Yaron Goykhman: Embryo selection based on genetic predictions takes decades to evaluate

Yaron Goykhman: Embryo selection based on genetic predictions takes decades to evaluate

On October 22, reproductive geneticist Yaron Goykhman argued against using polygenic risk scores to select an embryo for transfer. For an adult patient, a prediction can lead to treatment and monitoring; the consequences of selecting an embryo will become apparent only when the resulting child reaches adulthood.

A polygenic risk score, or PRS, combines many DNA variants into a measure of disease risk. Goykhman compared the use of these scores in adult patients with their use in embryo selection.

He cited the MI-GENES study. Adults at intermediate risk of coronary heart disease received either a conventional risk estimate or an estimate incorporating a PRS. They discussed their genetic results with a genetic counselor and a physician, who could prescribe statins, drugs that lower cholesterol. The researchers then followed the participants: those in the PRS group were more likely to start taking statins and had larger reductions in LDL, the “bad” cholesterol, during the first few years.

In embryo selection, a PRS ranks the available embryos before transfer. Observing the relationship between that prediction and disease in the resulting child's adult life will take decades.

In August, Eric Topol challenged promises to predict a future child's IQ and height accurately: an average pattern in a large group does not provide a precise prediction for an individual. Goykhman adds another issue to the debate over embryo selection: what follow-up observations could establish whether a decision made before birth was justified.

He also noted that the accuracy of these models varies across ancestry groups. In the eMERGE study, one coronary heart disease risk score had a weaker association with new cases of the disease in people of African ancestry than in people of European ancestry.

The American Society for Reproductive Medicine describes the same timing problem in its 2026 ethics opinion: assessing the clinical value of polygenic embryo testing requires long-term follow-up to evaluate prediction accuracy and children's health.

For an adult patient, a risk estimate can lead to a clinical decision and a measurable outcome. In embryo selection, the decision precedes the life of the person whose health will be assessed much later.