Despite Costing Millions of Won, Evidence for Improved Birth Rates Is Limited International Societies Also Advise: “Should Not Be Recommended to All Patients”
Among infertile couples preparing for In Vitro Fertilization (IVF), PGT-A (Preimplantation Genetic Testing for Aneuploidy) has effectively become a ‘mandatory course.’
Clinics often explain that “transferring a genetically normal embryo increases pregnancy success rates,” and anxiety spreads through online communities with questions like, “Doesn’t the probability of success drop if I don’t do PGT-A?” Although the test costs several million won extra, many couples choose it without hesitation. However, in the global reproductive medicine community, a fundamental question is being raised: “Is this test really necessary for every patient?”
What Is PGT-A?
PGT-A is a technology where a few cells are biopsied from a blastocyst-stage embryo to check for chromosomal abnormalities, allowing for the prioritized transfer of embryos deemed ‘normal’ (euploid). With the expectation that it reduces the risk of miscarriage and shortens the time to pregnancy, its implementation has increased globally, and it has spread rapidly in Korea, centered around large fertility centers. However, PGT-A is a non-covered service not subject to health insurance. Including the biopsy and genetic analysis costs, it adds millions of won to each cycle—a significant financial burden for couples already struggling with the costs of IVF.
The Question of Evidence: Is It Effective for Everyone?
The problem is whether the effectiveness has been proven for all patients to justify these costs. The American Society for Reproductive Medicine (ASRM) stated in its latest 2024 recommendations that there is insufficient evidence to implement PGT-A uniformly for all IVF patients. Recent comprehensive analyses of randomized clinical trials suggest a lack of evidence that PGT-A significantly increases final live birth rates for young women, first-time IVF patients, or patients with a good prognosis. The European Society of Human Reproduction and Embryology (ESHRE) also maintains the position that while it may be helpful for specific patient groups, it is not a test to be recommended to every patient.
Why Did PGT-A Spread So Quickly?
The medical community analyzes that the message, “Success rates increase if you select a normal embryo,” has been strongly delivered to patients alongside technological advancements. Many patients choose the test after hearing phrases like “latest technology,” “improved success rates,” and “miscarriage prevention.”
However, experts emphasize that PGT-A is not a technology that improves embryo quality; it is merely a selection tool to decide which embryo to transfer first. It is a classification tool, not a process that creates a normal embryo where none existed.
The Challenge of ‘Mosaic Embryos’
Recent academic caution is also fueled by the issue of ‘mosaic embryos’—embryos where some cells are normal and some carry chromosomal abnormalities. While most were previously discarded, cases of healthy children born from transferred mosaic embryos have been reported steadily over the last decade. Consequently, the ASRM now recommends that transfer of some mosaic embryos can be considered after sufficient counseling. The confirmation that embryos once destined for the trash can lead to healthy births has heightened voices claiming that PGT-A results should not be accepted as an absolute standard.
Concerns About Over-application
Some senior reproductive medicine specialists in Korea with over 30 years of experience express concern about the reckless expansion of PGT-A. They point out, “For patients with diminished ovarian reserve who obtain only a few embryos, applying PGT-A uniformly makes finding a transferable embryo nearly impossible. We cannot entirely rule out the possibility that embryos classified as ‘abnormal’ and denied a transfer chance actually had the potential for successful implantation and a healthy birth.”
They emphasize, “PGT-A is an important technology that clearly helps specific patient groups, but it is not a panacea that should be recommended to all infertility patients. Customized application that comprehensively considers the patient’s age, ovarian function, history of recurrent miscarriage, and embryo count is paramount.”
Technical Limitations
This controversy is also linked to the testing method itself. PGT-A does not examine the entire embryo but analyzes only 5–10 cells from the trophoblast (the outer layer). It does not touch the inner cell mass that actually becomes the fetus. Therefore, there is always a possibility that the biopsied cells do not perfectly represent the state of the entire embryo. This is why it is difficult to assert that the test results and the actual developmental potential of the embryo always coincide.
For patients with a low number of embryos, this can actually work to their disadvantage. If all 2 or 3 hard-won embryos are classified as ‘abnormal,’ the patient may be forced to give up on the transfer entirely.
Conclusion: “Is It Essential for This Patient?”
Of course, PGT-A is not a useless test. Studies show it can be clearly beneficial for elderly women, patients with recurrent miscarriages, cases where parents have structural chromosomal abnormalities, or when one must prioritize the best among many embryos. In fact, reduced miscarriage rates and fewer required transfers have been reported in some patients over 38. The problem is the reality of it being recommended by custom, regardless of these indications.
The ultimate goal of infertility treatment is not to secure many ‘normal embryos’ but to safely give birth to a healthy child. Therefore, the common view of the international community is that PGT-A should not be selected simply because it is ‘latest technology,’ but decided upon after comprehensively considering age, miscarriage history, embryo count, and the risk of chromosomal abnormalities.
PGT-A is certainly an important technology born of modern reproductive medicine. However, good technology does not mean it is a good test for every patient. The most important thing in infertility treatment is not performing many tests, but performing the right test on the patient who truly needs it. The real question surrounding PGT-A should not be “Is it the latest test?” but “Is it absolutely necessary for this patient?”
※ This article was synthesized based on the 2024 ASRM PGT-A recommendations, ESHRE guidelines, and clinical studies published in recent international journals. It does not replace a specific individual’s diagnosis or treatment, and actual medical judgment must be made through consultation with a specialist.
※ Images: Created using generative AI (ChatGPT, OpenAI); depicts fictional individuals, not real people.