title: Dynamics and ethics of comprehensive preimplantation genetic testing: a review of the challenges.
abstract: BACKGROUND
  Genetic testing of preimplantation embryos has been used for preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS). Microarray technology is being introduced in both these contexts, and whole genome sequencing of blastomeres is also expeted to become possible soon. The amount of extra information such tests will yield may prove to be beneficial for embryo selection, will also raise various ethical issues. We present an overview of the developments and an agenda-setting exploration of the ethical issues.
  
  
  METHODS
  The paper is a joint endeavour by the presenters at an explorative 'campus meeting' organized by the European Society of Human Reproduction and Embryology in cooperation with the department of Health, Ethics & Society of the Maastricht University (The Netherlands).
  
  
  RESULTS
  The increasing amount and detail of information that new screening techniques such as microarrays and whole genome sequencing offer does not automatically coincide with an increasing understanding of the prospects of an embryo. From a technical point of view, the future of comprehensive embryo testing may go together with developments in preconception carrier screening. From an ethical point of view, the increasing complexity and amount of information yielded by comprehensive testing techniques will lead to challenges to the principle of reproductive autonomy and the right of the child to an open future, and may imply a possible larger responsibility of the clinician towards the welfare of the future child. Combinations of preconception carrier testing and embryo testing may solve some of these ethical questions but could introduce others.
  
  
  CONCLUSIONS
  As comprehensive testing techniques are entering the IVF clinic, there is a need for a thorough rethinking of traditional ethical paradigms regarding medically assisted reproduction.
authors: Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 Maastricht, The Netherlands. k.hens@maastrichtuniversity.nl
authors: Kristien
authors: K
authors: Hens
authors: Wybo
authors: W
authors: Dondorp
authors: Alan H
authors: AH
authors: Handyside
authors: Joyce
authors: J
authors: Harper
authors: Ainsley J
authors: AJ
authors: Newson
authors: Guido
authors: G
authors: Pennings
authors: Christoph
authors: C
authors: Rehmann-Sutter
authors: Guido
authors: G
authors: de Wert
mesh_terms: D001755:Blastocyst; D001757:Blastomeres; D002970:Cleavage Stage, Ovum; D005260:Female; D005307:Fertilization in Vitro / Q000941:ethics; D006801:Humans; D008297:Male; D009426:Netherlands; D020411:Oligonucleotide Array Sequence Analysis; D019836:Preimplantation Diagnosis / Q000941:ethics* / Q000379:methods / Q000639:trends
keywords: comprehensive screening; embryos; ethics; microarrays; preimplantation genetic diagnosis; preimplantation genetic screening; whole genome sequencing