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The uncertain science of preimplantation genetic testing in Japan

Nature Medicine volume 28, pages 1732–1733 (2022)Cite this article

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To the Editor — We agree with the comment by Gleicher et al.1 about the uncertain science of preimplantation genetic testing (PGT). Japan is unique in its approach to reproductive medicine in that it does not have laws regulating such testing, and instead physicians are self-regulated according to principles formulated by the Japan Society of Obstetrics and Gynecology (JSOG). Patient groups for neuromuscular diseases, Down’s syndrome and other disorders have been against the use of preimplantation genetic testing for monogenic defects (PGT-M). The JSOG made a rule in 1998 that each proposed instance of such testing must be submitted to and reviewed by committee. On the basis of the review, only patients with extremely severe genetic disease and recurrent pregnancy loss caused by translocation have been permitted to use PGT in Japan.

Much of the media was critical of PGT-M when it was implemented in two patients in Japan in 2004, and the issue was given front-page coverage in national newspapers during consideration by the JSOG. The JSOG invited major media outlets, as well as groups for patients with disabilities, to attend public ethics committee meetings organized by JSOG. Some patients with neuromuscular disease asked if they shouldn’t have been born, given their disability, and criticized the use of PGT-M. In response to their concerns, a patient of ours with an inherited disorder and a history of stillbirth caused by the disease and who had applied for PGT-M said, “I’m not going to discriminate against people with disabilities. I want my child to live longer than me. That’s it.” Upon hearing this, it was our impression that the negative views of the ethics committee toward PGT-M disappeared. PGT-M was approved for two patients. PGT for structural rearrangement (PGT-SR) for recurrent pregnancy loss was subsequently permitted in 2006, while PGT for aneuploidy (PGT-A) remained prohibited. From January 1999 to March 2016, 125 out of 138 patients of PGT-M and 359 out of 411 of PGT-SR were approved, and 17 and 84, respectively, resulted in live births2.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan

    Mayumi Sugiura-Ogasawara & Takeshi Sato

  2. Research Center for Recurrent Pregnancy Loss, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan

    Mayumi Sugiura-Ogasawara & Takeshi Sato

Authors
  1. Mayumi Sugiura-Ogasawara
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  2. Takeshi Sato
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M.S.-O. generated the concept and wrote the initial draft, T.S. edited the manuscript and commented on the draft and both authors approved the final version.

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Correspondence to Mayumi Sugiura-Ogasawara.

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Sugiura-Ogasawara, M., Sato, T. The uncertain science of preimplantation genetic testing in Japan. Nat Med 28, 1732–1733 (2022). https://doi.org/10.1038/s41591-022-01920-1

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