Speakers BIO:
Sjoerd Repping, The Netherlands
Master's
University: University of Amsterdam
October 1998, cum laude Main subject: Medical Biology (genetics / immunology)
Doctorate
University: University of Amsterdam, Faculty of Medicine
October 2003, cum laude Supervisors: prof. F. van der Veen, prof. N.J. Leschot (UvA), prof. D.C. Page, dr. S. Rozen (MIT, USA)
Title of thesis: Reproductive Fitness of the Human Y Chromosome
Courses
Executive Leadership Harvard, 2014
Financial Management AMC, 2009
Animal welfare /article 9 UvA, 1998
Radiation hygiene / level 5b UvA, 1997
Andreas Schmutzler, Germany
The International School of Medicine was founded in 2008. It is managed by Dr.med. Andreas Schmutzler, a German gynaecologist and lawyer, head of the Kiel University IVF programme,
Overview
For: Preimplantation genetic diagnosis (PGD) is a widespread method in artificial reproductive technology (ART), globally applied in about half of all countries, with primarily preimplantation genetic screening (PGS), with 1% (Europe) to 5% (USA) of all cases. It is the most interesting and most promising technique now, demands a cooperation of clinics, embryology and genetics and requires an ethical balancing of conviction and responsibility.
PGS has five aims: increase birth rates, decrease rates of multiple pregnancies, miscarriages, malformations and senseless therapies. All theses aims are reachable, primarily based on new findings of randomized controlled trials published since 2012 and branded as “PGS 2.0”, based primarily on the combination of blastocyst biopsy and array CGH.
The clinician has to detect the primary aim of the patient, balance its chances and risks, extrapolate from the scientific findings and the possibilities of his treatment center and make a decision, together with the patient, primarily based on his clinical intuition. E.g., it can be ethically correct to shorten time to pregnancy by compromising the cumulative pregnancy chance of oocyte retrieval. The clinician must discuss this with all patients.
Against: The aim of preimplantation genetic screening (PGS) is to select out embryos that are aneuploid. The reason to do so has generally been to increase the chance of live birth in couples undergoing IVF/ICSI. However, data that supports the notion that PGS increases live birth rates is lacking. In fact, PGS using day 3 biopsy and FISH results in a significant reduction in live birth rates. For novel technologies using day 5 biopsy and array based or NGS analysis, well designed trials are lacking. Simple reasoning demonstrates that no selection method will ever increase live birth rates per started cycle; at best, it could reduce time to pregnancy but at what cost? If one proposes that PGS should be applied to prevent the (unethical) birth of aneuploid offspring, there is sufficient data to demonstrate that PGS is neither sensitive nor specific enough to do so, while there is sufficient data to demonstrate that this will be at the cost of lowering live birth rates.
