Decision-making criteria in polygenic embryo screening: A survey of reproductive medicine physicians.

Abstract

Polygenic embryo screening (PES) examines embryos for their genetic likelihood of developing complex conditions and traits. The commercialization of PES places reproductive endocrinologists and infertility specialists (REIs) as the primary decision-makers in its use, despite professional guidelines cautioning that PES is not ready for clinical use. This survey examines how 152 US REIs perceive and approach potential clinical decision-making scenarios regarding the use of PES. REIs were more likely to offer PES for medical conditions (up to 62% for cancer) than for traits (eg, 0% for skin color, 10% for body mass index). When evaluating 11 potential criteria to assess condition severity, clinical burden (eg, high mortality [80%]) was rated significantly higher than contextual burden (eg, low lifestyle modifiability [28%]); however, 82% to 93% of respondents considered each criterion at least slightly important. In hypothetical scenarios where PES rankings conflicted with embryo ploidy or morphology, only 8% preferred PES over ploidy, and 30% preferred PES over morphology. Still, 47% supported patient choice in morphology-based cases, and 30% supported patient choice in ploidy-based cases. These findings indicate skepticism toward PES, while underscoring the nuanced, context-dependent factors that influence its potential use.