By David Adamson, MD, Founder and CEO, ARC Fertility
The Role of Genetics in Modern Fertility Care
As family-forming benefits evolve, employers can enhance the value and effectiveness of fertility coverage by including Preimplantation Genetic Testing for Aneuploidy (PGT-A). Conducted during IVF, PGT-A screens embryos for chromosomal abnormalities before transfer, helping identify the embryo most likely to result in a healthy, full-term pregnancy.
PGT-A is typically performed on day 5 or 6 of embryo development at the blastocyst stage. A few cells from the outer layer of the embryo (trophectoderm) are biopsied and analyzed. Euploid embryos, those with the correct number of chromosomes, are prioritized for transfer, which reduces miscarriage risk and improves implantation efficiency in specific clinical populations.
This cutting-edge genetic screening process also identifies chromosomal abnormalities that could impact the health of the baby and supports more personalized family planning. For patients with a family history of inherited disorders, PGT-A which assesses the number of chromosomes, PGT-M which looks for single gene disorders, PGT-SR which looks for structural rearrangements of chromosomes, and PGT-P for estimation of polygenic disease risk can each provide value when appropriately used in specific clinical situations.
When paired with elective Single Embryo Transfer (eSET), PGT-A also helps minimize the risk of multiple gestations. A 2024 matched cohort study demonstrated that two consecutive SETs—one fresh, one frozen—resulted in higher live birth rates (44.8% vs. 34.5%) and lower preterm birth risk compared to a double embryo transfer (DET) in the same cycle, especially in women under 38 with multiple embryos available.
The American Society for Reproductive Medicine (ASRM) advises against universal use of PGT-A, citing insufficient benefit for all IVF patients. However, for certain subgroups, such as those with advanced maternal age (AMA), recurrent miscarriage (RM) or recurrent implantation failure (RIF), PGT-A has shown clinically significant value, including shorter treatment timelines and reduced emotional and financial strain.
In a 2022 retrospective cohort study, recurrent miscarriage patients who used PGT-A saw early pregnancy loss drop to 18.1% from 75% and live birth rates rise from 12.5% to 50%. Patients with RIF also benefited, with implantation rates nearly doubling (69.5% vs. 33.3%).
Clinical Evidence: Why Pgt-A Matters
Improved Outcomes in Select Populations
PGT-A has not demonstrated universal benefit across all IVF patients but consistently shows value in specific subgroups. Women over 35, those with a history of miscarriage or failed implantation, and older patients with multiple embryos available for transfer tend to see the greatest improvements.
Evidence for PGT‑A benefit in recurrent miscarriage is suggestive but insufficient to support routine recommendation in absence of confirmed parental chromosomal rearrangement. This means that both intended parents should have their karyotype (chromosome status) tested before they attempt to get pregnant. If an abnormality is found, then PGT-A can be helpful when IVF is performed. Also, if a woman has had repeated miscarriage with documented fetal aneuploidy (abnormal chromosome number in the fetus) then the evidence is stronger that PGT-A may be helpful. Therefore, PGT‑A may be offered on a case-by-case basis with appropriate counseling but is not standard of care for all women with recurrent miscarriage.
For recurrent implantation failure (RIF), which is variably defined but refers to women who have had more than 2 or 3 failed IVF cycles or transfers of multiple embryos, the evidence is less clear since there can be multiple reasons for RIF including lifestyle factors, immunological conditions, uterine or endometrial abnormalities or other causes. The prevalence of aneuploid embryos is high in RIF, suggesting PGT-A could improve outcomes, but large well-designed randomized controlled data are limited. Therefore, PGT-A may be useful and should be considered but is not the first priority for intervention because the evidence is incomplete.
The Case for Single Embryo Transfer
Elective single embryo transfer (eSET) is widely recognized as best practice for reducing the risks of twin or triplet pregnancies. PGT-A strengthens the case for eSET by increasing confidence in selecting the most viable embryo. The 2024 study confirms that two SETs, when combined with embryo screening, yield superior outcomes to DET, with fewer preterm births and no loss in live birth potential.
SET is also supported by major reproductive health organizations as the safest approach, contributing to healthier outcomes for both parents and babies. For employers, integrating PGT-A-supported eSET into fertility benefits reduces the risk of costly high-risk pregnancies and supports more predictable outcomes for employees pursuing IVF.
Cost-Effectiveness and Efficiency
Reducing High-Risk Pregnancies
PGT-A helps mitigate medical and financial risks by supporting eSET. Multiple gestations often lead to preterm births and NICU admissions, both costly and traumatic for employees. One study showed that eSET with PGT-A had a 0% twin rate, compared to over 50% in the DET group, while maintaining comparable live birth outcomes. It is important to remember, however, that identical twins result from the splitting of one embryo, so a small number of twins is still possible even with eSET.
