PGT-A shows no clear live birth benefit per woman in systematic review

A systematic review in Human Reproduction Update assessed the efficacy, safety and cost-effectiveness of preimplantation genetic testing for aneuploidy (PGT-A) in IVF/ICSI. Searches through November 2024 identified seven randomised controlled trials for efficacy, 55 studies on complications and two health-economic studies. Efficacy analyses included only trials using techniques that assessed all chromosomes, with live birth per randomised woman as the primary outcome.

PGT-A showed no clear live birth advantage for the first planned embryo transfer (odds ratio 1.16; 95% CI 0.94–1.45) or cumulatively per oocyte retrieval (0.87; 0.64–1.19). Evidence certainty was low, and no clear benefit was found in women older than 35 years. Live birth per embryo transfer was higher with PGT-A, also with low-certainty evidence. Evidence on miscarriage was very uncertain; neither of the two studies assessing time to pregnancy showed a shorter time to live birth.

Safety studies found no indication of increased maternal or child complications, but included observational evidence and biopsy for PGT-A, PGT-M and PGT-SR, rather than PGT-A alone. In a Swedish setting, adding PGT-A almost doubled treatment costs without increasing live births. The findings do not establish a benefit for routine use and underscore the importance of reporting outcomes per randomised woman rather than only among those receiving embryo transfer. Low evidence certainty and setting-specific economic findings limit definitive conclusions.