A tale of two studies: now is no longer the best of times for preimplantation genetic testing for aneuploidy (PGT-A)

Preimplantation genetic testing for aneuploidy (PGT-A) does not create normal embryos, but selecting a viable embryo for a fresh transfer has the potential to deliver an extra effect for live birth from a stimulated cycle by evading the attrition associated with embryo cryopreservation. Improved genetic tests are now available for selecting viable embryos; however, current embryo cryopreservation techniques also have a superior survival rate, which means it is now possible to transfer most morphologically suitable embryos from a stimulated cycle one at a time. The cumulative live birth rate from a stimulated cycle is now unlikely to be superior compared with morphological assessment alone, with any benefit likely to be associated with a reduction in the risk of miscarriage and the time to pregnancy. This communication offers a perspective on the likely benefit and disbenefit of PGT-A based on the outcome of modern-day clinical studies. Caution should be advised regarding offering PGT-A to every woman. Quantifying the likely miscarriage benefit and live birth disbenefit for an appropriate patient group may help to better inform couples who might be considering adding aneuploidy screening to their treatment cycle.