Fewer Failed Cycles, Faster Resolution
For some groups of women over 35, PGT-A has been associated with higher implantation and lower miscarriage rates. SART data show that in women aged 38–40, implantation improved from 30% to 59.5%, and miscarriage rates dropped from 27.7% to 13.6% with PGT-A. Fewer failed cycles mean less medication, fewer absences from work and quicker emotional recovery, benefits that translate directly to improved productivity and workforce continuity.
Targeted Use, Better Outcomes
PGT-A is most effective when applied selectively. In advanced maternal age (AMA) patients , PGT-A did not significantly increase live births per transfer but did reduce early biochemical loss (3.7% vs. 31.5%). In the same study, chromosomal abnormalities were detected in 75.2% of AMA embryos and 57.9% of RIF embryos, supporting targeted genetic screening.
Employers should structure fertility benefits to allow clinical discretion in offering PGT-A, rather than adopting a one-size-fits-all model. This ensures medical appropriateness while avoiding unnecessary spend.
Inclusivity in Reproductive Benefits
Supporting Diverse Family-Building Needs
PGT-A offers meaningful value for a wide range of patients pursuing parenthood. Screening embryos for chromosomal abnormalities helps optimize outcomes on the first embryo transfer, reducing the need for repeated procedures and limiting the emotional and financial burden of multiple IVF cycles. It is important to note that PGT-A does not increase the eventual chances of having a baby, since the use of PGT-A results in the loss of some embryos through damage during testing and freezing or mis-categorization of embryos as abnormal (and therefore not used) when in fact they might be capable of creating a healthy baby. PGT-A simply enables the selection of embryos with a higher chance of creating a healthy baby so that the best embryo can be selected for an earlier transfer into the uterus.
Improving Access to High-Quality Care
Offering fertility coverage is a meaningful first step but access alone does not guarantee positive outcomes. To ensure that employees can make the most of their fertility benefits, employers should prioritize programs that go beyond reimbursement and provide comprehensive support throughout the care journey.
High-quality fertility benefits should include personalized navigation, educational resources and logistical coordination that help individuals make informed decisions about PGT-A and related services. This includes ensuring that employees receive accurate, timely information about when PGT-A is clinically appropriate and what outcomes they can expect based on their specific situation.
Employers should also confirm that their benefits partners offer access to board-certified fertility specialists and accredited embryology labs, both of which are essential for the safe and effective use of PGT-A. Additionally, coordinated support with appointment scheduling, follow-up communication and clear next steps can reduce friction and improve the overall care experience.
Finally, fertility care is often emotionally demanding. Benefits programs should incorporate tools for emotional support and mental health, helping employees navigate the stress and uncertainty that can accompany IVF and genetic testing.
By emphasizing quality and support alongside access, employers can ensure their fertility benefits deliver real value to both employees and the business. These services help employees better understand their options and make confident decisions, supporting more successful and efficient family-building journeys.
Guidance For Employers and Benefits Leaders
When PGT-A Is Most Appropriate
PGT-A can offer significant benefits, but its value is closely tied to patient-specific factors. For employers designing fertility coverage, understanding the clinical scenarios where PGT-A is most likely to improve outcomes is essential to delivering high-value, evidence-based benefits.
PGT-A is most appropriate for individuals who face a higher risk of chromosomal abnormalities in embryos, particularly women aged 35 or older and especially those over 38. As maternal age increases, so does the likelihood of aneuploidy, which can lead to failed implantation, miscarriage or complications during pregnancy. In these cases, PGT-A can improve implantation efficiency and help reduce the emotional and financial strain of repeated IVF cycles.
The procedure can also be recommended for some patients with a history of RM or RIF. By identifying embryos with the correct number of chromosomes prior to transfer, PGT-A can help reduce the chance of future losses or failed attempts, streamlining the path to a successful pregnancy.
In IVF cycles that produce multiple embryos, PGT-A can be used to prioritize which embryo has the highest likelihood of success, reducing the need for multiple transfers. Similarly, patients in time-sensitive or resource-constrained situations, such as those undergoing fertility preservation before cancer treatment, may benefit from PGT-A as a way to maximize each transfer and minimize treatment delays.
By offering PGT-A as an option in these clinically supported scenarios, employers can ensure their benefits align with best practices and meet the needs of employees facing complex fertility journeys. In contrast, routine use of PGT-A for young patients with a low risk of chromosomal abnormalities and limited embryos may offer little or no benefit while increasing costs.
Employers should avoid universal coverage requirements and instead design benefit structures that allow for clinical discretion. Fertility providers, not policy mandates, should guide decisions on when PGT-A is appropriate.
