Evaluating risk, safety and efficacy of novel reproductive techniques and therapies through the EuroGTP II risk assessment tool
Authors: Trias Esteve , Nijs Martine , Rugescu Ioana Adina , Lombardo Francesco , Nikolov Gueorgui , Provoost Veerle , Tolpe Annelies , Vermeulen Nathalie , Veleva Zdravka , Piteira Rita , Casaroli-Marano Ricardo , Tilleman Kelly ,   EuroGTP II Study Group, Vilarrodona Anna , Rita Piteira A , Agustí Elba , Tahull Elisabet , Trias Esteve , Martinez Eva Maria , Miranda Ivan , Tabera Jaime , Perez Maria Luisa , Torrabadella Marta , Otero Nausica , Fariñas Oscar , López-Chicón Patricia , Querol Sergi , Casaroli Ricardo , Chandrasekar Akila , Bennett Kyle , Rooney Paul , Lomas Richard , Carmona Mar , Molano Esteban , Ormeño Myriam , Ćepulić Branka Golubić , Rozman Ivan , Dragović Marijana , Pintus Cristina , Porta Eliana , Bariani Fiorenza , Lombardini Letizia , Santilli Liliam , Mariani Mariapia , Di Ciaccio Paola , Pisanu Silvia , Kamiński Artur , Uhrynowska-Tyszkiewicz Izabela , Olender Ewa , van Walraven Anne Marie , Bokhorst Arlinke , van Veen Ingrid , Tilleman Kelly , Annelies Tolpe , Provoost Veerle , Nuytinck Lieve , Simeonova Maryana , Staneva-Petkova Daniela , Tzoneva Dessislava , kircheva-Nikolova Tsvetelina , Marinkova Violetta , Georgiev Valery , Peev Yoran , Manova Elizabeth , Surján Cecilia , Belicza Éva , Szarvas Gábor , Lám Judit , Bencze László , Börgel Martin , Derks Mareike , Schwarz Sibylla , Jashari Ramadan , Noumanje Richard N , Rodriguez Rosario Daiz , Tallinen Tiia , Kankkonen Hanna , Pakarinen Toni-Karri , Verbeken Gilbert , Pirnay Jean-Paul , Rose Thomas , Draye Jean-Pierre , Hennerbichler Simone , Davies Jill , Ibañez Jacinto , Magli Cristina , Vermeulen Nathalie , Boada Monserrat , McGrath Eoin , Armitage John , Jones Gary , Fraga Marta , Roldao Dulce , Oliveira Josefina , Paolin Adolfo , Trojan Diletta , Montagner Giulia , Ponzin Diego , Ferrari Stefano , Lombardo Francesco , Voermans Carlijn , Richters Nelleke , Rugescu Ioana Adina , Azzena Gianpaolo , Fabozzo Assunta , Schoenmans Helene , Pomar Jose Luis , Gelber Pablo , Rajczy Katalin , Calmels Boris , Mielke Stephan , Netelenbos Tanja , Ragazzo Mirko , Nikolov Gueorgui , Marton Elisabetta , Nijs Martine , Franch Antonella , Piovan Gianluca , Dell’Antonia Francesco , Snow Martyn , Bojanic Ines , Veleva Zdravka , Basak Grezgorz , Amil Margarida , Shaw Sandra , Navarro Aurora , Spalding Tim , Verdonk Peter 
Published: May 2020

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.

STUDY FUNDING / COMPETING INTEREST(S)

This study was called EUROGTP II and was funded by the European Commission (Grant agreement number 709567). The authors declare no competing interests concerning the results of this study.