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Use of preimplantation genetic testing for monogenic adult-onset conditions: an Ethics Committee opinion (2024)

Preimplantation genetic testing for monogenic diseases for adult-onset conditions is ethically permissible for various conditions, including when the condition is fully penetrant or confers disease predisposition. The Committee strongly recommends that a genetic counselor experienced with both preimplantation genetic testing for monogenic diseases and assisted reproductive technology therapies counsel patients considering such procedures. (Fertil Steril® 2024;122:607–11.©2024 by American Society for Reproductive Medicine.)

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KEY POINTS

  • Preimplantation genetic testing for monogenic (PGT-M) diseases for adult-onset conditions that are most often fully penetrant or confer disease predisposition is ethically justifiable. Decisions on whether conditions are significantly impactful such that PGT-M is warranted are personal ones that differ among patients, whose autonomy to make such distinctions should be supported as a matter of reproductive liberty.
  • Patients considering PGT-M should be carefully and thoroughly counseled by a genetic counselor with expertise in preimplantation genetic testing to understand the risks, benefits, and limitations of PGT-M, as well as to discuss the potential manifestations of the hereditary condition. Consulting medical professionals with expertise in the condition to be tested should be considered in addition to help patients make decisions regarding using PGT-M in these situations.
  • Physician counseling should address the patient-specific prognosis for achieving pregnancy through in vitro fertilization treatment when used in conjunction with PGT-M.
  • Nondirective counseling is important when considering PGT-M to support patient autonomy.

The use of preimplantation genetic testing for monogenic (PGT-M) diseases for adult-onset conditions that are fully penetrant or confer disease predisposition has been increasing steadily in the United States (1). Comprehensive counseling by a genetic counselor knowledgeable in assisted reproductive technology therapies, PGT, and the hereditary condition being tested is critical to ensure that patients are adequately informed before determining their course of action. Prenatal diagnostic testing via chorionic villus sampling or amniocentesis to confirm the results obtained with PGT-M, or as an alternative to PGT-M, should also be discussed with individuals as part of their prenatal genetic counseling. Some reproductive decisions, including termination of pregnancy, may not be available to patients depending on the state in which they reside. Such restrictions should be included in preconceptual counseling regarding reproductive options.

Initially, PGT-M was developed to identify embryos resulting from in vitro fertilization (IVF) therapy cycles that carried genes for serious childhood-onset diseases. Preimplantation genetic testing for monogenic diseases has been used recently for adult-onset single-gene disorders and disease predispositions (1). Examples include diseases that are not always but most often fully penetrant (e.g., Huntington disease and polycystic kidney disease) and genes that indicate a predisposition for cancer (e.g., BRCA1 and BRCA2 gene variants) (2–7). Although Huntington disease is an autosomal dominant condition that is uniformly fatal, the age of onset varies with the pathogenic variant. In contrast, for cancer syndromes such as BRCA1 or BRCA2-associated hereditary breast and ovarian cancer, the presence of the identified gene variant(s) does not predict with certainty that an individual will ever develop the disease but significantly increases the lifetime risks for associated cancers. Moreover, some conditions can be treated successfully and may not be ultimately fatal or significantly affect the quality of life (8). For other conditions, successful treatments may be developed over time to prevent or treat the conditions for which the offspring are at risk. The use of PGT-M for serious adult-onset conditions thus raises challenging policy and ethical questions, given what is known about the human genome, disease etiology, the pace of medical progress, and embryo biopsy procedures. This includes questions of whether and how the role of commercial laboratories in developing new testing applications may impact prospective patients’ choices regarding what tests may be accessible for use. In addition, it calls for acknowledging that the seriousness of a condition may be based on individual judgment, which is often dependent on a person’s values, beliefs, and lived experience. Patients should be supported as they determine whether they wish to undergo PGT-M for a given condition as a matter of respect for reproductive autonomy. As of the publication of this article, testing for multifactorial diseases and/or the use of PGT-P (preimplantation testing for polygenic conditions) and polygenic risk score assessment for embryo selection remains investigational and should not be offered outside of research protocols (2, 9).

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 on the basis of revelation of a genetic disorder through prenatal testing, and 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, and the potential risks of IVF therapy as well as embryo biopsy. Furthermore, the use of PGT-M may have negative impacts on persons living with the genetic disease or predisposition for the condition by calling into question the value of their lives and decreasing funding of research when the disease or predisposition becomes less prevalent in the population.

