Should PGT-A be routinely utilized for advanced maternal age?

Preimplantation genetic testing for aneuploidy (PGT-A) is often presented to women of advanced maternal age as a logical safeguard against miscarriage and chromosomal abnormality. Yet intuitive rationale and biological plausibility do not establish net clinical benefit. PGT-A does not improve oocyte or embryo quality; it ranks embryos that already exist. The appropriate objective endpoint is therefore cumulative live birth from an initiated treatment strategy, not implantation after transfer of a selected euploid embryo. Randomized clinical trials, contemporary systematic reviews, meta-analyses, and professional guidance have not shown that routine PGT-A improves cumulative live birth rates in older women, while mosaicism, limitations of trophectoderm sampling, invasive biopsy, variability in laboratory protocols, freeze-thaw requirements, embryo exclusion, financial cost, and treatment delay can impose material harms. These concerns are amplified in older women with fewer transferable blastocysts. Sociocultural anxiety about disability and delayed childbearing, reinforced by commercial promotion, clinical normalization, and misleading risk communication, can further compromise autonomous choice. PGT-A may be utilized selectively for older women, especially when several blastocysts are available and patients prioritize avoiding an aneuploid transfer, but advanced maternal age alone should not convert an uncertain add-on into a routine clinical strategy.