Rethinking PGT-A: What Patients Should Know

Preimplantation genetic testing (PGT-A) was introduced as a promising approach to improve in vitro fertilization (IVF) outcomes by identifying embryos with the correct number of chromosomes before transfer. However, early randomized controlled trials conducted in Belgium found no significant improvement in pregnancy rates or overall IVF success. Subsequent analyses and a Dutch study published in The New England Journal of Medicine further raised questions about the clinical benefits of embryo testing, particularly among older patients with infertility. These findings prompted continued investigation into the effectiveness of PGT-A and its role in optimizing IVF outcomes. 

Despite the evidence, PGT-A remains widely used across fertility treatments. The American Society for Reproductive Medicine's (ASRM) 2024 committee opinion concluded that routine PGT-A has not been shown to improve pregnancy rates, miscarriage rates, or time to pregnancy in the general infertility population. While the test provides information about an embryo's chromosomes, that information does not necessarily translate into a greater likelihood of having a baby.  

Dr. Gleicher suggests that PGT-A remains popular because its underlying concept seems logical, despite limited clinical evidence supporting its benefits. He also highlights concerns regarding the costs of embryo biopsy and laboratory testing, along with variations in testing techniques and result of interpretation across laboratories. These considerations emphasize the need to provide patients with clear and evidence-based information about the potential advantages and limitations of embryo testing. 

At the Center for Human Reproduction, Dr. Gleicher and his colleagues have questioned the routine use of PGT-A for nearly two decades. Based on the available evidence, the CHR generally does not recommend routine PGT-A, apart from selected exceptions. Our approach emphasizes evaluating fertility treatments based on demonstrated clinical benefits rather than assuming that additional testing will necessarily improve outcomes. 

For patients considering IVF, understanding the evidence behind recommended procedures is essential. Discussing the potential benefits, limitations, costs, and alternatives with a fertility specialist can help patients make informed decisions based on their individual circumstances. 

Want to learn more about the evidence behind PGT-A? Listen to the latest episode of The Egg Factor featuring Dr. Norbert Gleicher here.