The Increasing Subtle Marketing of Polygenic Embryo Scoring (PGT-P) in Association With IVF and the Mysteriously Disappearing Strongly Negative Opinions of ESHRE and ASRM
Where have the original strong-negative opinions of ESHRE and ASRM about polygenic risk scoring (PGT) vanished to?
The subtle marketing of PGT-P in association with IVF has begun, and ESHRE, as well as ASRM, in association with PGT-A, follow their usual policy of deniable ignorance.
We, of course, have by now often enough written about polygenic embryo scoring (or screening)—also given the acronym PGT-P—so that most of our readers already know what this new testing of embryos is supposed to accomplish. But—just in case a refresher is needed—here it is, as short as possible: PGT-P must be differentiated from PGT-M and PGT-T, though all three of these PGTs require that an embryo be biopsied at the blastocyst stage. PGT-M is the oldest and most reliable test since it checks for the presence of a so-called monogenic disease (i.e., a disease cause by a single mutation in a gene; therefore: -M). Examples are sickle cell disease, Tay–Sachs, etc.
Everybody, of course, knows that PGT-A means testing of embryos for abnormalities in the count of their chromosomes (i.e., for aneuploidy, therefore: -A) Everybody by now, of course, also knows that—even though especially in the U.S. very widely utilized in IVF—this test has become very controversial and even ASRM and SART in a combined statement just a few months ago concluded that PGT-A does not offer any outcome benefits for IVF (1), as the genetic testing industry incorrectly still claims. It, of course, is also no secret that the CHR has been opposing the routine utilization of PGT-A not only because it does not improve IVF outcomes as has been incorrectly alleged for over 20 years, but because PGT-A for many subgroups of patients will actually reduce pregnancy and live birth chances, while adding significant costs to an already too expensive IVF cycle (2-3).
And now the genetic testing industry (and its proponents and investors) have started preparing us for the next embryo testing excess, PGT-P. And this time we are not alone in categorically—yes, in this case, and of this moment, really categorically—rejecting the use of PGT-P. The reasons are very obvious: Testing for so-called polygenic genetic risk (i.e., for genetic risk, not caused by a single, but by many different genetic mutations on different chromosomes, as, for example, in heart disease, diabetes, etc.) does not even work well enough yet in adults to be used clinically. Therefore, very obviously, it simply cannot be considered to work reliably in human embryos, where absolutely no short-, intermediate-, or even long-term follow-up studies exist.
And then there is a second major concern: When a risk is inherited through multiple genes, evolution usually establishes this genetic predisposition for a biological purpose that enhances the survival chances of the species. Excluding one specific polygenic pattern may—relatively—enhance other patterns, some of which may also be undesirable.
And a third major concern may be the most important among them all: PGT-P has already, for years, been advertised to, for example, select embryos for eye color (can you imagine in an IVF cycle to discard embryos because of their alleged unwanted eye color?) (4,5). How about selecting for basketball talent like Michael Jordan, or higher IQ, etc.? In other words, we are starting to get into ethically very questionable territories when starting to pursue polygenic patterns to genetically “enhance” our offspring.”
And then something very interesting has been happening regarding how professional societies have come to view PGT-P. Professional genetic societies on both sides of the Atlantic came out in quite strong words against the clinical utilization of PGT-P. The European Society for Human Genomics (ESHG), indeed, in 2021 concluded that the use of PGT-P was not only clinically currently unproven but was unethical (6)—only to be attacked by a group of mostly U.S. geneticist with very obvious commercial interests in the performance of PGT-P, claiming, “scientific consensus and potential utility of this new technology,”—all, of course, pure fantasy (7).
The American Society for Human Genetics (ASHG) acknowledged the potential of PGT-P to inform reproductive decisions but also highlighted the need for careful consideration of its ethical and social implications. It also noted that PGT-P is not expected to enhance IVF success rates, and its clinical utility is still being evaluated. The ASHG also acknowledged that clinical validation studies are still needed to assess the effectiveness of PGT-P and that more research is needed to understand the complex interplay between genetics and the environment in the development of complex diseases (8).
ESHRE fully and completely endorsed the above-noted ESHG statement (9), only to— quite recently—withdraw this endorsement and replace it with a statement on its website that ESHRE currently does not have a formal opinion on the utilization of PGT-P (10).
What, however, happened at ASRM was even more interesting because for the longest time, ASRM had remained mum on the subject of PGT-P. But then, as is routine before the publication of new policy statements of ASRM and SART, several months ago, ASRM/SART circulated for comments among its membership a confidential draft under the title, “Use of preimplantation genetic testing for polygenic disorders (PGT-P), an Ethics Committee opinion.” Interestingly, it was the opinion of the Ethics and not of the Practice committees!