Arguments in favor of PGT-M for adult-onset conditions

The goal of preventing serious disease supports using PGT-M for adult-onset conditions that are most often fully penetrant or confer disease predisposition. Preimplantation genetic testing for monogenic diseases is an effective intervention to identify these genetic variants (2). Prospective parents may wish to try to avoid the possibility that their offspring will inherit the condition or predisposition of concern. The potential benefit to society is also to avoid the high costs of long-term treatment of severe and/or chronic diseases (10).

In the case of adult-onset diseases, prospective parents may have many reasons for choosing PGT-M. Reproductive liberty is an important, albeit not absolute, right. Prospective parents may wish to avoid the lifelong concern caused by the chance that their children may develop adult-onset health-affecting conditions that have limited or highly burdensome treatments or may shorten their lifespan. 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 18 years of age and adulthood (11–13). This argument is based on the idea that the child has the right to an open future that is not burdened with the knowledge of a genetic condition. Critics have argued that this recommendation against testing fails to understand emerging autonomy and to appreciate the harms that may be associated with uncertainty (14), yet the recommendation was reviewed in 2013 (11). In the case of PGT-M, the concept of an open future does not readily apply.

With some late-onset conditions, testing may be medically indicated before the child reaches adulthood. For example, autosomal dominant polycystic kidney disease (ADPKD) results in a progressive decline in kidney function, with kidney failure tending to occur in middle age. Children with ADPKD may not have any symptoms during childhood but require interval blood pressure assessment and renal ultrasonography beginning in childhood to monitor for early signs of kidney damage.

Finally, cost considerations also support the reproductive liberty to choose PGT-M in cases of diseases that are most often fully penetrant or confer disease predisposition. This is particularly relevant given the 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 by comparison. However, the costs of IVF therapy with PGT-M should not be discounted. These are expensive procedures with no certainty of live birth. Currently, IVF therapy with PGT-M for adult-onset conditions may not be covered by insurance, and access to care is often limited. Efforts should be made to equitably increase access to this technology for those who may benefit from it.

Patients with a genetic condition often require repeated testing and treatment, often from early adulthood or beyond. For example, the financial and public health burdens of ADPKD include lost wages as well as long-term medical treatment (15). Those with disease predispositions often need increased screening, which confers costs on themselves and increases burdens on the health care system. They may also opt for prophylactic procedures such as mastectomy or oophorectomy in the case of a BRCA variant that confers an increased risk for the development of cancer. The psychological impact of these diseases should also be considered, because many individuals who carry these genetically inherited conditions must live with the ongoing burden of fear and concern about the development of disease. Individuals whose embryos are undergoing PGT-M for adult-onset diseases such as Huntington disease may also request that their own carrier status not be disclosed to them. It is ethically acceptable to honor such requests, but this practice remains controversial (16, 17).

Arguments against PGT-M for adult-onset conditions

There are ethical reasons against using PGT-M for adult-onset conditions that are fully penetrant or confer disease predisposition. 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 disease-causing genetic variant may live healthy lives for several decades before a disease becomes an active concern in adulthood. Moreover, some of these genes may have variable expressivity or reduced penetrance, manifesting as a much milder form of illness than anticipated or perhaps never expressing illness at all, as in the case of some pathogenic variants that increase the lifetime risk of cancer. Genes that indicate a predisposition to cancer, such as BRCA1 and BRCA2, present unique challenges. The current understanding of the complex interactions between DNA and the environment is limited. A woman who carries a BRCA1 or BRCA2 pathogenic variant has an increased lifetime risk of developing breast and/or ovarian cancer but may never develop these cancers for reasons that are not yet fully understood (18).

Critics of PGT-M also argue that using the procedure for embryo selection risks devaluing certain lives (19).They contend that PGT-Mcan potentially 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 a physical manifestation of the syndrome (20).

SUMMARY

After careful review and consideration, the Committee concludes, on the basis of the above arguments, that PGTM for adult-onset conditions that are most often fully penetrant or confer disease predisposition is ethically justified. Considerations including patient autonomy and the importance of supporting reproductive liberty dictate that decisions regarding the use of PGT-M in these situations should be made by patients as they consider the risk of disease development, the role of disease severity, and the age of onset. The complexity of the scientific, psychological, and social issues involved in this arena compels the Committee to strongly recommend that an experienced preimplantation genetic testing genetic counselor with knowledge about both the condition and assisted reproductive technology treatment play a significant role in the counseling of prospective patients considering using PGT-M for adult-onset conditions. Counseling from medical professionals with expertise in the condition should also be considered as appropriate.

