ESHRE PGT Consortium good practice recommendations for the organisation of PGT

Abstract

The field of preimplantation genetic testing (PGT) is evolving fast, and best practice advice is essential for regulation and standardisation of diagnostic testing. The previous ESHRE guidelines on best practice for preimplantation genetic diagnosis, published in 2005 and 2011, are considered outdated and the development of new papers outlining recommendations for good practice in PGT was necessary. The current updated version of the recommendations for good practice is, similar to the 2011 version, split into four documents, one of which covers the organisation of a PGT centre. The other documents focus on the different technical aspects of embryo biopsy, PGT for monogenic/single-gene defects (PGT-M) and PGT for chromosomal structural rearrangements/aneuploidies (PGT-SR/PGT-A). The current document outlines the steps prior to starting a PGT cycle, with details on patient inclusion and exclusion, and counselling and information provision. Also, recommendations are provided on the follow-up of PGT pregnancies and babies. Finally, some further recommendations are made on the practical organisation of an IVF/PGT centre, including basic requirements, transport PGT and quality management. This document, together with the documents on embryo biopsy, PGT-M and PGT-SR/PGT-A, should assist everyone interested in PGT in developing the best laboratory and clinical practice possible.

Keywords: ESHRE; IVF; PGT centre organisation; counselling; preimplantation genetic testing; reporting; training.

Figure 1

Overview of the IVF/PGT process, and how all aspects are covered by one of the four recommendations papers. IVF: in vitro fertilisation, PGT: preimplantation genetic testing.

Figure 2

Outline of the biopsy and genetic testing procedure with indications of the seven critical steps where labelling and sample identification should be confirmed. Further details on labelling and sample identification during the PGT testing are included in the specific sections of the PGT-A/SR paper. Witnessing is recommended during the following stages: (i) immediately after biopsy to confirm the embryo and sample number match; (ii) during spreading or tubing, to confirm that the sample identification matches the labelling on the relevant slide or tube, respectively; (iii) in case of cryopreservation, immediately after biopsy before acquiring the genetic analysis results, at placing and labelling the embryo into the cryopreservation device; (iv) for further embryo culture, at placing and labelling the embryo into the culture dish; (v) when diagnostic results are issued to ensure accuracy and correlation with the correct sample identification; (vi) during the thawing/warming procedure to ensure accuracy and correlation with the correct embryo diagnostic result; and (vii) at the time of selecting the embryo(s) for embryo transfer.