Avoiding Common Pitfalls
Designing effective fertility benefits requires more than offering coverage, it means structuring that coverage to support safe, efficient and clinically appropriate care. Employers can avoid common pitfalls by aligning benefit design with established best practices in reproductive medicine.
First, it’s essential to ensure that employees have access to board-certified reproductive endocrinologists and accredited genetics laboratories. The accuracy of PGT-A results and the overall success of fertility treatment depends on high-quality clinical care and reliable lab processes.
Second, benefit plans should avoid outdated requirements that delay treatment. For example, mandating multiple rounds of intrauterine insemination (IUI) before approving IVF, regardless of patient history, can unnecessarily prolong the path to parenthood and increase costs without improving outcomes.
Third, employers should encourage eSET when clinically appropriate. When paired with PGT-A, eSET can help reduce the risk of multiple gestations while maintaining strong success rates, improving both health outcomes and cost efficiency.
Finally, offering fertility navigation, access to counseling and digital education tools can make a significant difference in employee experience. These services help individuals understand their options, manage the emotional demands of treatment and make well-informed decisions with greater confidence.
By addressing these areas, employers can ensure that fertility benefits are not only comprehensive but also structured to promote high-value, patient-centered care. These strategies promote quality care, reduce complications and support employees through a complex and emotionally charged process.
The Employer Opportunity
Fertility Benefits as a Strategic Asset
Fertility benefits have shifted from a “nice-to-have” to a strategic necessity within modern employee benefits packages. As more individuals delay parenthood for personal or professional reasons, the demand for comprehensive, inclusive reproductive support has grown, particularly among younger professionals.
Recent data reflect this evolving landscape. Nearly 70% of millennials report they would consider changing jobs for better fertility coverage. In workplaces where fertility benefits are offered, 61% of employees say they feel greater loyalty to their employer. Moreover, HR leaders anticipate that the absence of fertility benefits will be viewed as discriminatory. And, increasingly, states are mandating coverage for fertility care, making it important for all employers to stay competitive for talent recruitment and retention.
These findings underscore the competitive value of fertility support. Companies that prioritize family-forming benefits are not only meeting employee expectations, they’re also strengthening recruitment, retention and workplace satisfaction.
Offering thoughtful fertility coverage, including access to PGT-A where appropriate, signals a company’s commitment to supporting employee life goals and providing meaningful health benefits.
Why PGT-A Matters in the Benefits Equation
When used in the right clinical scenarios, PGT-A can significantly enhance the efficiency of fertility treatment. For eligible patients, PGT-A may help resolve treatment more quickly by identifying the most viable embryo earlier in the process. This can reduce the number of IVF cycles needed to achieve a successful pregnancy, along with the physical, emotional and financial toll those cycles often carry.
Additionally, PGT-A supports safer pregnancy outcomes by enabling eSET, thereby lowering the risk of complications associated with multiple gestations.
Importantly, offering PGT-A as an option, rather than a requirement, enables shared decision-making between patients and clinicians.
Employers who support PGT-A as part of a flexible, clinically guided fertility benefit program demonstrate leadership in health plan design. This approach meets employees where they are, supporting different paths to parenthood and maximizing the value of every treatment cycle.
Smart Benefits, Stronger Outcomes: Where Pgt-A Fits in Modern Fertility Care
PGT‑A shows promise in improving outcomes for recurrent miscarriage and implantation failure, but robust evidence remains lacking—guidelines recommend its selective, not routine, use. Physicians should engage in informed shared decision-making with patients detailing the current uncertainties.
PGT-A is a clinically supported tool that helps optimize embryo selection during IVF. When used selectively for patients most likely to benefit, it can reduce miscarriages, improve live birth rates and reduce the medical risks and costs of multiple pregnancies.
For employers, incorporating PGT-A into a well-structured fertility benefits package offers a clear opportunity to:
- Improve treatment success rates in appropriate cases.
- Shorten time-to-pregnancy and reduce employee time away from work.
- Lower total healthcare costs by avoiding complications.
- Support employees pursuing family-building through IVF, regardless of personal or medical background.
The key is precision. Fertility benefits should allow clinical teams to make individualized decisions on PGT-A use, rather than applying blanket rules. By designing benefits that are both flexible and evidence-based, employers can improve outcomes for employees and gain measurable value from their investment.
PGT-A is not a universal solution but when applied in the right circumstances, it’s a powerful tool in modern fertility care. Forward-looking benefits professionals have a unique opportunity to lead in this space by offering benefits that are smart, personalized and truly supportive of employee well-being.
This article originally appeared in the September/October 2025 issue of Journal of Compensation and Benefits.
