An additive opinion to the committee opinion of ASRM and SART on the use of preimplantation genetic testing for aneuploidy (PGT-A).

After over 20 years of progressively increasing clinical utilization of PGT-A (and its precursors), the American Society for Reproductive Medicine (ASRM) and its daughter society, the Society for Assisted Reproduction (SART), for the first time published a committee opinion clearly acknowledging that "the value of PGT-A as a routine screening test for patients undergoing in vitro fertilization (IVF) has not been demonstrated." This statement is timely and welcome but requires some additions and raises some new questions, among those why, if PGT-A in a general population does not improve IVF cycle outcomes, the routine clinical utilization of PGT-A should continue.

Endometrial Receptivity Analysis (ERA) test: an unproven technology.

This article addresses the limitations of the endometrial receptivity array (ERA) methodology to increase implantation. Such limitations vary from the assumed inconsistency of the endometrial biopsy, the variable number of genes found to be dysregulated in endometrium samples without the embryonal-induced effect, the failure to account for the simultaneous serum progesterone level, and the expected low percentage of patients who may need this add-on procedure, to the difficulties in synchronising the endometrium with hormone replacements in successive cycles and the inherent perinatal risks associated with routine cryopreservation of embryos. Without a gold standard to compare, the claim that the window of implantation (WOI) might be off by ±12 h only requires a good argument for the advantage it provides to human procreation, knowing that embryos can linger for days before actual embedding starts and that the window is actually a few days.

Should we still offer elective freezing of all embryos in all IVF cycles?

Elective 'freeze all', also called 'freeze only', refers to an IVF cycle where all embryos are frozen for later embryo transfer in a non-stimulated cycle, with the promise of increased success rates and prevention of ovarian hyperstimulation syndrome (OHSS) in most patients. However, 'freeze all' is associated with significantly higher perinatal complications including eclampsia, preeclampsia, chronic hypertension and large-for-gestational-age infants, without the demonstrated advantages of providing better results, except for a decrease in the incidence of OHSS, which should matter to women with polycystic ovary syndrome (PCOS) and high responders to ovarian stimulation but not to all patients. 'Freeze all' is also suggested for all simulated IVF cycles, due to the alleged 'faulty endometrium' caused by ovarian stimulation.

Repeated implantation failure (RIF): an iatrogenic meaningless definition that generates unnecessary and costly use of add-on procedures.

This opinion paper addresses the literature regarding repeated implantation failure (RIF) in IVF embryo transfer programmes. We provide several lines of discussion as to why such diagnosis might be wrong, why it should not be a call for action or a reason to change the course of treatment, and how RIF biases the quality of the publications and leads to the use of unnecessary and costly adjuvant procedures beyond basic IVF. We argue that these costly add-on procedures are being offered to patients in this highly privatized sector to prevent them from quitting the programme and as a by-product to increase the clinic income.