Acknowledgments

This report was developed under the direction of the Ethics Committee of the American Society for Reproductive Medicine (ASRM) as a service to its members and other practicing clinicians. Although this document reflects appropriate management of a problem encountered in the practice of reproductive medicine, it is not intended to be the only approved standard of practice or to dictate an exclusive course of treatment. Other plans of management may be appropriate, taking into account the needs of the individual patient, available resources, and institutional or clinical practice limitations. The Ethics Committee and the Board of Directors of the ASRM have approved this report.

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: Sigal Klipstein, M.D.; Kavita Shah Arora, M.D., M.B.E.; Katherine Cameron, M.D.; Susan Crockin, J.D.; Ruth Farrell, M.D.; Elizabeth Ginsburg, M.D.; Jessica Goldstein, R.N.; Catherine Hammack Aviran, M.A., J.D.; Mandy Katz-Jaffe, Ph.D.; Jennifer Kawwass, M.D.; Catherine Racowsky, Ph.D.; Robert Rebar, M.D.; Mary Samplaski, M.D.; Chevis N Shannon, Dr.P.H., M.P.H., M.B.A.; Sean Tipton, M.A.; Lynn Westphal, M.D.; and Julianne Zweifel, Ph.D. The Ethics Committee acknowledges the special contribution of Ruth Farrell, M.D. and Mandy Katz-Jaffe, Ph.D., in the preparation 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.

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 and Genetic Counseling Professional Group of the American Society for Reproductive Medicine. Indications and management of preimplantation genetic testing for monogenic conditions: a committee opinion. Fertil Steril 2003;120:61–71.
  3. BBC News. Embryos to be screened for squint. Available at: http://news.bbc.co.uk/2/hi/health/6634015.stm. Accessed November 23, 2016.
  4. Wang CW, Hui EC. 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). Approved PGT-M and PTT conditions. Human Fertilisation & Embryology Authority. Available at: https://www.hfea.gov.uk/treatments/embryo-testing-and-treatments-for-disease/approved-pgt-m-and-ptt-conditions/. 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., eds. GeneReviews. Seattle University of Washington; 2008:1993–2016.
  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.
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  10. Chevreul K, Michel M, Brigham KB, López-Bastida J, Linertovà 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.
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  12. Kopelman LM. Using the best interest standard to assess whether to test children for untreatable, late-onset genetic disease. J Med Philos 2007;32:375–94.
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  16. 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.
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  18. Li S, Silvestri V, Leslie G, Rebbeck TR, Neuhausen SL, Hopper JL, et al. Cancer risks associated with BRCA1 and BRCA2 pathogenic variants. J Clin Oncol 2022;40:1529–41.
  19. Petersen TS. Just diagnosis? Preimplantation genetic diagnosis and injustices to disabled people. J Med Ethics 2005;31:231–4.
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Fertility and Sterility On Air - TOC: July 2024

Articles this month include: predicting ART complications, laser assisted hatching on vitrified blastocysts, predictive models of miscarriage and more.
Listen to the Episode
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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
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Journal Club Global: Recent clinical trials in Fertility and Sterility from the Asia Pacific region

Join ASPIRE 2024 for a Journal Club Global on PGT-A and IVF. Learn from top experts discussing recent clinical trial data and pregnancy outcomes View the Video
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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
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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
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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
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Genetics: Is Expanded Carrier Screening the Standard of Care?

Hannah Green, a genetic counselor at NYU, discusses the benefits and limitations of expanded carrier screening, highlighting its impact on clinical practice and patient care. View the ASRMed Talk Video
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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
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Sperm DNA Fragmentation

Is there a CPT code for HALO DNA Fragmentation for sperm? View the Answer
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Results Review

What CPT code is most appropriate to submit for Physician Time to review CCS/PGS/PGD results? View the Answer
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ICSI and Embryo Biopsy

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

Have any new codes been introduced for the lab portion of PGT? View the Answer
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Embryo Biopsy Embryologist Travel Costs

Can we bill insurance for the biopsy procedure? Can we bill for travel expenses? View the Answer
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Embryo Biopsy PGS Testing

What codes are appropriate for PGS testing? View the Answer
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Genetic Counseling

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

Topic Resources

View more on the topic of infertility
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Use of preimplantation genetic testing for monogenic adult-onset conditions: an Ethics Committee opinion (2024)

Preimplantation genetic testing for adult-onset monogenic diseases is ethically allowed when fully penetrant or conferring disease predisposition. View the Committee Opinion
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Fertility Care Gets Important Win in California

ASRM celebrates California's SB 729, expanding IVF coverage for same-sex couples and singles, advancing equitable fertility care access.

