The Disagreement of PGS Application

[Picture Source: Fertility Associates]

Women after the age of 35 years oftentimes have a gradual decline in fertility (Maheshwari, Hamilton, & Bhattacharya, 2008). A study in 2012 found that the chromosomal abnormality as one of the causes of the miscarriage experience by the aged women (Khandekar, Dive, & Munde, 2016). A procedure in which the genes of embryos created through in vitro fertilization (IVF) are examined for a number of potential genetic disorders before being transferred into a uterus, preimplementation genetic screening (PGS), has been proposed since the early 1990s to improve IVF result (Sermon et al., 2016).

Recently, PGS is such a promising procedure for the aged women to prevent the miscarriage due to chromosomal abnormalities especially aneuploidy, Human embryos are normally euploid which the egg contributes 23 chromosomes and the sperm contributes another 23, so in total 46 chromosomes (Khandekar et al., 2016). While aneuploid embryos contain one more or less than the number of the normal chromosomes which are more likely to fail to implant or end in the miscarriage. This procedure is such good news for the aged women with infertility and the recurrent pregnancy loss. 

In Japan, Japan Society of Obstetrics and Gynecology (JSOG) has made the decision to embark on the clinical research on PGS. The clinical research will investigate how PGS improves the pregnancy and miscarriage rates among women between the ages of 35 and 42 who experience infertility or an inability to give birth (Mainichi Japan, 2017). From 503 women aged 35 to 79 who underwent health checkups in the study conducted in Okazaki, Aichi Prefecture, during a one-year period from February 2007, 458 had experienced pregnancy, of whom 190 or 41.5 percent had suffered the miscarriage (Japan Times, 2009). That's why, with unexpectedly high miscarriage rate, JSOG finally decided to start the clinical research on PGS.

Nevertheless, the decision of JSOG was criticized as being too hasty. PGS is still debatable due to its ethical view and social aspect. Therefore, in my humble opinion, I can not agree with the application of PGS to prevent miscarriage due to some reasons.

Firstly, indirectly PGS deny the existence of the people with disabilities because by applying the PGS before performing IVF, the abnormal embryos can be found and can be decided not to be selected. Indirectly it also puts discrimination toward disable people. Even though, by if the result finds that the embryo is aneuploid (abnormal) and the mother still wants to transfer it to her uterus, the embryo will grow as a disabled person. This condition is also such a dilemma when the mother has already known about the disability but she still wants to transfer it and if her child knows about it, her child may live with regret and hatred. 

Secondly, in the future, it is possible for human with normal embryos to apply PGS to select desired gender of the embryo (to select between girl or boy) since PGS uses screening panels that also contain probes for sex chromosomes, a side effect of this technology, it provides IVF patients with information about the sex of their embryos prior to transfer (Dondorp et al., 2013). If most of the people conduct this procedure, then it will damage the diversity of the people in the world. How if most of the people in the world in the future are women? Then, some of the women will find her life partner difficultly. Then, only a few couples can do reproduction. In the end, the regeneration will also become extremely difficult. No future generation means no life which will be the end of the world.

Thirdly, PGS costs a lot, the IVF/PGS strategy was 100 times more expensive rather than pregnancy management, costing $45,300 per live birth compared with $418 (Murugappan, Ohno, & Lathi, 2015). Therefore, economically, only people with a high income can conduct this procedure which is injustice with the people from the low income. In this case, about the rate of the success of the application of PGS is also still in the investigation which means the procedure may also give a failure. So after performing all the steps, it is still possible to just waste all the money without any good results due to its failure.

Lastly, the cause of the miscarriage is not only because of the abnormal chromosomes, there are still numerous causes, for example, infection, medical conditions in the mother (such as diabetes or thyroid disease), hormone problems, immune system responses, physical problems in the mother, or uterine abnormalities (Adolfsson, 2006). So, I believe, there is still numerous way to prevent the miscarriage rather than applying PGS.

In conclusion, based on my review on its denial disability, the possibility of diversity damage, high cost, and the existence of another way to solve the miscarriage problems, I still in my standpoint that I can not agree with the application of PGS. 

References:

Adolfsson, A. (2006). Miscarriage: Women's Experience and its Cumulative Incidence.

Dondorp, W., De Wert, G., Pennings, G., Shenfield, F., Devroey, P., Tarlatzis, B., … Diedrich, K.

(2013). ESHRE Task Force on ethics and Law 20: Sex selection for non-medical reasons.

Human Reproduction, 28(6), 1448–1454. https://doi.org/10.1093/humrep/det109

Japan Times. 2009. https://www.japantimes.co.jp/news/2009/08/03/national/miscarriagerate-

found-unexpectedly-high/#.WyLdwqczY2w, accessed on June 2018.

Khandekar, S., Dive, A., & Munde, P. (2016). Chromosomal abnormalities -A review

Chromosomal abnormalities - A review, (January 2012).

Maheshwari, A., Hamilton, M., & Bhattacharya, S. (2008). Effect of female age on the

diagnostic categories of infertility. Human Reproduction, 23(3), 538–542.

https://doi.org/10.1093/humrep/dem431

Mainichi Japan. 2017. http://mainichi.jp/english/articles/20170214/p2a/00m/0na/013000c,

accessed on June 2015.

Murugappan, G., Ohno, M. S., & Lathi, R. B. (2015). Cost-effectiveness analysis of

preimplantation genetic screening and in vitro fertilization versus expectant management

in patients with unexplained recurrent pregnancy loss. Fertility and Sterility, 103(5),

1215–1220. https://doi.org/10.1016/j.fertnstert.2015.02.012

Sermon, K., Capalbo, A., Cohen, J., Coonen, E., DeRycke, M., DeVos, A., … Geraedts, J. (2016).

The why, the how and the when of PGS 2.0: Current practices and expert opinions of

fertility specialists, molecular biologists, and embryologists. Molecular Human

Reproduction, 22(8), 545–557. https://doi.org/10.1093/molehr/gaw034

(DISCLAIMER)

This writing is my essay submitted for my master course assignment.