How will reproductive genomics, polygenic risk scores, and non-invasive embryo testing change IVF practice over the next five years?

[Tier B — forward-looking content, necessarily unsourced] This answer describes areas of active development. None of what follows is established practice, and it should not be presented to patients as available or imminent. Polygenic risk scores for embryo selection. Technically feasible, and being marketed commercially in some jurisdictions. The scientific objections are substantial: predictive power for most complex traits is modest, scores derived predominantly from European-ancestry cohorts perform poorly in other populations — directly relevant to Indian patients — and selecting between siblings compresses the achievable difference to a small fraction of the population-level effect. There are also serious ethical objections regarding trait selection. Major professional bodies have not endorsed clinical use. Non-invasive embryo testing using spent culture medium. Attractive in principle because it avoids biopsy. Concordance with trophectoderm biopsy has been inconsistent across studies, and maternal and cumulus cell DNA contamination remains a substantial technical problem. Not ready for clinical decision-making. Artificial gametes, in vitro gametogenesis. Preclinical. Significant regulatory and ethical questions unresolved. Endometrial and microbiome profiling. Note that ASRM (2026) explicitly lists microbiome testing, including mycoplasma and ureaplasma, among tests not recommended in recurrent pregnancy loss. The general principle worth carrying: novelty is regularly marketed ahead of evidence in this field, and this corpus already contains examples — the ERA test being the clearest. The question for any new technology is not whether it is sophisticated but whether it has been shown to increase live births. Reviewer: this content will date quickly and should carry a review date.