View the Press Release
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Appropriate Use of Modifier -25

Is Modifier -25 appropriate in the monitoring cycle when an ultrasound View the Answer
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Billing for E/M Visits

When billing Evaluation & Management (E/M) visits based on medical decision-making, would we View the Answer
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When to use code Z31.83

When a patient is completing an approved fertility cycle, is it necessary View the Answer
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Timed Intercourse Cycle Codes

Is it appropriate to utilize codes N97.8 or View the Answer
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The use of preimplantation genetic testing for aneuploidy: a committee opinion (2024)

PGT-A use in the U.S. is rising, but its value as a routine IVF screening test is unclear, with mixed results from various studies. View the Committee Opinion
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National Infertility Awareness Week

April 20-26, 2025, is National Infertility Awareness Week (NIAW)! 

View the NIAW Toolkit
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Fertility Support and AI: Help or Hinderance

Discover how fertility apps impact patient care and nursing staff. Explore the balance between tech and human touch in complex fertility treatments View the ASRMed Talk Video
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Fertility and Sterility On Air - Seminal Article: Ernest Ng and Zhi Chen

June issue Seminal Contribution: a randomized controlled trial studying the use of progestins for ovulation supression in predicted high responders.  Listen to the Episode
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ASRM announces support for HOPE with Fertility Services Act

The American Society for Reproductive Medicine is proud to endorse the HOPE with Fertility Services Act (HR 8821).

View the Press Release
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HyCoSy and CPT 74740

When Office HSG/HyCoSy is performed but no x-ray/fluoroscopic imaging is performed, only ultrasound is done, is it appropriate to bill CPT code 74740? View the Answer
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Subclinical hypothyroidism in the infertile female population: a guideline (2024)

This guideline reviews the risks and benefits of treating subclinical hypothyroidism in female patients with a history of infertility and miscarriage. View the Committee Guideline
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Tobacco or marijuana use and infertility: a committee opinion (2023)

In the United States, approximately 21% of adults report some form of tobacco use, although 18% report marijuana use. View Committee Opinion
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Journal Club Global: The future of REI Fellowship training: debating opportunities and threats

This exciting collaboration discusses the controversy and future directions for the field of Reproductive Endocrinology and Infertility medicine. View the Video
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Journal Club Global: Infertility and Subclinical Hypothyroidism

The impact of treating SCH on fertility, obstetric outcomes, and offspring neurocognitive development is debated in the literature. View the Video
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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
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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. View the Committee Opinion
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Definition of infertility: a committee opinion (2023)

‘‘Infertility’’ is a disease, condition, or status characterized by several factors. View the Committee Opinion
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Diagnostic evaluation of sexual dysfunction in the male partner in the setting of infertility: a committee opinion (2023)

It is the responsibility of the clinician to assess for erectile dysfunction, ejaculatory dysfunction, or diminished libido in men presenting for infertility. View the Committee Opinion
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Journal Club Global - Actualización en la suplementación con progesterona en fase lútea para transferencias de embriones congelados

Efectividad del rescate de progesterona en mujeres que presentan niveles bajos de progesterona circulante alrededor del día de la transferencia de embriones View the Video
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The International Glossary on Infertility and Fertility Care, 2017†‡§ (2017)

Terms and definitions currently used infertility care, infertility and medically assisted reproduction (MAR) can have different meanings that are dependent upon the setting, their usage in research or clinical interventions, or among diverse populations.
View the Committee Joint Guideline
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Endometriosis and infertility: a committee opinion (2012)

Women with endometriosis typically present with pelvic pain, infertility, or an adnexal mass, and may require surgery. View the Committee Opinion
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Testing With No History of Infertility

What diagnosis codes should  providers submit to insurance carriers while trying to evaluate fertility issues? View the Answer
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Self-referred New Patient

A patient self-refers to our physician for an initial new patient consultation instead of referred by another physician, how do we code for the consult? View the Answer
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Surgery Coding

I took the ASRM coding course, and in that course, coding for bilateral neosalpingostomies was coded using only a dx of N70.11 (hydrosalpinx). View the Answer
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Telephone Consult

Does a physician need to speak directly to a patient to code for a telephone consult (99371-99373) or can a staff member relay physician notes to patients? View the Answer
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Post Vasectomy Infertility

If a husband has had a vasectomy, does the sterilization code apply to the wife's visits? View the Answer
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Pregnancy Of Uncertain Viability Ultrasound

