Patient attitude to preimplantation genetic diagnosis and counseling issues

Background: During the last half of the twentieth century, there were a series of advancements in reproductive medicine and genetic testing. Preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS) are the two main methods of preconception genetic testing. The purpose of this article is to present the existing literature regarding the patients’ attitudes towards PGD and to stress the important of genetic and infertility counseling. Methods: The literature concerning the patients’ attitudes towards PGD was reviewed. Relevant studies were identified by searching the following databases: the Cochrane Library, Medline, Embase and PubMed. Results: The patients ‘attitudes towards PGD have been examined in a series of studies. In general the studies that have examined the acceptability of PGD have shown two main points. First, there is overall high general approval of PGD by couples at high risk and of PGS by infertile couples. Second, infertile patients have low concern about the extension of the technology to testing for non-health-related traits like social sexing. It has been also argued that Muslims might reject prenatal diagnosis and termination of pregnancy because of religious reasons. Preimplantation diagnosis may be preferable to prenatal diagnosis for Muslim parents. Conclusion: This review shows that there is a general high approval of PGD by couples at high risk and low concern about the extension of the technology to testing for non-health-related traits. However, there is big debate on the advantages and disadvantages of PGS/PGS in IVF and the international use of PGD varies from explicit legislation with or without restriction to a ‘professional guideline’ approach to legal prohibition through restrictive laws. Therefore, all couples who consider PGD or PGS should first receive genetic and infertility counseling in order to have realistic expectations, understand the advantages and disadvantages, and consider the limitations and the risks of each technique. Countries which offer PGD should also provide training in genetic counseling and/or in reproductive genetic counseling.