified. View the Committee Opinion
Document Icon

Interpretation of clinical trial results: a committee opinion (2020)

Evidence from clinical trials is fundamental to ethical medical practice. View the Committee Opinion
Document Icon

Ethics in embryo research: a position statement by the ASRM Ethics in Embryo Research Task Force and the ASRM Ethics Committee (2020)

Scientific research using human embryos advances human health and offspring well-being and provides vital insights into the mechanisms for reproduction and disease. Research involving human embryos is ethically acceptable if it is likely to provide significant new knowledge that may benefit human health, well-being of the offspring, or reproduction. View the Committee Opinion
Document Icon

Compassionate transfer: patient requests for embryo transfer for nonreproductive purposes (2020)

A patient request to transfer embryos into her body in a location or at a time when pregnancy is highly unlikely ... View the Committee Opinion
Document Icon

Child-rearing ability and the provision of fertility services: an Ethics Committee opinion (2017)

Fertility programs may withhold services on the basis that patients will be unable to provide minimally adequate or safe care for offspring. View the Committee Opinion
Document Icon

Financial ‘‘risk-sharing’’ or refund programs in assisted reproduction: an Ethics Committee opinion (2016)

Financial ‘‘risk-sharing’’ fee structures in assisted reproduction programs charge patients a higher initial fee but provide reduced fees for subsequent cycles and often a partial or complete refund if treatment fails. View the Committee Document
Document Icon

Disclosure of medical errors involving gametes and embryos: an Ethics Committee opinion (2016)

Medical providers have an ethical duty to disclose clinically significant errors involving gametes and embryos as soon as they are discovered. Clinics also should have written policies in place for reducing and disclosing errors. View the Committee Document
Document Icon

Informed consent and the use of gametes and embryos for research: a committee opinion (2014)

The ethical conduct of human gamete and embryo research depends upon conscientious application of principles of informed consent. View the Committee Opinion

Topic Resources

View more on the topic of genetic screening/testing
Podcast Icon

Fertility and Sterility On Air - TOC: May 2024

Topics this month include Iatrogenic and demographic determinants of the national plural birth increase, outcomes between ICSI and IVF with PGT-A. Listen to the Episode
Coding Icon

Coding for an endometrial biopsy/Mock cycle

We had patients request us to bill their insurance for the two monitoring visits and the Endo BX and change the diagnosis code to something that is payable.  View the Answer
Podcast Icon

Fertility and Sterility On Air - Unplugged: March 2024

Topics include: melatonin and implantation (4:38), whole-genome screening of embryos, and bioengineering assisted reproductive technology. Listen to the Episode
Videos Icon

Journal Club Global: Cost effectiveness analyses of PGT-A

Infertility treatments can be financially burdensome, often without insurance coverage, making understanding the cost effectiveness of PGT-A crucial. View the Video
Podcast Icon

Fertility and Sterility On Air - TOC: February 2024

Topics this month include the optimial AMH level in oocyte donors, the role of mean number of DNA breakpoints (MDB) in sperm DNA integrity, and more. Listen to the Episode
Podcast Icon

ASRM Today: Genetic Counseling Complexities with Katherine Hornberger

Katherine Hornberger stops by to talk about some of the complexities that can come with genetic counseling in areas such as carrier screenings and more. Listen to the Episode
Coding Icon

Coding PGT requisitions to the PGT lab

Do you have any recommended codes to use for PGT requisitions to the PGT lab?   View the Answer
Podcast Icon

Fertility and Sterility On Air - TOC: December 2023

Topics this month include: the growing role of private equity in fertility care, ART outcomes after fertility-sparing treatment for endometrial neoplasia, and more. Listen to the Episode
Document Icon

Clinical management of mosaic results from preimplantation genetic testing for aneuploidy of blastocysts: a committee opinion (2023)

This document incorporates studies about mosaic embryo transfer and provides evidence-based considerations for embryos with mosaic results on PGT-A. View the Committee Opinion
Videos Icon

Journal Club Global - Revisiting the STAR trial: The Fellows debate PGT-A

We are excited to host a debate covering the pros and cons of PGT-A and how new technologies should be validated before clinical implementation. View the Video
Coding Icon

Sperm DNA Fragmentation

Is there a CPT code for HALO DNA Fragmentation for sperm? View the Answer
Coding Icon

Results Review

What CPT code is most appropriate to submit for Physician Time to review CCS/PGS/PGD results? View the Answer
Coding Icon

ICSI and Embryo Biopsy

How to bill for ICSI or embryo biopsies that occur in different days?  View the Answer
Coding Icon

Embryo Biopsy

Have any new codes been introduced for the lab portion of PGT? View the Answer
Coding Icon

Embryo Biopsy Embryologist Travel Costs

Can we bill insurance for the biopsy procedure? Can we bill for travel expenses? View the Answer
Coding Icon

Embryo Biopsy PGS Testing

What codes are appropriate for PGS testing? View the Answer
Coding Icon

Genetic Counseling

Does ASRM have any guidance for how to bill for genetic counseling services provided by a genetic counselor?
View the Answer
Coding Icon

