Abstract

Preimplantation genetic testing for aneuploidy (PGT-A), single gene mutations (PGT-M) or structural rearrangements (SR) allows for the diagnosis of an abnormal embryo prior to embryo transfer and pregnancy. While it is not the expectation, there are instances in which prospective parents request to transfer an abnormal embryo. In the case of mosaic embryos, the embryo may implant and result in an abnormal fetus or may result in normal development. Such requests place physicians at odds with the individual or couple requesting the embryo transfer. ASRM guidelines acknowledge that arguments exist to support providers in their decision to either assist or decline transfers of abnormal embryos (Daar, J Law Biosci 5(2):219–261, 2018). Relevant ethical principles include reproductive autonomy, physician autonomy, professional conscience, nonmaleficence, procreative beneficence and child autonomy and welfare. While patients have autonomy to request transfer of aneuploidy or mosaic embryos after informed consent, physicians also have the professional autonomy to decline to proceed if they feel the outcome could result in serious disability or illness. Clinics should develop clear guidelines made available to patients and should require that genetic counselors and mental health providers are involved in the informed consent process.