My staff is telling me that I am getting reimbursed for the first sonogram and OB visit (using ICD 10 code for pregnancy of uncertain viability – O36.80X0. View the Answer
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Pregnancy Ultrasound

Our practice does routine ultrasounds (sac check- 76817) at the end of an IVF cycle and bill with a diagnosis code O09.081, pregnancy resulting from ART.  View the Answer
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Psychological Evaluation

Many REs require patients (and their spouses/partners) who are considering using donor gametes to see an infertility counselor first. View the Answer
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Infertility Consult

Does ASRM have any examples of evaluation and management documentation for patients being seen for an initial infertility evaluation? View the Answer
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Infertility Consult by Nurse

What code is used for a nurse practitioner seeing a fertility patient for the first time? View the Answer
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Initial Visit for Infertility With No Mandated Coverage

What code would be appropriate for an initial visit for infertility?  View the Answer
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IUI or IVF

Should other ovarian dysfunction (diagnosis code E28.8) or unspecified ovarian dysfunction (diagnosis code E28.9) can be used for an IUI or an IVF cycle View the Answer
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Monitoring E&M

Our group would like to know if others are billing an evaluation and management code for ultrasound and blood draw visits? View the Answer
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New vs Established Patient

How soon can you bill as a new infertility patient? View the Answer
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General E&M Consult

Recently we have received a “re-code” on a new patient (we billed a 99203 and the insurance re-coded it to a 99213).  View the Answer
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Hysteroscopy Recurrent Implantation Failure

What is the appropriate ICD-10 code for recurrent implantation failure?  View the Answer
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D&C Under Ultrasound Guidance

What are the CPT codes and ICD-10 codes for coding a surgical case for a patient with history of Stage B adenocarcinoma of the cervix ... View the Answer
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Diagnosis of Infertility for IVF Procedure

How important is it to have accurate documentation of the type of infertility diagnosis for IVF procedures?  View the Answer
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Diagnostic Testing of an Infertile Couple

The Z31.41 is or is not the correct code to use for diagnostic testing of an infertile couple? And If so can if be used as the primary and only code? View the Answer
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Blood Draws

If a patient comes in only for a blood draw (venipuncture) and is seen only by the lab technician (not an MD, PA, or NP), may we bill for a (minimal) office visit? View the Answer
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Blood Tests

Patients are requesting to have lab work drawn from the female patient moved to the males account due to the female fertility coverage being maxed out.  View the Answer
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Male Infertility

A summary of common codes for Male Infertility compiled by the ASRM Coding Committee. View the Coding Summary
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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
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Intracytoplasmic sperm injection (ICSI) for non–male factor indications: a committee opinion (2020)

Intracytoplasmic sperm injection is frequently used in combination with assisted reproductive technologies. View the Committee Document
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Moving innovation to practice: an Ethics Committee opinion (2021)

The introduction of new strategies, tests, and procedures into clinical practice raises challenging ethical issues. View the Committee Opinion
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Fertility evaluation of infertile women: a committee opinion (2021)

Diagnostic evaluation for infertility in women should be conducted in a systematic, expeditious, and cost-effective manner. View the Committee Opinion
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Fertility treatment when the prognosis is very poor or futile: an Ethics Committee opinion (2019)

The Ethics Committee recommends that in vitro fertilization (IVF) centers develop patient-centered policies regarding requests for futile treatment.  View the Committee Opinion
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Use of exogenous gonadotropins for ovulation induction in anovulatory women: a committee opinion (2020)

Pretreatment evaluation, indications, treatment regimens, and complications of gonadotropin treatment. View the Committee Opinion
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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
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Guidance for Providers Caring for Women and Men Of Reproductive Age with Possible Zika Virus Exposure (Updated 2019)

This ASRM guidance specifically addresses Zika virus infection issues and concerns of individuals undergoing assisted reproductive technologies (ART). View the Guideline
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American Society for Reproductive Medicine position statement on uterus transplantation: a committee opinion (2018)

Following the birth of the first child from a transplanted uterus in Gothenburg, Sweden, in 2014, other centers worldwide have produced scientific reports. View the Committee Opinion
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Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline (2017)

This review evaluates if uterine myomas impact likelihood of pregnancy and pregnancy loss, and if myomectomy influences pregnancy outcomes. View the Guideline
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Improving the Reporting of Clinical Trials of Infertility Treatments (IMPRINT): modifying the CONSORT statement (2014)

Clinical trials testing infertility treatments often do not report on the major outcomes of interest to patients and clinicians and the public. View the Guideline