Background: Small supernumerary marker chromosomes (sSMC) are structurally abnormal chromosomes, and their characterization exclusively by banding cytogenetics is almost impossible. Multicolor fluorescence in situ hybridization approaches for their characterization are effective but expensive and time-consuming. Recently, the application of molecular karyotyping has resulted in improving the characterization of sSMC. Methods: Molecular karyotyping was used for the identification of a sSMC in this study. Results: In this case report, a fetus with a SMC derived from chromosome 11 is described. Conclusions: Molecular karyotyping is suited for sSMC characterization of prenatal cases. The obtained molecular data can directly be used to compare the actual case with data from the literature available on http://ssmc-tl.com/sSMC.html.

Background: Phelan-McDermid syndrome (PMS), or 22q13.3 deletion syndrome, is a neurodevelopmental disorder with an estimated prevalence of 1 in 10,000 to 20,000 newborns. It usually occurs de novo, but an unexpectedly high recurrence risk is observed in some families. Our aim is to provide an overview of the underlying causes of recurrence in families with PMS and to summarize the available detection methods used to assess increased recurrence risk. Methods: We report clinical and (cyto)genetic data for five families with a high recurrence risk for PMS and provide an overview of Dutch families and cases from literature. We also outline a comprehensive work-up of additional cytogenetic testing to follow initial diagnosis in a proband. Results: Using fluorescent in situ hybridization (FISH), we confirmed a paternal translocation in two and a maternal mosaicism in three of our reported families. Of 34 cytogenetically investigated Dutch families, 16 to 20% have a high recurrence risk based on a parental chromosomal rearrangement. We found 18 additional families in the literature. Conclusions: Parental translocations and mosaicisms are not rare events in families with PMS, making follow-up FISH testing necessary. However, existing methods may still miss low-grade parental mosaicisms, and prenatal testing should always be offered.

Women’s reproductive autonomy, and its translation into informed free choice regarding prenatal testing, is a dominant concept in the bioethical discourse concerning prenatal testing. This discourse is based on the premise that access to information regarding the pregnancy promotes autonomous decision-making. However, studies show that the offer of prenatal screening as a routine part of pregnancy care is not supported, to a large degree, by appropriate informed consent mechanisms. This means that the implementation of the concept of autonomy ought to be reconsidered. On the backdrop of these challenges, the introduction of Non-Invasive Prenatal Testing (NIPT) may present new challenges. The main advantages of NIPT, compared with earlier technologies, (namely the early availability of results, the non-invasive and risk-free nature of the test, as well as its increased accuracy) may exacerbate threats to women’s autonomy. Four of the most likely future uses of NIPT – first-tier screening, diagnosis, expanded targeted use, and whole-genome sequencing – will continue to challenge patients’ autonomy. To shed light on these developments, this paper presents some longstanding ethical concerns regarding prenatal screening, examines what makes NIPT different from earlier screening technologies, and charts the possible future courses of NIPT, while anticipating the ethical and social implications of the various signposts potentially encountered, particularly as they relate to reproductive autonomy.

The main aim of PGS has always been to improve IVF outcome, especially in patient groups assumed to have higher rates of chromosomally abnormal embryos, such as patients of advanced maternal age. In that sense, PGS is quite different from other types of screening as discussed in other papers in this issue. Today it bears no doubt that blastocysts found to be uniformly aneuploid in a biopsy will fail to implant, or worse, will implant and lead to a pregnancy and birth carrying a major chromosomal abnormality, such as trisomy 21. However, it has been argued that a cohort of embryos cannot be improved, and that PGS is only a selection method for which efficiency has not been proven. PGS would never increase the live birth rate for that given cohort. The current debate on whether PGS should be applied and to which patients it should be offered has shifted from the effect on live birth rates towards other outcomes such as the reduction of transfers and of miscarriages. Taking the undeniable higher cost of IVF into account when PGS is included, what is the benefit to the patient? The views on this question differ on whether PGS is an additional source of income for the IVF clinic and may or may not balance the extra cost for cryopreservation and embryo transfer for the patients, or whether society pays for IVF treatments and may decide not to want to invest in a medical act that does not improve the primary goal of IVF, i.e. having a healthy child. PGS is also often presented as diminishing patient anxiety and stress through decreasing unnecessary embryos transfers and miscarriages, although no data on this assertion are available. Whether this emotional argument will show to be strong enough to add PGS as a routine part of an IVF treatment remains to be seen.