Because it was mailed out with a request for confidentiality, we do not feel at liberty to describe the conclusions of the committee. We can only say so much about this document: Considering the decades-long hesitancy of ASRM to confront the useless practice of PGT-A, the CHR was very skeptical when receiving the document regarding PGT-P. We, however, were not only very pleased with all the conclusions of the document but were-frankly, surprised because they fully agreed with the CHR’s thinking about PGT-P.
And what happened next? ASRM went mum again and has not—as usually happens—several weeks to months after a policy is circulated—announced publication of a final version of the Ethics Committees’ opinions and, upon visiting the ASRM’s website, one suddenly—and very informally—finds a very different ASRM Opinion, listing ethical and practical concerns but no longer the very clear opinions originally expressed in the circulating document. Final recommendations per website currently are as follows (11):
The ASRM emphasizes the need for additional clinical validation studies to assess the effectiveness of PGT-P.
It also highlights the importance of ensuring equitable access to PGT-P and providing comprehensive genetic counseling to patients.
Furthermore, the committee recommends that PGT-P should only be offered after careful consideration of the ethical implications and potential unintended consequences.
We, overall, again considering the ASRM’s obvious hesitance to take on the genetic testing industry as displayed in regard to PGT-A, consider this to be a quite acceptable set of recommendations, but, in comparison to the document that was circulated and now apparently has gone “puff,” it’s pure political correctness.
Quite obviously, ESHRE as well as ASRM must have heard from representatives of the genetic testing industry, and that is now the biggest industry in the exhibition spaces of both societies’ annual meetings, and with great likelihood also the biggest sponsors of both societies in general. And if they are unhappy, there is, of course risk for both societies to become unhappy as well! And they see PGT-P as the next big cash cow in association with IVF practice.
Who then can be surprised that the genetic testing industry and its financiers have actually already started to actively pursue PGT-P? Some laboratories and IVF clinics do this openly by advertising PGT-P services. According to Google, in NYC alone, at least three clinics already offer PGT-P (12).
Yet others do it more subtly, and nobody is as talented in selling new “products” in the field of assisted reproduction as some of our Spanish colleagues. One just has to think back to the first embryoscope and all the promises about improved IVF cycle outcomes, or how about all the representations made for endometrial receptivity testing. Those tests were good enough to build a corporate behemoth, now offering laboratory services all over the world.
Which brings us finally, after a very long introduction, to the reason for this commentary, which was an Opinion Article in Human Reproduction by Italian and Spanish colleagues, which started the selling job for PGT-P with exquisitely brilliant subtlety by—seemingly just raising concerns about the psychological burden poor parents now have to carry, “facing complex decisions based on probabilistic risk scores , requiring them to weigh uncertain benefits against potential harm” (13).
Even though not even with a single word encouraging PGT-P, the authors brilliantly “normalize” the use of PGT-P because, sublimely, the article, of course, suggests that—if we have to be concerned about the patients’ psychological counseling, they must already stand in line to get PGT-P. Simply brilliant marketing!
References
Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology. The use of preimplantation genetic testing for aneuploidy: a committee opinion. Fertil Steril 2024;122(3):421-434
Gleicher et al., Hum Reprod 2022;37(12):2730-2734
Gleicher et al., Trends Mol Med 2021’27(8):731-742
Houser K. Futurism. October 3, 2018. https://futurism.com/the-byte/eye-color-designer-baby
The New York Times. https://www.nytimes.com/interactive/2025/04/01/opinion/ivf-gene-selection-fertility.html
Forzanto et al., Eur J Hum Genetics 2022;30:493-495
Tellier LCAM et al., Eur J Hum Genetics 2023;31:278
American Society of Human Genetics. ASHG Issues New Guidance on Addressing the Challenges of Polygenic Scores in Human Genetic Research. Published December 1, 2022. American Society of Human Genetics. https://www.ashg.org/advocacy/statement-archive/new-guidance-on-the-challenges-of-polygenic-scores-in-human-genetic-research/
ESHRE. https://www.eshre.eu/Europe/Position-statements/PRS
ESHRE. https://www.eshre.eu/Guidelines-and-Legal/Guidelines/PGT
Roura-Monllor JA, Walker Z, Reynolds JM, et al. Promises and pitfalls of preimplantation genetic testing for polygenic disorders: a narrative review. F&S Reviews. 2025;6(1):100085. doi:10.1016/j.xfnr.2024.100085.
https://www.google.com/search?q=Laboratories+and+IVF+clinics+that+offer+PGT-P&rlz=1C5CHFA_enUS1083US1083&oq=Laboratories+and+IVF+clinics+that+offer+PGT-P&gs_lcrp=EgZjaHJvbWUyBggAEEUYOdIBCjE3MjY0ajBqMTWoAgiwAgE&sourceid=chrome&ie=UTF-8
Forte et al., Hum Reprod 2025.40(6):977-982