An opposing perspective to "Clinical utility of polygenic risk scores for embryo selection: A points to consider statement of the American College of Medical Genetics and Genomics (ACMG)"
Currently in a debate over the cost-benefit of voluntary IVF for the purposes of embryo selection without trying naturally.
Has anyone laid one out? Considering the impact of IVF on maternal health vs natural conception and the expected gains in various health aspects of the child. The LessWrong post is pretty good on the benefits and $ cost, though is almost a year old and so I imagine things may have changed.
Also the benchmarking for nearly everything is somewhat unclear in whether it’s between natural conception or IVF without PGT-P. I know IVF is related to overall worse outcomes but would be interested to know how much of that is a selection effect from older, less fertile mothers
This is an important question that I am going to look into more, but it is complicated. The question of whether or not IVF + PGT-P is more harmful than IVF seems to favor PGT-P. If a couple is already undergoing PGT-A then a trophectoderm biopsy is already taking place. I looked over several studies about harms of trophectoderm biopsy and it doesn't appear to be an issue (please if someone is reading this point me toward evidence). There are some studies which suggest potential harms/benefits. A meta-analysis (https://pubmed.ncbi.nlm.nih.gov/37595823/) pointed to no particular adverse outcomes for mother/baby. If there was evidence of a bad outcome, then we would need to perform more cost benefit analysis. You're right that couples undergoing IVF are different and even couples undergoing PGT-P may be different, so that's tricky. Why are they seeking it out? Possibly they have medical issues they are concerned about which could complicate things. I'll have to do a deeper dive into that soon.
I may not have been clear, my question concerns the costs and benefits of voluntarily undergoing IVF for the purposes of PGT-P vs natural conception (no IVF). I think it’s clear that, if undergoing IVF, PGT-P is worth it, but it’s less clear if one should opt in to medically unnecessary IVF for the purposes of embryo selection
Got to scan through the linked analysis, not enough time for a full read at the moment, but I'm guessing the underlying argument is effectively that, while PGT-P passes a cost-benefit analysis, it does not pass the medical liability challenges that any hospital or practitioner would face.
Is this roughly true and, if so, are their foreign hospitals, say in Mexico City or elsewhere that provide IVF treatments where this work could be done?
The argument isn't about liability challenges. It is a series of many different concerns about utility, validity, pleiotropy, communication, etc. They do not state that it passes a cost-benefit analysis. They recommend against it being provided as a clinical service.
In the USA, we do not have restriction around this, so we are safe for now.
Seems like an excellent opportunity for you to do a such cost-benefit analysis.
You're right. I'll start working on it as a project.
GM, I have a question: is someone studing if we are selecting for the WRONG poly-genes?
Currently in a debate over the cost-benefit of voluntary IVF for the purposes of embryo selection without trying naturally.
Has anyone laid one out? Considering the impact of IVF on maternal health vs natural conception and the expected gains in various health aspects of the child. The LessWrong post is pretty good on the benefits and $ cost, though is almost a year old and so I imagine things may have changed.
Also the benchmarking for nearly everything is somewhat unclear in whether it’s between natural conception or IVF without PGT-P. I know IVF is related to overall worse outcomes but would be interested to know how much of that is a selection effect from older, less fertile mothers
This is an important question that I am going to look into more, but it is complicated. The question of whether or not IVF + PGT-P is more harmful than IVF seems to favor PGT-P. If a couple is already undergoing PGT-A then a trophectoderm biopsy is already taking place. I looked over several studies about harms of trophectoderm biopsy and it doesn't appear to be an issue (please if someone is reading this point me toward evidence). There are some studies which suggest potential harms/benefits. A meta-analysis (https://pubmed.ncbi.nlm.nih.gov/37595823/) pointed to no particular adverse outcomes for mother/baby. If there was evidence of a bad outcome, then we would need to perform more cost benefit analysis. You're right that couples undergoing IVF are different and even couples undergoing PGT-P may be different, so that's tricky. Why are they seeking it out? Possibly they have medical issues they are concerned about which could complicate things. I'll have to do a deeper dive into that soon.
I may not have been clear, my question concerns the costs and benefits of voluntarily undergoing IVF for the purposes of PGT-P vs natural conception (no IVF). I think it’s clear that, if undergoing IVF, PGT-P is worth it, but it’s less clear if one should opt in to medically unnecessary IVF for the purposes of embryo selection
My fault ha. Yeah I think that’s a more complicated question, but I’m going to look into it
Thanks for bringing this up.
Got to scan through the linked analysis, not enough time for a full read at the moment, but I'm guessing the underlying argument is effectively that, while PGT-P passes a cost-benefit analysis, it does not pass the medical liability challenges that any hospital or practitioner would face.
Is this roughly true and, if so, are their foreign hospitals, say in Mexico City or elsewhere that provide IVF treatments where this work could be done?
You're welcome.
The argument isn't about liability challenges. It is a series of many different concerns about utility, validity, pleiotropy, communication, etc. They do not state that it passes a cost-benefit analysis. They recommend against it being provided as a clinical service.
In the USA, we do not have restriction around this, so we are safe for now.