A Note on PGT-A Genetic Screening: When Does It Help, When Is It Marketed?

Key Takeaways

PGT-A is not a magic filter for every couple. In young patients with good ovarian reserve, routine PGT-A does not increase live birth rates and may result in discarding viable embryos.

Key evidence: STAR Trial — Munné et al. Fert Steril 2019 (PMID 31551155) · Cochrane Systematic Review — PGT-A for IVF (2020) · ASRM Practice Committee Opinion on PGT-A (2024)

In over 30 years of clinical practice in reproductive medicine, I have witnessed multiple technological innovations presented as “universal filters.” While advanced technologies offer remarkable possibilities, marketing narratives often confuse a diagnostic tool with a guaranteed outcome.

On this page

• First the Patient — Then the Glossy Brochures
• The Desire for Perfection vs. Clinical Evidence
• Trophectoderm Biopsies and the Mosaic Embryo Reality
• When Can PGT-A Be Considered?
• Conclusion

First the Patient — Then the Glossy Brochures

Couples sometimes arrive in my consultation room holding a glossy brochure from another clinic and ask, with genuine hope, whether all their embryos should be genetically tested, because the brochure promises to select the healthiest baby and remove the risk.

Many of these couples are on a first IVF attempt, with good ovarian reserve and normal sperm parameters. The brochure promises certainty. Yet in biology and good medical practice, absolute certainty does not exist.

For couples in this situation, my explanation is that routine PGT-A is not expected to increase their cumulative chance of a live birth, and that it carries the risk of discarding viable embryos labelled ‘suspicious’ or ‘mosaic’.

This article summarises the reasoning I share with patients in those conversations.

The Desire for Perfection vs. Clinical Evidence

Modern society naturally seeks control, efficiency, and perfection. In reproductive medicine, this manifests as a desire to use technology as an absolute screening tool to guarantee a flawless outcome.

However, three decades in fertility care have taught me a fundamental lesson: Hypothesis is one thing; clinical evidence is another.

What Does the Scientific Evidence Show?

1. STAR Trial (Munné et al., 2019): In a large multicenter randomized clinical trial involving good-prognosis IVF patients aged 25–40 (mean age 33.7), routine PGT-A showed no significant difference in ongoing pregnancy rates compared to standard morphological embryo selection (41.8% vs. 43.5%).
2. Cochrane Systematic Review (Cornelisse et al., 2020): Synthesizing data from 13 randomized trials and nearly 2,800 women, Cochrane concluded that evidence is insufficient to show that PGT-A improves cumulative live birth rates.
3. ASRM Practice Committee Opinion (ASRM, 2024): The American Society for Reproductive Medicine states that the value of PGT-A as a routine screening test for all IVF patients has not been demonstrated.

Trophectoderm Biopsies and the Mosaic Embryo Reality

PGT-A analyzes a few cells taken from the outer trophectoderm layer of a blastocyst (which forms the placenta), not the inner cell mass (which forms the baby).

The embryo is a dynamic, self-correcting organism.

• Mosaic Embryos: Even if some cells in the outer layer show chromosomal variation, the inner cells can be entirely normal.
• Greco et al. (NEJM, 2015): Clinical transfers of embryos reported as “mosaic” have resulted in completely healthy, normal live births.

Discarding every embryo labelled mosaic can therefore mean losing embryos that could have become healthy babies.

When Can PGT-A Be Considered?

I am not opposed to PGT-A; I am opposed to marketing it as a routine add-on for everyone. Its role depends on the clinical situation:

• Advanced maternal age: PGT-A may be more meaningful at an older age, especially in selected patients from whom enough embryos can be obtained. ASRM notes that it may have a beneficial role in advanced maternal age, especially in women with good ovarian reserve (ASRM, 2024). Implantation per transfer may be higher and miscarriage lower, but it is not certain that it increases the cumulative live birth rate for every older patient.
• Recurrent pregnancy loss: PGT-A has not been shown to significantly reduce miscarriage or increase live births compared with expectant management (ASRM, 2026). In women over 40 with a proven aneuploid miscarriage, it can be discussed through shared decision-making to reduce the risk of another loss caused by aneuploidy.
• Known parental chromosomal rearrangements or single-gene conditions: these call for targeted testing (PGT-SR for structural rearrangements, PGT-M for monogenic conditions) rather than PGT-A.

For a 32-year-old woman in her first IVF cycle, routine PGT-A narrows the embryo pool, adds significant financial cost, and introduces unnecessary anxiety.

Conclusion

Medicine should provide honest clarity, not commercial illusions. PGT-A is a vital diagnostic tool for the right patient; for the wrong patient, it is an expensive source of distress.

In my practice, I evaluate every case based on individual biology, medical history, and clinical evidence — not marketing brochures.

Sources

• Munné S, Kaplan B, Frattarelli JL, et al. Preimplantation genetic testing for aneuploidy versus morphology as selection criteria for single frozen-thawed embryo transfer in good-prognosis patients: a multicenter randomized clinical trial (STAR). Fertility and Sterility. 2019;112(6):1071-1079.
• Cornelisse S, Zagers M, Kostova E, et al. Preimplantation genetic testing for aneuploidies (abnormal number of chromosomes) in in vitro fertilisation. Cochrane Database of Systematic Reviews. 2020;9(9):CD005291.
• ASRM Practice Committee. The use of preimplantation genetic testing for aneuploidy: a committee opinion. Fertility and Sterility. 2024;122(3):421-434. doi:10.1016/j.fertnstert.2024.04.013
• ASRM Practice Committee. Recurrent pregnancy loss: a committee opinion. Fertility and Sterility. 2026;125(6):1023-1041. doi:10.1016/j.fertnstert.2026.03.001
• Greco E, Minasi MG, Fiorentino F. Healthy babies after intrauterine transfer of mosaic aneuploid blastocysts. New England Journal of Medicine. 2015;373(21):2089-2090.

Dr. Senai Aksoy

Dr. Senai Aksoy studied and trained in France before returning to Turkey, where he was a member of the ICSI team at Sevgi Hospital, Ankara — the country's first ICSI centre (1994-95) — and a co-author on the first Turkish ICSI publications produced in collaboration with the Brussels Van Steirteghem group (Human Reproduction, 1996; PMID 8671323). He helped build the IVF programme at the American Hospital Istanbul and has been running his own fertility practice since 1998.

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The content has been created by Dr. Senai Aksoy and medically approved.