Genetic Testing and IVF — Should You Test Your Embryos?

I’m not a fertility specialist and this article is not medical advice. The decision about whether to test your embryos should be made in close consultation with your fertility doctor. What I can offer is the perspective of someone who has sat with fertility patients through this decision for over 20 years — and who thinks it deserves more nuanced conversation than it often gets.

What Is Preimplantation Genetic Testing?

Preimplantation genetic testing (PGT) is the analysis of an embryo’s genetic material before it is transferred to the uterus. It is performed on embryos that have been created through IVF and have developed to the blastocyst stage — typically day 5 or 6 of development.

A small number of cells are biopsied from the outer layer of the blastocyst (the trophectoderm, which becomes the placenta) and sent to a genetics laboratory for analysis. The embryo is then frozen while results are pending, and only embryos that pass testing are candidates for transfer in a subsequent FET cycle.

PGT-A — Preimplantation Genetic Testing for Aneuploidies

The most commonly offered form of testing. PGT-A screens embryos for chromosomal abnormalities — specifically, whether an embryo has the correct number of chromosomes (46 in humans). Embryos with an abnormal chromosome number (aneuploid embryos) are the most common cause of implantation failure and early miscarriage. PGT-A identifies which embryos are chromosomally normal (euploid) and therefore most likely to implant and develop into a healthy pregnancy.

PGT-M — Preimplantation Genetic Testing for Monogenic Disorders

PGT-M tests for specific single-gene disorders — conditions like cystic fibrosis, BRCA mutations, Huntington’s disease, or spinal muscular atrophy — in couples who are known carriers. This is a more targeted and specialized form of testing used when there is a specific inherited condition at risk of being passed to a child.

PGT-SR — Preimplantation Genetic Testing for Structural Rearrangements

Used when one or both partners carries a chromosomal structural rearrangement such as a translocation that increases the risk of chromosomally abnormal embryos. Less commonly offered than PGT-A or PGT-M.

The Case for Testing — When It Makes Sense

In my view, PGT-A makes the most sense — and I would certainly lean toward it — in the following situations:

Recurrent Miscarriage

If you have experienced two or more pregnancy losses, chromosomal abnormalities in the embryo are one of the most common underlying causes. Testing your embryos allows you to identify chromosomally normal embryos before transfer, significantly reducing the risk of another loss. For couples who have been through the heartbreak of recurrent miscarriage, the peace of mind this offers — alongside the improved odds — is real and significant.

Both Partners Are in Their Mid-to-Late Thirties or Older

The rate of chromosomal abnormalities in eggs increases significantly with age — particularly after 35 and more steeply after 38. This means a higher proportion of embryos created from older eggs are likely to be aneuploid. PGT-A allows you to identify which embryos are chromosomally normal rather than transferring in sequence and waiting to see which ones implant. For couples in this age range, testing can reduce the number of transfers required to achieve a successful pregnancy.

Multiple Failed IVF Cycles or Implantation Failures

If you have been through multiple transfer cycles without a successful pregnancy, and other causes have been investigated, chromosomally abnormal embryos may be contributing to the pattern. Testing provides information that can change the clinical approach.

Significant Concern About Pregnancy Loss

Even for patients who don’t fit neatly into the categories above, the emotional burden of IVF is real — and for some people, the knowledge that they are transferring a chromosomally screened embryo provides meaningful reassurance. That is a legitimate consideration. If the anxiety of not knowing is significantly affecting your wellbeing during the process, testing may be worth it for that reason alone.

Specific Genetic Conditions (PGT-M)

If you or your partner carries a known genetic condition that carries a significant risk of being passed to a child, PGT-M is a genuinely powerful tool. This is one of the clearest indications for genetic testing, and the decision is usually more straightforward.  Most fertility clinics have extremely qualified genetic counsellors to help with this.

The Honest Complications — When the Numbers Don’t Add Up

Here is where the conversation gets more nuanced — and where I think clinics sometimes make testing sound simpler than it is.

What If You Only Have One or Two Embryos?

This is one of the most difficult situations, and there is genuinely no clear right answer.

If you have one embryo, most people — understandably — choose not to test. The cost of testing adds significantly to an already expensive process, and biopsy carries a small but real risk of damage to the embryo. With only one embryo, many couples prefer to simply transfer it and see what happens.

With two embryos, the calculation is harder. If both are euploid, you have two good candidates for transfer. If one or both are aneuploid, you have important information — but you may also be left with fewer or no transferable embryos. Some couples feel that knowing is worth it regardless. Others feel that with only two embryos, they would rather transfer both in sequence and let nature make the determination.

I do not think there is a wrong answer here. What matters is that you make an informed choice that you feel comfortable with — not one made because testing was presented as the obvious default.

