Uncertainties, risks, or hope? Managing embryos in a multidisciplinary team of PGT

Preimplantation genetic testing (PGT) is a genetic testing method used in assisted reproduction to select embryos without apparent genetic anomalies for transfer into the uterus. However, PGT often involves uncertainties, such as the identification of genetic variants of uncertain significance (VUS) in embryos, which complicates clinical management and embryo selection. Based on an ethnographic study conducted from 2021 to 2024 at a fertility center in Shanghai, China, including observations and interviews with 11 PGT professionals and five couples, we examined how a multidisciplinary PGT team manages embryos with such genetic uncertainties. We observed that professionals in the team embody one or more epistemic cultures of certain disciplines. In addition to the epistemic strategies of certain disciplines, their epistemic culture(s) are influenced by various local factors, such as institutional, social, cultural, political, and emotional influences. Close collaboration across multiple epistemic cultures may lead to conflicts when facing challenges such as genetic uncertainties, contributing to clinical uncertainties and influencing both the strategies for reporting genetic uncertainties and the information ultimately provided to patients. Compared to a macrolevel, collective understanding of epistemic cultures, we focused on the microlevel collaborations and conflicts between epistemic cultures in the context of PGT in Shanghai. We argue that PGT fosters interdisciplinary collaboration; in a context where disciplines such as genetics, embryology, and reproductive medicine are highly interdependent, opening epistemic boundaries can help establish a new foundation for collaboration.