Evaluating risk, safety and efficacy of novel reproductive techniques and therapies through the EuroGTP II risk assessment tool

Esteve Trias, Martine Nijs, Ioana Adina Rugescu, Francesco Lombardo, Gueorgui Nikolov, Veerle Provoost, Annelies Tolpe, Nathalie Vermeulen, Zdravka Veleva, Rita Piteira, Ricardo Casaroli-Marano, Kelly Tilleman, EuroGTP II Study Group, Anna Vilarrodona, A. Rita Piteira, Elba Agustí, Elisabet Tahull, Esteve Trias, Eva Maria Martinez, Ivan MirandaJaime Tabera, Maria Luisa Perez, Marta Torrabadella, Nausica Otero, Oscar Fariñas, Patricia López-Chicón, Sergi Querol, Ricardo Casaroli, Akila Chandrasekar, Kyle Bennett, Paul Rooney, Richard Lomas, Mar Carmona, Esteban Molano, Myriam Ormeño, Branka Golubic Ćepulic, Ivan Rozman, Marijana Dragovic, Cristina Pintus, Eliana Porta, Fiorenza Bariani, Letizia Lombardini, Liliam Santilli, Mariapia Mariani, Paola Di Ciaccio, Silvia Pisanu, Artur Kaminski, Tiia Tallinen, Hanna Kankkonen, Toni-Karri Pakarinen, Stefano Ferrari

    Research output: Contribution to journalArticleScientificpeer-review

    3 Citations (Scopus)

    Abstract

    STUDY QUESTION: Can risks associated with novelties in assisted reproduction technologies (ARTs) be assessed in a systematic and structured way? SUMMARY ANSWER: An ART-specific risk assessment tool has been developed to assess the risks associated with the development of novelties in ART (EuroGTP II-ART). WHAT IS KNOWN ALREADY: How to implement new technologies in ART is well-described in the literature. The successive steps should include testing in animal models, executing pre-clinical studies using supernumerary gametes or embryos, prospective clinical trials and finally, short- and long-term follow-up studies on the health of the offspring. A framework categorizing treatments from experimental through innovative to established according to the extent of the studies conducted has been devised. However, a systematic and standardized methodology to facilitate risk evaluation before innovations are performed in a clinical setting is lacking. STUDY DESIGN, SIZE, DURATION: The EuroGTP II-ART risk assessment tool was developed on the basis of a generic risk assessment algorithm developed for tissue and cell therapies and products (TCTPs) in the context of the project 'Good Practices for demonstrating safety and quality through recipient follow-up European Good Tissue and cells Practices II (EuroGTP II)'. For this purpose, a series of four meetings was held in which eight ART experts participated. In addition, several tests and simulations were undertaken to fine-tune the final tool. PARTICIPANTS/MATERIALS, SETTING, METHODS: The three steps comprising the EuroGTP II methodology were evaluated against its usefulness and applicability in ART. Ways to improve and adapt the methodology into ART risk assessment were agreed and implemented. MAIN RESULTS AND THE ROLE OF CHANCE: Assessment of the novelty (Step 1), consisting of seven questions, is the same as for other TCTPs. Practical examples were included for better understanding. Identification of potential risks and consequences (Step 2), consisting of a series of risks and risk consequences to consider during risk assessment, was adapted from the generic methodology, adding more potential risks for processes involving gonadic tissues. The algorithm to score risks was also adapted, giving a specific range of highest possible risk scores. A list of strategies for risk reduction and definition of extended studies required to ensure effectiveness and safety (Step 3) was also produced by the ART experts, based on generic EuroGTP II methodology. Several explanations and examples were provided for each of the steps for better understanding within this field. LIMITATIONS, REASONS FOR CAUTION: A multidisciplinary team is needed to perform risk assessment, to interpret results and to determine risk mitigation strategies and/or next steps required to ensure the safety in the clinical use of novelties. WIDER IMPLICATIONS OF THE FINDINGS: This is a dynamic tool whose value goes beyond assessment of risk before implementing a novel ART in clinical practice, to re-evaluate risks based on information collected during the process.

    Original languageEnglish
    Pages (from-to)1821-1838
    Number of pages18
    JournalHUMAN REPRODUCTION
    Volume35
    Issue number8
    DOIs
    Publication statusPublished - 2020
    Publication typeA1 Journal article-refereed

    Keywords

    • Assisted reproduction technologies
    • Efficacy
    • Embryo
    • Gamete
    • Novel techniques
    • Quality management
    • Reproductive tissue
    • Risk analysis
    • Safety
    • Validation

    Publication forum classification

    • Publication forum level 2

    ASJC Scopus subject areas

    • Reproductive Medicine
    • Obstetrics and Gynaecology

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