Please read the following scientific journal article:
Should PGT-A be routinely utilized for advanced maternal age?
PGT-A is not a Must-Have for Older Women undergoing IVF
When a woman in her late 30s or 40s begins IVF, she is often handed a frightening set of statistics. With age, the chance of chromosome errors in eggs and embryos rises, which increases the risks of having a Down syndrome baby. Miscarriage becomes more likely. Time feels short. Against that anxiety, preimplantation genetic testing for aneuploidy—better known as PGT-A—can sound like the obvious next step.
The pitch is simple: test embryos before transfer, identify the “normal” one, avoid a failed attempt and reduce the risk of miscarriage. Who would not want that?
But medicine should not be governed by what sounds reassuring. The more important question is whether the test helps more people take home a baby after the whole IVF journey—not merely whether a selected embryo looks more promising in the laboratory.
That is the uncomfortable message of a recent commentary in the Journal of Assisted Reproduction and Genetics: advanced maternal age, by itself, is not enough reason to make PGT-A routine.
A test is not a treatment
PGT-A does not make an egg younger. It does not repair an embryo, improve ovarian reserve or create another blastocyst. It is a sorting tool. A few cells are removed from an embryo, tested for chromosome numbers and used to rank which embryos should be transferred first.
That distinction matters. If a patient has many embryos, sorting may be useful. If she has only one or two, the test may not give her more choices. It may instead determine whether a potentially viable embryo is transferred, delayed or discarded.
The strongest way to judge IVF is therefore “cumulative live birth”: the chance of having a baby after all usable embryos from an initiated retrieval have been considered. This measure includes embryos that stop developing, cycles in which no embryo reaches the testing stage, inconclusive results, repeated frozen transfers, miscarriages and embryos that are never labeled suitable for transfer.
A result reported only “per euploid embryo transferred” can look impressive because it removes the hardest cases from the calculation. It excludes patients who never produce a testable blastocyst or who have no embryo labeled euploid. Those patients still matter. They are part of the real-world treatment outcome.
The evidence is more modest than the marketing
The 2025 systematic review of IVF treatments for women of advanced maternal age examined 151 studies. Its conclusion was not that PGT-A is useless. It was that the available evidence does not show a consistent live-birth advantage over IVF without PGT-A when decisions are made at the level that matters to patients.
The review found seven randomized trials that reported live birth. The rate was about 27.5% with PGT-A and 27.2% without it. That is essentially the same result, with the usual statistical uncertainty around both figures. Some studies found fewer miscarriages or fewer embryo transfers with testing. Those may be meaningful benefits for particular patients. But fewer miscarriages do not automatically mean more babies overall.
A large randomized trial published in the New England Journal of Medicine makes the point clearly, even though it studied younger women with a good prognosis rather than older patients. Among 1,212 women who already had at least three good-quality blastocysts, cumulative live birth was 77.2% with PGT-A and 81.8% with conventional IVF. The PGT-A group had fewer pregnancy losses, but it did not have a higher chance of a live birth.
That trial cannot settle the question for women in their 40s. It does, however, expose a common error: treating a better first transfer, or a lower miscarriage rate, as proof that the overall IVF strategy is better.
The American Society for Reproductive Medicine’s 2024 committee opinion reaches a similarly cautious position. It says the value of PGT-A as a routine test for everyone undergoing IVF has not been demonstrated. It also says the technology may have a role for some older patients, especially those with good ovarian reserve. That is a very different message from “every woman above a certain age should have it.”
The embryo is more complicated than a label
There is another reason for caution. PGT-A usually tests roughly five to ten cells taken from the outer layer of a blastocyst. That layer mainly contributes to the placenta. The future fetus develops from a different group of cells inside the embryo.
In a uniformly normal or abnormal embryo, the sample may provide useful information. But embryos can contain a mixture of cells with different chromosome patterns. This is called mosaicism. A small sample can accurately describe the cells removed while failing to represent the embryo as a whole.
“Mosaic” is not a direct photograph of an entire embryo. It is an interpretation based on a biological sample and a laboratory threshold. The ASRM guidance on mosaic results emphasizes that results can be affected by true mosaicism, technical noise, contamination, amplification problems and differences between laboratories.
This does not mean every mosaic embryo should be transferred, or that all mosaic findings are equally reassuring. It means a binary “normal” or “abnormal” label can hide genuine uncertainty. A false reassuring result can lead to an affected pregnancy, which is why prenatal screening and, where appropriate, diagnostic testing remain important after IVF. A false abnormal result can remove the only embryo that might have led to a birth.
Older does not mean identical
The phrase “advanced maternal age” can make patients sound like one uniform group. They are not.
One woman may produce six blastocysts and have a strong preference to minimize the chance of transferring an embryo with a chromosome abnormality. Another may produce one blastocyst after a physically and financially demanding cycle. Their decisions should not be identical simply because they cross the same age threshold.
For the first patient, PGT-A might help prioritize transfers and reduce the chance of an aneuploid transfer. For the second, a test result could eliminate or delay the only available option. The fewer embryos there are to rank, the less room there is for the test to add value—and the greater the consequence of an uncertain result.
That is not an argument against offering PGT-A. It is an argument against using age as a shortcut for individualized care.
Fear is not informed consent
The emotional market around fertility treatment can make this distinction difficult. Older patients already face pressure about the “biological clock,” disability and the fear of making the wrong choice. When a commercial add-on is presented as the responsible way to protect a future child, declining it can feel like negligence.
But a relative-risk headline can mislead. Saying a risk is “ten times higher” may be mathematically accurate while concealing the absolute change. Patients deserve both numbers, plus a clear explanation of what PGT-A can and cannot do. The test cannot guarantee implantation, a live birth or a child without health problems.
It is also important not to confuse PGT-A with tests designed for a known inherited disease or a known chromosome rearrangement in a family. PGT-M and PGT-SR can be valuable for those specific situations. The debate over routine PGT-A should not erase the value of all embryo testing.
What should replace the age trigger?
Clinics should begin with a conversation, not an automatic add-on. Before testing, patients should be told how many embryos are likely to be available, the clinic’s rates of no-result and mosaic findings, its policy on storing or transferring embryos with uncertain results, the costs and delays involved, and the outcome that will be used to judge success.
Most importantly, “not testing” should be presented as a legitimate clinical choice—not as a failure of responsible parenthood.
PGT-A may be sensible for some older patients. It may reduce the likelihood of an aneuploid transfer and spare some people a miscarriage. But those benefits must be weighed against biopsy, freezing, cost, delay and the possibility of losing an embryo because a small sample was treated as a final verdict.
The right lesson is not that PGT-A never works. It is that reproductive medicine should stop confusing a plausible idea with a proven benefit. Advanced maternal age should prompt better counseling, clearer numbers and more respect for patient priorities. It should not, by itself, turn an uncertain test into a routine requirement.