Assisted Zona Hatching

Can assisted hatching and embryo biopsy for PGT-A; PGT-M or PGT-SR be billed during the same cycle? View the Answer
Document Icon

Indications and management of preimplantation genetic testing for monogenic conditions: a committee opinion (2023)

ASRM has updated its opinion on PGT for monogenic conditions, providing guidance on clinical and technical complexities. View the Committee Opinion
Videos Icon

Journal Club Global - PGT-A - Can non-invasive approaches based on spent medium analysis

PGT-A by trophectoderm biopsy aims to select available euploid embryos for transfer. View the Video
Document Icon

ASRM müllerian anomalies classification 2021

The Task Force set goals for a new classification and chose to base it on the iconic AFS classification from 1988 because of its simplicity and recognizability. View the Committee Opinion
Videos Icon

Journal Club Global - Accuracy of Preimplantation Genetic Testing for Aneuploidies

One of the highest aspirations in reproductive medicine is to develop a technology allowing for ID of embryos that have true reproductive potential.
View the Video
Document Icon

Reproductive and hormonal considerations in women at increased risk for hereditary gynecologic cancers: Society of Gynecologic Oncology and American Society for Reproductive Medicine Evidence-Based Review (2019)

Providers who care for women at risk for hereditary gynecologic cancers must consider the impact of these conditions. View the Joint Statement
Document Icon

Disclosure of sex when incidentally revealed as part of preimplantation genetic testing (PGT): an Ethics Committee opinion (2018)

Clinics may develop a policy to disallow selecting which embryos to transfer based on sex and choose to use only embryo quality as selection criteria. View the Committee Opinion
Document Icon

Transferring embryos with genetic anomalies detected in preimplantation testing: an Ethics Committee Opinion (2018)

Patient requests for transfer of embryos with genetic anomalies linked to serious health-affecting disorders detected in preimplantation testing are rare but do exist. View the Committee Document
Document Icon

Best practices of ASRM and ESHRE: a journey through reproductive medicine (2012)

ASRM and ESHRE are the two largest societies in the world whose members comprise the major experts and professionals working in reproductive medicine. View the Committee Joint Guideline
Membership Icon

Preimplantation Genetic Testing Special Interest Group (PGTSIG)

The ASRM PGTSIG coordinates research, education, and training in preimplantation genetic diagnosis (PGT). Learn more about the PGTSIG

Ethics Opinions

Ethics Committee Reports are drafted by the members of the ASRM Ethics Committee on the tough ethical dilemmas of reproductive medicine.
Ethics Committee teaser

Family members as gamete donors or gestational carriers: an Ethics Committee opinion (2024)

The use of adult intrafamilial gamete donors and gestational surrogates is ethically acceptable when all participants are fully informed and counseled.
Ethics Committee teaser

Planned oocyte cryopreservation to preserve future reproductive potential: an Ethics Committee opinion (2023)

Planned oocyte cryopreservation is an ethically permissible procedure that may help individuals avoid future infertility.
Ethics Committee teaser

Ethical obligations in fertility treatment when intimate partners withhold information from each other: an Ethics Committee opinion (2024)

Clinicians should encourage disclosure between intimate partners but should maintain confidentiality where there is no harm to the partner and/or offspring.
Ethics Committee teaser

Ethical considerations for telemedical delivery of fertility care: an Ethics Committee opinion (2024)

Telemedicine has the potential to increase access to and decrease the cost of care.

More Resources

MAC 2021 teaser
ASRM Academy on the Go

ASRM MAC Tool 2021

The ASRM Müllerian Anomaly Classification 2021 (MAC2021) includes cervical and vaginal anomalies and standardize terminology within an interactive tool format.

View the MAC Tool
EMR Phrases teaser
Practice Guidance

EMR Shared Phrases/Template Library

This resource includes phrases shared by ASRM physician members to provide a template for individuals to create their own EMR phrases.

View the library
Practice Committee Documents teaser

ASRM Practice Documents

These guidelines have been developed by the ASRM Practice Committee to assist physicians with clinical decisions regarding the care of their patients.

View ASRM Practice Documents
Ethics Committee teaser

ASRM Ethics Opinions

Ethics Committee Reports are drafted by the members of the ASRM Ethics Committee on the tough ethical dilemmas of reproductive medicine.

View ASRM Ethics Opinions
Coding Corner general teaser
Practice Guidance

Coding Corner Q & A

The Coding Corner Q & A is a list of previously submitted and answered questions from ASRM members about coding. Answers are available to ASRM Members only.

View the Q & A
Covid-19 teaser
Practice Guidance

COVID-19 Resources

A compendium of ASRM resources concerning the Novel Corona virus (SARS-COV-2) and COVID-19.

View the resources
Couple looking at laptop for online patient education materials

Patient Resources

ReproductiveFacts.org provides a wide range of information related to reproductive health and infertility through patient education fact sheets, infographics, videos, and other resources.

View Website