Under the revised Federal Act on Medically Assisted Reproduction (RMA), embryos created by in vitro fertilisation can now undergo preimplantation genetic testing (PGT) in Switzerland. The performance of PGT raises practical and ethical questions. Medical-ethical recommendations on PGT were issued by the SAMS in 2020.
The fear of passing on a serious disease to a child places a considerable burden on the couples concerned. Under the revised Reproductive Medicine Act and the associated Ordinance, preimplantation genetic testing (PGT) has been permissible in Switzerland, under certain conditions, since 1 September 2017. PGT makes it possible to analyse embryos before they are transferred to the uterus, and to select an embryo which does not have a genetic predisposition to a specific disease. However, PGT can only be performed if the legally specified indications are present. These include the requirement that the hereditary disease must meet certain criteria and be sufficiently serious.
Under the legislation, PGT may also be employed in connection with infertility treatment. Here, the aim is not to prevent the transmission of a hereditary disease, but to screen embryos created by IVF for impaired developmental capacity. Counselling couples and deciding whether PGT can and should be performed in a particular case involves delicate ethical questions and requires a careful assessment.
In the SAMS recommendations, both of these areas are covered – establishment of the indication for PGT for couples with hereditary diseases and the screening of embryos as part of infertility treatment. Other key topics include the management of surplus information, such as the sex of the embryo or health-related abnormalities which do not meet the legally specified criteria for indication of PGT.
The recommendations discuss, from an ethical perspective, important aspects of the PGT counselling and decision-making situation, with the aim of contributing to the harmonisation of Good Clinical Practice at all fertility centres in Switzerland. The SAMS recommendations are endorsed by the Swiss Societies of Reproductive Medicine (SGRM), Obstetrics and Gynecology (SGGG), and Medical Genetics (SGMG).
In June 2022, the National Advisory Commission on Biomedical Ethics (NCE) published guidelines that specify the legal framework for PGT (in French). The NCE refers in part to the recommendations of the SAMS, but comes to different conclusions on a few points, particularly with regard to the management of surplus information. The SAMS, on the other hand, adheres to its medical-ethical recommendations of 2020: no new knowledge has been acquired that could lead to different conclusions in the ethical weighing of interests.