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Rajeev Agarwal: What 3 New Studies Reveal About PGT-A and IVF Outcomes

Rajeev Agarwal/LinkedIn

Oct 15, 2026, 17:38

Rajeev Agarwal: What 3 New Studies Reveal About PGT-A and IVF Outcomes

Rajeev Agarwal, Director of Renew Healthcare, shared on LinkedIn:

“Three new PGT-A papers. None show more babies per cycle.

The PGT-A test is now part of most IVF conversations in India, and searches for it here have nearly doubled in a year. Here is what has just been published, and where I stand.

What the new studies show:

A double-blind trial in 1,189 women aged 35 to 42 tested embryo DNA shed into the culture medium, without a biopsy. Live birth was 37.0% with testing against 35.5% without. Early miscarriage was lower with testing, 18.0% against 25.2%.
A Fertility and Sterility cohort of 40,308 biopsied blastocysts across three commercial labs found that a ‘euploid’ embryo from one lab had lower odds of live birth than one from another (adjusted OR 0.71). The label may depend partly on which lab reads the biopsy, though clinic and patient differences may also contribute.
In unexplained recurrent miscarriage, an observational cohort found cumulative live birth of 48.5% with PGT-A and 47.4% without, not significantly different.

They fit the larger picture. A Human Reproduction Update review of 7 trials and 3,442 women found no difference in cumulative live birth per woman (OR 0.87, 95% CI 0.64 to 1.19), a higher live birth per transfer at low certainty, and no shorter time to live birth in the two trials that measured it.

Why the gap? A biopsy reads 5 to 10 cells from the outer layer, and in a mosaic embryo those cells may not represent the rest.

What the guidelines say: ESHRE, ‘currently not recommended for routine clinical use’. ASRM: its value as a routine test for all IVF patients ‘has not been demonstrated’. The UK regulator, the HFEA, rates it red for having a baby and green for reducing miscarriage.

Where I stand. PGT-A does not create a healthier embryo or add babies to a cycle. It changes the order and number of transfers. For a woman of 38 with several blastocysts, a couple flying in from abroad for a transfer, or a couple after losses, I think avoiding a failed transfer or a miscarriage matters as much as the final number. The trials have not shown a shorter time to pregnancy, and I say so to every couple before they decide.

What I would ask of all of us:

Quote live birth per started cycle and per transfer, never just one.
Tell couples which lab reads their embryos, and its live birth rate per euploid transfer.
Discuss low- and medium-level mosaic embryos before discarding them. In one blinded study they gave live birth rates of about 42 to 43%, against 43.4% for euploid embryos.
Offer PGT-A for a reason, not as a package.

If you are offered PGT-A, ask: what does it change for me, per cycle and per transfer?

Colleagues: when you counsel PGT-A, which figure do you quote first?”

Rajeev Agarwal: What 3 New Studies Reveal About PGT-A and IVF Outcomes