Does PGT-A improve cumulative live birth rates, and in which patient populations is it most beneficial?

Two separate questions get conflated here, and they have different answers. Does PGT-A improve outcomes? The ASRM RPL committee opinion (2026) states PGT-A has not been shown to significantly reduce miscarriage or improve live births compared with expectant management in recurrent pregnancy loss. In women over 40 with a proven aneuploid miscarriage it is reasonable to discuss PGT-A using shared decision-making — with explicit counselling that it has not been shown to reduce time to successful pregnancy or increase live birth rate. Note what the denominator does. Comparisons per euploid transfer favour PGT-A; comparisons per intention to treat, per retrieval, or per cycle started do not. Cycles yielding no transferable embryo drop out of per-transfer analyses. When evaluating any published figure, establish the denominator first. What ESHRE (2020) says about interpreting the test itself: The clinical significance of transferring embryos with mosaicism or de novo segmental abnormalities is under investigation and therefore unknown. Transfer could potentially carry a risk of first-trimester miscarriage or of viable unbalanced offspring. Sensitivity and specificity of mosaicism detection are specific to each platform, protocol and bioinformatics pipeline, and cannot be exchanged among platforms. With few cells in a biopsy it is almost impossible to detect changes representing less than 20–30% of the sample. Biological limitations include cells in S-phase producing non-specific gain or loss, the biopsy being non-representative of the embryo, failure to detect mosaicism arising from non-disjunction, and apoptotic or dead cells generating profiles resembling mosaicism. Those limitations belong in counselling. A euploid result is a probabilistic statement about five trophectoderm cells, not a verdict on the embryo.