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Lesson 5 of 6

Is ICSI Required For PGT-A & PGT-M or PGT-SR?

Video Lesson

Written Lesson

PGT-A and PGT-M or PGT-SR Aren’t the Same

We should make the distinction here between PGT-A (formerly known as "PGS") and PGT-M and PGT-SR (formerly known as "PGD"). In PGT-A, there is debate whether ICSI is necessary. In PGT-M or PGT-SR, for the moment, there is no debate: ICSI must be used.

PGT-A (Pre-implantation Genetic Screening of Aneuploidies)

We have a rich course on PGT-A but here is the crux as it pertains to ICSI. PGT-A theoretically helps the doctor determine whether an embryo is chromosomally normal (or not) so the doctor can prioritize which embryo(s) to transfer. To get this information, an embryologist must cleave a few cells from the outer layer of an embryo for analysis.

Most patients who want PGT-A performed on their embryos are told this is only possible if those embryos were created using ICSI. There is debate on that point.

Pro-ICSI Argument

The argument for using ICSI when doing PGT-A is that it makes PGT-A more accurate. When eggs are fertilized during CI, they are surrounded in a petri dish with droplets that contain sperm that compete to fertilize the egg. As a result, sperm may get stuck to the outside of the egg and leave their genetic residue behind.

The fear is when the PGT-A biopsy is performed, residue on the outside of the egg (now an embryo) may get included and confuse the analysis. In theory, ICSI eliminates this risk because a single sperm is injected directly into the egg with no residue left on the egg / embryos outside.


Some doctors disagree and point to the lack of data behind the pro-PGT-A assertions. They believe PGT-A is accurate enough that it won’t be thrown off by potential residue of other sperm.


Just as with PGT-A, PGT-M or PGT-SR requires a biopsy sample of the embryo to be taken and read. However this time the lab is looking to detect a specific genetic disease or chromosomal disorder when there is good reason to believe one will exist. PGT-M (preimplantation genetic testing for monogenic disorders) is used to evaluate embryos for genetic disorders. PGT-SR (preimplantation genetic testing for structural chromosomal rearrangements) is performed to test for chromosomal issues. Both tests in the past have been referred to as PGD.

The risks (and consequences) for wrongly diagnosing a problematic embryo as “normal” here are enormous. The field is in agreement that using ICSI to fertilize eggs slated to be PGT-M or PGT-SR-tested is the more conservative, sensible approach. We don’t expect to ever see data disproving this.

Pro Tips

  • If you plan to have PGT-A, PGT-M, or PGT-SR done, ensure your clinic can, and will, grow your embryos to blastocyst stage. Otherwise the biopsy can have damaging effects

  • In the case of PGT-M or PGT-SR, ICSI must be used. Ensure you are being treated at a clinic with high fertilization rates (again, at least 70% of mature oocytes)

  • In the case of PGT-A, ask your clinic and reference laboratory to provide you data on why they have their policy. Some clinics and reference do not require ICSI to do PGT-A.