PGT-A as an IVF Add-On: 25 Years of Controversy

The second session of the 2025 PET (Progress Educational Trust) Annual Conference was entitled 'PGT-A as an IVF Add-On: 25 Years of Controversy', and controversial it proved to be. Chaired by science writer and broadcaster Dr Deborah Cohen – who presented the BBC exposé Inside Britain's Fertility Business a decade previously (see BioNews 880 and 1262) – the session saw speakers debate the evidence base for offering PGT-A (preimplantation genetic testing for aneuploidy) to fertility patients.

Professor Karen Sermon, former chair of the European Society of Human Reproduction and Embryology (ESHRE), gave a presentation entitled 'ESHRE's Guidelines and Good Practice Recommendations on PGT-A'. She explained that while 'guidelines' – properly understood – are systematically developed and based on high-quality evidence, 'good practice recommendations' are the next best option, if scientific evidence is limited. This is the case with ESHRE's Good Practice Recommendations on Add-Ons in Reproductive Medicine.

Professor Sermon outlined the findings and limitations of several clinical trials, concluding that there is limited evidence to support the effectiveness of PGT-A. Studies to date suggest that live birth rates do not increase after PGT-A, and although miscarriage rates may decrease, this outcome may be different for individual patients. Professor Sermon called for a large, adequately powered randomised controlled trial using properly validated techniques – including a broad patient population, and all embryo types – to establish an evidence base for offering (or not offering) PGT-A.

The next presentation was by Dr Justin Chu, medical director of TFP Oxford Fertility, whose presentation – entitled 'PGT-A: The Clinical Application of Research Data' – offered a clinician's perspective on interpreting available evidence. He explained that there are still many unsuccessful cycles overall, and embryo aneuploidy remains a primary reason for pregnancy failures and miscarriages, especially in women older than 35. Dr Chu argued that while PGT-A is unable to bring about a pregnancy or a live birth, it could potentially shorten the time to success, lower costs, and reduce miscarriage risk for certain patients, including older women and women with a history of miscarriage.

Having reviewed the available data, Dr Chu concluded that current evidence is not sufficient to support the use of PGT-A in routine clinical practice. However, PGT-A might help to reduce treatment time for certain patients, and Dr Chu said that he considered it important to discuss PGT-A with patients and clarify what it can and cannot do. He said that for him, the key question is what patients want from IVF, and that ultimately it is up to patients to decide which route is best for them.

James Lawford Davies, partner at LDMH Partners, gave a presentation entitled 'In a Class of Its Own? PGT-A, Liability and Litigation'. He explained that it is a criminal offence to test a human embryo without a licence from the Human Fertilisation and Embryology Authority (HFEA), and that the HFEA can only authorise certain testing processes (which include PGT-A).

He stated that it is incumbent on clinics offering PGT-A to advise patients of the risks, and signpost those patients to HFEA guidance on fertility treatment add-ons. The relevant HFEA guidance gives PGT-A a 'red' rating (safety concerns) for increasing the chances of having a baby for most patients (because it often reduces the number of embryos available for transfer), but gives PGT-A a 'green' rating (evidence of positive effects) for reducing the chances of miscarriage.

Lawford Davies continued by exploring the potential liability of clinics offering PGT-A, following several class actions in the USA based on false or misleading advertising (see BioNews 1261), and following a notable class-action on behalf of over 700 patients – involving a particular version of PGT-A – that was settled and approved by the Supreme Court of Victoria, Australia, for AU$56 million (see BioNews 1253). Regarding whether similar claims could arise in the UK, Lawford Davies said that the possibility cannot be ruled out, but such claims would not necessarily be strong.

Lawford Davies concluded by discussing that the Competition and Markets Authority (CMA)'s guidance for fertility clinics (see BioNews 1035, 1071, 1072, 1099, 1160, 1161, 1231 and 1240). This guidance requires clinics to be open and transparent with patients – ensuring that patients understand risks and benefits, including in relation to experimental treatments – and to avoid misleading or overstating information. Lawford Davies advised clinics to comply with legislation, follow HFEA guidance on add-ons, adhere to CMA requirements, and ensure that consent is properly recorded.

Finally, Professor Manuela Perrotta – leader of the Remaking Fertility initiative – gave a presentation entitled 'From Science to Sales: Marketing PGT-A in UK Fertility Care'. She began by observing that although PGT-A is not currently recommended for routine clinical use, patients reporting the use of PGT-A have nearly doubled from 2021 to 2024. Patients aged 40-42 are most likely to have used PGT-A, compared to other age groups (see BioNews 1283).

Professor Perrotta presented research findings about where patients seek information about add-ons. Perhaps unsurprisingly, Google is the first source they turn to, followed by clinic websites and the HFEA website. This is followed, more surprisingly, by specialist articles in scientific journals. Patients also use social media and online forums.

When patients are asked how reliable they believe these sources are, they identify charities as the most trusted, followed by the HFEA and then private and NHS fertility services. Professor Perrotta questioned the narrative prevalent on fertility clinic websites, about using PGT-A to increase chances of having a healthy pregnancy. She raised the possibility that patients are seeking PGT-A because they are told repeatedly that it improves their chances of success, even though the evidence remains uncertain.

There was then a lively discussion, with contributions from audience members who favoured PGT-A and also from audience members who opposed it. Professor Sermon recognised that those who favour of PGT-A may feel frustrated when they are told to exercise caution by EHSRE, but said that this is all part of healthy scientific debate. She argued that refinements to PGT-A over the years have been driven in large part by friction between detractors and supporters.

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PET would like to thank the sponsors of this session (Remaking Fertility) and the other sponsors of its conference (the British Fertility Society, ESHRE, PRECAS, the Adelphi Genetics Forum, the Anne McLaren Memorial Trust Fund, Born Donor Bank, CooperSurgical, Ferring Pharmaceuticals, Merck, Salve, Theramex, Xytex, Juno Genetics and the Institute of Medical Ethics).

Register now for PET's next free-to-attend online events.

• Fertility and the Workplace: Can Employers Help? Should They?, taking place online on Wednesday 14 January 2026 – register here.
• Understanding Egg Donation: The Give and Take, taking place online on Wednesday 28 January 2026 – register here.
• Ancestry, Ethnicity, IVF Outcomes: Why Do Some Patients Fare Better than Others?, taking place online on Wednesday 4 February 2026 – register here.