Three or More Embryos — Testing Makes More Sense

With three or more embryos, the calculation shifts meaningfully in favour of testing. You have enough embryos that identifying the chromosomally normal ones gives you genuinely useful information without leaving you with nothing to transfer. The more embryos you have, the more value testing adds by helping you prioritize.

Batching Embryos Across Multiple Cycles

One strategy that makes both clinical and financial sense for couples who expect to need multiple IVF cycles is batching — doing two or more egg retrievals before testing any embryos, accumulating a larger pool of blastocysts, and then testing them all at once.

This approach maximizes the value of a single testing round, potentially reduces the overall cost of genetic testing across multiple cycles, and gives you a better picture of your embryo pool before committing to transfers. The tradeoff is that it delays the transfer phase — which can be emotionally difficult when you are ready to move forward.

For couples who are younger and have reasonable ovarian reserve, batching is worth discussing with your clinic. For those who are older or have diminished reserve, time may be a more pressing factor.

Testing Is Not a Guarantee

This is perhaps the most important thing I want you to understand: a euploid (chromosomally normal) embryo is not a guaranteed pregnancy.

Chromosomal normality is one important variable in a complex process. Uterine receptivity, immune factors, endometrial quality, and other variables all play a role in whether a euploid embryo implants and develops into a healthy pregnancy. Testing significantly improves your odds — it does not eliminate the possibility of a failed transfer or a loss.

What Testing Does Not Tell You

PGT-A screens for chromosomal number — it does not assess every possible genetic variant or guarantee a healthy baby. There are genetic conditions that PGT-A does not detect. It also cannot assess embryo quality beyond chromosomal normality — a euploid embryo can still have other factors that affect its developmental potential.

PGT-A also has a known false positive and false negative rate — though this has improved significantly with advances in technology. Mosaic embryos — those with a mix of normal and abnormal cells — present a particular interpretive challenge, as some mosaic embryos are capable of implanting and producing healthy pregnancies (I’ve witnessed this a number of times).

These are conversations worth having directly with your fertility clinic’s genetic counsellor before making a decision.

My Bottom Line

After 20 years of working alongside couples navigating IVF, here is my honest perspective:

• Genetic testing is a genuinely valuable tool — not just a revenue stream for clinics — but it is not right for every situation.

• If you have recurrent miscarriage, are in your mid-to-late thirties or older, or have been through multiple failed transfers, testing makes strong clinical sense.

• If you have only one or two embryos, the decision is more personal and there is no universally right answer.

• With three or more embryos, testing generally adds meaningful value.

• Batching across cycles before testing is a financially and clinically smart strategy for couples who can tolerate the wait.

• Testing is not a guarantee — it is a tool that improves the odds and provides important information.

Take the time you need to have a full conversation with your fertility doctor and genetic counsellor — and feel genuinely comfortable with whatever you decide. This is your journey, and it should be your informed choice.

How Acupuncture Fits In

Regardless of whether you choose to test your embryos, acupuncture has a meaningful role to play in your IVF process.

For couples doing multiple retrieval cycles before testing — batching — acupuncture during each stimulation cycle supports ovarian response, egg quality, and recovery. The 90-day principle applies here: the work you do in the months before retrieval influences the quality of the eggs in that cycle.

For couples proceeding directly to transfer with or without testing, acupuncture supports uterine receptivity, endometrial development, and the physiological conditions for implantation — as well as the stress response during what is often an emotionally demanding process.

I work with patients at every stage of the IVF journey and coordinate treatment timing directly with your clinic’s schedule.

Working With Me

I have been supporting fertility patients through IVF cycles for 20 years — including through the significant evolution in genetic testing technology that has taken place over that time. I understand both the genuine value that testing offers and the complexity of the decision, particularly when the numbers are small or the situation is nuanced.

My role is not to make this decision for you — but to make sure you have the information and support you need to make it yourself, with confidence.

Whatever you decide, I am here to support your body and your wellbeing through the process.

Key Research References

• “Preimplantation genetic testing for aneuploidy — a systematic review and meta-analysis of randomized controlled trials“ — Fertility and Sterility, 2021. 

• “PGT-A: the biological basis, current clinical applications and future prospects“ — Human Reproduction Open, 2021. 

• “Mosaic embryos — clinical implications and transfer outcomes“ — Journal of Assisted Reproduction and Genetics, 2019. https://pubmed.ncbi.nlm.nih.gov/30949921/

• “Does preimplantation genetic testing for aneuploidy improve live birth rates? A systematic review and meta-analysis“ — Human Reproduction Update, 2019.

• “Cumulative live birth rates with and without preimplantation genetic testing — a cohort study“ — BJOG: An International Journal of Obstetrics and Gynaecology, 2021.